Pulmonary

Question 1

what is a normal RR?

Answer 1

14-20 breaths per min

Question 2

tachypnea

Answer 2

> 25 breaths/min

Question 3

true or false- the intercostal space is the same number as the rib above

Answer 3

true

Question 4

what is the most prominent bony landmark of the posterior neck?

Answer 4

spinous process of C7

Question 5

this line is halfway between the clavicles

Answer 5

midclavicular

Question 6

this line overlies the spinous process of the vertebrae

Answer 6

vertebral line

Question 7

this line drops from the inferior angle of the scapula

Answer 7

scapular line

Question 8

the inferior tip of the scapular lies about at the level of the _____ rib

Answer 8

7th

Question 9

true ribs

Answer 9

1-7

Question 10

false ribs

Answer 10

8-10

Question 11

floating ribs

Answer 11

11 and 12

Question 12

this is where the lower border of the rib is anteriorly

Answer 12

6th rib at the MCL
8th rib at the MAL

Question 13

this is where the lower border of the rib is posteriorly

Answer 13

T10 spinous process

Question 14

this fissure splits each rib in half

Answer 14

oblique

Question 15

approximation of oblique fissure location

Answer 15

T3 spinous process to the 6th rib at the MCL (midclavicular line)

Question 16

the right lung has this extra fissure which becomes the superior border of the right middle lobe

Answer 16

horizontal fissure

Question 17

horizontal fissure approximate location

Answer 17

4th rib and meets oblique fissure around MAL near 5th rib

Question 18

where does the trachea bifurcate?

Answer 18

sternal angle anteriorly and T4 posteriorly

Question 19

which pleural layer hurts when inflamed?

Answer 19

parietal

Question 20

this layer lines the inner thoracic cage and superior surface of the diaphragm

Answer 20

parietal pleura

Question 21

this layer covers the surface of the lung

Answer 21

visceral

Question 22

where to insert for tension pneumothorax

Answer 22

2nd intercostal space

Question 23

where to insert for anterior chest tube placement

Answer 23

4th intercostal space

Question 24

where to insert for ET tube tip placement

Answer 24

T4- nipple line (lower margin)

Question 25

true or false- always poke inferior to rib margin

Answer 25

FALSE- always poke superior to avoid the intercostal bundle (VAN)

Question 26

in ______ position, abdominal movements are easier to see than the thoracic respiratory movements

Answer 26

supine

Question 27

in the ______ position, thoracic movements are more prominent than abdominal respiratory movements

Answer 27

seated

Question 28

exercise and respiratory disease lead to the recruitment of ________ muscles

Answer 28

accessory (scalenes and SCMs)

Question 29

is inspiration or expiration an active process?

Answer 29

inspiration

Question 30

what are you inspecting for in the respiratory section of the PE?

Answer 30

RR rhythm, depth, effort color shape of chest use of accessory muscles asymmetry of expansion trachea midline audible noises skin abnormalities

Question 31

this occurs when the anteriorposterior diameter of the chest increases (age and respiratory diseases)

Answer 31

barrel chest

Question 32

"hump back"

Answer 32

kyphosis

Question 33

this refers to when the sternum sticks out

Answer 33

pectus carinatum

Question 34

this refers to when the sternum caves in

Answer 34

pectus excavatum

Question 35

this refers to when the skin of the thorax is separated and moves inversely

Answer 35

flail chest

Question 36

this is high pitched inspiratory whistling and may be due to upper airway obstruction

Answer 36

stridor

Question 37

this is an audible noise made on expiration

Answer 37

wheezing

Question 38

this is crackling or grinding over bones or joints

Answer 38

crepitus

Question 39

where should you place your thumbs for chest expansion?

Answer 39

level of 10th ribs

Question 40

what could asymmetry on lung excursion indicate?

Answer 40

pleural effusion splinting from pain chronic fibrosis unilateral airway obstruction paralysis of hemidiaphragm

Question 41

this is palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking

Answer 41

fremitus

Question 42

where is fremitus best heard?

Answer 42

interscapular space

Question 43

what part of the hand should be used for tactile fremitus?

