Pulmonary Exam (Lab)

Question 1

What should you look for for general appearance?

Answer 1

Look for pallor, cyanosis, or normal coloring of the skin of the face and extremities including blanching of nail beds, digital clubbing, and JVD.

Question 2

The thoracic cage is out more on one and comes out; occurs mostly with multiple rib fractures.
This clinical presentation is describing…

Answer 2

Flail chest

Question 3

The sternum is sinking in and sits down in the chest. This clinical presentation is describing…

Answer 3

Pectus excavatum

Question 4

The sternum protrudes and the ribs come out to a point at the sternum.
This clinical presentation is describing…

Answer 4

Pectus carinatum

Question 5

A patient who demonstrates a more barrel chest (increased A-P) compared to our typical elliptical chest is found with what diagnosis?

Answer 5

COPD

Question 6

What breathing pattern is being described?
1 side moving more or less than the other; typically the side that is moving less is involved.

Answer 6

Lateral costal

Question 7

What breathing pattern is being described?
Increase in anterior and apical movement of thoracic cage; chest breather.

Answer 7

Apical

Question 8

What breathing pattern is being described?
Opposite movement of the thoracic cage and abdomen; sink and expand in opposite motions.

Answer 8

Paradoxical

Question 9

What breathing pattern is being described? Person is breathing out longer than normal.

Answer 9

Prolonged expiration

Question 10

What breathing pattern is being described? The patient’s mouth is just opening and closing when breathing.

Answer 10

Fish-mouthed

Question 11

What breathing pattern is being described? Irregular depth of respiration with periods of apnea.

Answer 11

Cheyne-Stokes

Question 12

What breathing pattern is being described? Slow rate, shallow depth, followed by period of apnea (brain kicks in to breathe more because of increased CO2 in tissues), followed by irregular depths, then settles back into slow and shallow. Seems like the person isn’t really breathing.

Answer 12

Apneustic

Question 13

What breathing pattern is being described? Sudden stop in breathing pattern. Usually one side or the other but can be both, typically due to pain.

Answer 13

Doorstop

Question 14

Any use of accessory muscles at rest, in the absence of hypertrophy, is indicative of an acute or chronic respiratory insufficiency?

Answer 14

Acute

Question 15

To assess lung expansion or chest wall excursion, should you tell your patient to breathe in through their mouth or nose?

Answer 15

Nose

Question 16

What test listens to the air moving inside the lung?

Answer 16

Fremitus

Question 17

To test for Fremitus, what should you tell your patient to do?

Answer 17

Say “99”

Question 18

How would you describe your findings for Fremitus?

Answer 18

Normal resonance, hyporesonance, or hyperresonance

Question 19

What test listens to air in the tissue beneath?

Answer 19

Percussion

Question 20

What are the options for interpretation when testing percussion?

Answer 20

Resonant, dull, flat, or tympanic (hyper-resonant)

Question 21

When completing auscultation, do you want your patient to breathe through their nose or mouth, and why?

Answer 21

Have them take a deep breath through their mouth because the nose has hair cells that may contain mucous that can be picked up by the stethoscope.

Question 22

Signs of pallor or cyanosis (tips of ears and nose) suggest…

Answer 22

Low PO2 and high CO2

Question 23

Slow return of pink color in nail beds after compression is indicative of…

Answer 23

PVD

Question 24

Signs of digital clubbing are indicative of…

Answer 24

Long-standing high CO2 retention

Question 25

If the mediastinum is shifted to one side, this could mean...

Answer 25

A space-occupying lesion on the other side of the shift, or partial collapse or underdevelopment of lung tissue on the same side of the shift.

Question 26

Signs of barrel chest are indicative of...

Answer 26

Overinflation of lungs that can lead to larger than normal residual volume as a result of COPD; or gross asymmetry from kyphosis or scoliosis that could suggest low ventilatory capacity.

Question 27

Limited lung excursion suggests...

Answer 27

Regional ventilation impairment

Question 28

Hyporesonance with Fremitus is associated with...

Answer 28

Either low ventilatory effort, air trapping, or fluid accumulation.

Question 29

Hyperresonance with Fremitus is associated with...

Answer 29

Increased tissue density such as consolidated pneumonia.

Question 30

Elevated diaphragm or hemi-diaphragm is an indication of...

Answer 30

Impaired ventilation may occur as a result of atelectasis or increased intra-abdominal pressure from gas, pregnancy, or even subphrenic abscess.

Question 31

Dull percussion is indicative of...

Answer 31

Low inflation of underlying tissue which may be the result of low, ventilatory effort, fluid accumulation, accumulation of mucous, or pneumonia.

Question 32

Flat sounds are heard with percussion when...

Answer 32

You are over visceral tissue.

Question 33

Tympanic sounds are heard with percussion when...

Answer 33

The lungs are over-inflated such as with COPD.