Pulmonary

Question 1

Which pleura hurts when inflamed?

Answer 1

parietal

Question 2

Where do you insert a chest tube with a tension pneumothorax?

Answer 2

2nd intercostal space

Question 3

Where is anterior chest tube placement?

Answer 3

4th intercostal space

Question 4

Where is ET tube tip placement?

Answer 4

T4

Question 5

In what order do you perform a lung exam?

Answer 5

inspect, palpate, percuss, auscultate

Question 6

What are you inspecting?

Answer 6

rhythm, depth, effort of breathing. Color, shape of chest, use of accessory muscles, asymmetry, trachea midline, stridor (high pitched inspiratory whistling, urgent), wheezes (expiratory), the skin

Question 7

What are the two ways you palpate the lungs?

Answer 7

chest expansion and tactile fremitus

Question 8

What should you look for while palpating?

Answer 8

areas of tenderness, any crepitus, brusing

Question 9

What could asymmetry in the chest expansion indicate?

Answer 9

pleural effusion, splinting, chronic fibrosis, unilateral airway obstruction, paralysis of hemidiaphragm

Question 10

What is fremitus?

Answer 10

palpable vibrations transmitted from bronchus to chest, repeating “ninety-nine” and identify decreased, increased, absent fremitus

Question 11

What does decreased fremitus mean?

Answer 11

excessive amounts of air, pleural effusion, pneumothorax, asthma, COPD

Question 12

What does increased fremitus mean?

Answer 12

increased transmission through consolidated tissue

Question 13

What does percussion help with?

Answer 13

to determine if there is fluid in the lungs or not: flat (pleural effusion), dullness (fluid or solid), resonant (healthy), hyperresonant (hyperinflated), tympanic (large pneumothorax)

Question 14

What does the diaphramatic excursion identify?

Answer 14

the amount of distance of diaphragm into thorax during inspiration
3-5.5 cm is normal

Question 15

Do you listen to the lungs with the diaphragm or a bell?

Answer 15

diaphragm

Question 16

What should you be paying attention to in auscultation?

Answer 16

pitch, intensity, duration

Question 17

What is a vesicular breath sound?

Answer 17

normal, soft low pitched heard in inspiration

Question 18

What is a bronchovesicular breath sound?

Answer 18

normal with equal inspiratory and expiratory sounds with a gap in between

Question 19

What is a bronchial breath sound?

Answer 19

normal with louder and harsher in pitch with short silence in between I & E sounds, e lasting longer than i

Question 20

What is a tracheal breath sound?

Answer 20

loud harsh sounds over trachea (normal)

Question 21

What are irregular sounds?

Answer 21

crackles/rales (discontinuous, intermittent, brief), rhonchi (continuous, musical, prolonged with snoring quality), wheezes (high pitched hissing or shrill quality)

Question 22

What is a bronchophony?

Answer 22

asking the patient to say ninety-nine as you listen to the same ladder positions
anything clearly heard is BAD

Question 23

What is an egophony?

Answer 23

ask the patient to say “Eeeee” as you listen in ladder format
normal = long E sound
abnormal = a sound “bleating”

Question 24

What is a whispered pectoriloguy?

Answer 24

ask patient to whisper ninety-nine as you listen in the ladder format
abnormal = loud and clear sound

Question 25

What are you inspecting of the anterior chest wall?

Answer 25

shape of chest and movements of chest wall; deformities, asymmetries, bruising, skin changes

Question 26

What palpation is done on the anterior chest?

Answer 26

chest expansion (verbalize in PE) tactile fremitus (have ms girl hold her boobs up)

Question 27

how many spots do you percuss on the anterior chest?

Answer 27

12

Question 28

What are clinical tests of pulmonary function?

Answer 28

6 minute walk test, forced expiratory time (longer the time, more likely for COPD)

Question 29

What can you hear better with inspiration manuever?

Answer 29

right side murmurs

Question 30

What can you not hear as well with inspiration?

Answer 30

left side murmurs

Question 31

What can you hear better with making the patient lean forward?

Answer 31

aortic murmurs (aortic stenosis, aortic regurgitation)

Question 32

What can you hear better in lateral decubitus position?

Answer 32

mitral murmurs

Question 33

What can you hear better when you are increasing venous return (squatting/raising legs)?

Answer 33

all murmurs EXCEPT mitral valve prolapse, hypertrophic cardiomyopathy

Question 34

What can you hear better when you are decreasing venous return (standing)?

Answer 34

Mitral valve prolapse and hypertrophic cardiomyopathy and the rest are quieter

Question 35

What can you hear better when you increase afterload and utilize handgrips?

Answer 35

aortic regurg/mitral regurg

Question 36

What can you hear better when you lower afterload with amyl nitrate?

Answer 36

aortic stenosis, mitral valve prolapse, hypertrophic cardiomyopathy

Question 37

What's the most prominent bony landmark on the back?

Answer 37

C7/T1

Question 38

What's the landmark for thoracentesis?

Answer 38

between 7th and 8th ribs (superior 8th)

Question 39

What is the triangle of safety?

Answer 39

lateral border of pectoralis major, lateral border of latissmus dorsi, and nipple line for safe chest tube positioning

Question 40

Where does the lower lung lie?

Answer 40

T10

Question 41

If an endotracheal tube is advanced too far during intubation, where will it broach?

Answer 41

right mainstem bronchus

Question 42

What does it mean when the SCM and scalenes become visible during respiration?

Answer 42

extra work is required to breathe

Question 43

What is hemoptysis?

Answer 43

blood coughed up

Question 44

What are you listening for in auscultation?

Answer 44

sounds generated by breathing, added sounds, abnormalities