Answer 43

ball of hand or ulnar surface

Question 44

_________ (+/-) fremitus occurs with excessive amounts of air in the lungs or increased distance to chest wall ex- pleural effusion, pneumothorax, asthma, COPD, decreased transmission of low freq sounds

Answer 44

decreased

Question 45

_________ (+/-) fremitus occurs in penumonia tumor and leads to increased transmission through consolidated tissue

Answer 45

increased

Question 46

this technique of the respiratory exam helps identify if the underlying tissue if air or fluid filled or solid.

Answer 46

percussion

Question 47

percussion technique

Answer 47

left DIP joint (pleximeter finger) firm on pt surface R 3rd digit strikes with pad of finger (plexor)

Question 48

this structure on percussion sounds flat and is similar sounding to a large pleural _______

Answer 48

thigh; effusion

Question 49

dullness on percussion signifies what?

Answer 49

fluid or solid

Question 50

what is dull on percussion?

Answer 50

liver lobar pneumonia empyema pleural effusions hemothorax fibrous tissue tumor

Question 51

this is what healthy lungs sound like on percussion

Answer 51

resonant

Question 52

this is what hyperinflated lungs sound like emphysema, asthma, unilateral pneumothorax

Answer 52

hyperresonant

Question 53

this sound is more than hyperresonant on percussion gastric air bubble, puffed out cheek, large pneumothorax

Answer 53

tympanic

Question 54

this test identifies the distance of the diaphragm dissention into the thorax during full inspiration

Answer 54

diaphragmatic excursion

Question 55

what is a normal distance of diaphragmatic excursion?

Answer 55

3- 5.5 cm

Question 56

what landmark do you do diaphragmatic excursion on?

Answer 56

midclavicular line

Question 57

this is the most important exam technique for assessing air flow through the tracheobronchial tree

Answer 57

auscultation of the lungs

Question 58

when performing lung auscultation, should you use the bell or diaphragm?

Answer 58

diaphragm

Question 59

true or false- you should listen to one full breath in each ladder position when auscultating the lungs

Answer 59

true

Question 60

what should be listened for during respiratory auscultation?

Answer 60

pitch intensity duration of inspiration and expiration

Question 61

this type of normal breath sound is heard over both lungs, is low and soft, and lasts longer in inspiration

Answer 61

vesicular

Question 62

this sound is often in the 1st and 2nd intercostal spaces anteriorly and between the scapula and inspiratory and expiratory sounds are almost equal

Answer 62

broncho-vesicular

Question 63

this breath sound is heard over the manubrium, is high and loud, and expiratory lasts longer than inspiratory

Answer 63

bronchial

Question 64

this breath sound is heard over the trachea in the neck, is high and very loud and inspiratory and expiratory are almost equal

Answer 64

tracheal

Question 65

these lung sounds are discontinuous, intermittent, brief and may be fine or coarse

Answer 65

crackles/ rales

Question 66

this lung sound is continuous, musical, prolonged, low pitched with snoring quality and suggests secretions in large airways

Answer 66

rhonchi

Question 67

this lung sound is high pitched with hissing or shrill quality and suggests airway narrowing (asthma, bronchitis)

Answer 67

wheezes

Question 68

when to perform bronchophony

Answer 68

when bronchovesicular or bronchial sounds are heard

Question 69

how to perform bronchophony

Answer 69

listen in all 14 ladder positions while having pt say "99"

Question 70

on bronchophony, are clearly heard sounds good or bad?

Answer 70

BAD

Question 71

true or false- egophony does not occur in pneumonia

Answer 71

false

Question 72

true of false- the dullness of a middle lob pneumonia typically occurs behind the right breast

Answer 72

true

Question 73

this pulmonary function test measures the distance a patient can walk on a flat hard surface in 6 min (used mostly for COPD outcomes)

Answer 73

6 min walk test

Question 74

this pulmonary function test measures how quickly a pt can expire and the clinical should listen over the trachea with the diaphragm

Answer 74

forced expiratory time

Question 75

pts with >60 y/o w/ FET >9 sec are ____ times as likely to have COPD

Answer 75

4 x