Pulmonary PE Lecture

Question 1

Chest cavity

Answer 1

All that falls between clavicles and diaphragm

Question 2

Anterior chest

Answer 2

Formed by the ribs

Question 3

Intercostal spaces are named by:

Answer 3

The rib superior to it

2nd ICS space is between 2nd and 3rd rib

Question 4

Diaphragm at rest is located between which ribs?

Answer 4

5th and 6th

Question 5

Sternal angle is at the level of the:

Answer 5

2nd rib

Question 6

Posterior chest borders

Answer 6

C7 SP is superior border

T8 (9th rib or 2nd rib below scapula) is inferior portion

Question 7

Where is the RLL represented anteriorly?

Answer 7

Costophrenic angle

Question 8

Inspection for systemic signs of pulmonary disease:

Answer 8

Cyanosis of lips/fingers
Clubbing of fingers
Barrel chest
Tripod position

Question 9

Signs of respiratory distress:

Answer 9

Rate and effort of breathing
Use of accessory muscles
Unusual respiratory noises

Question 10

Displacement of the trachea could mean:

Answer 10

PTX

Atelectasis

Question 11

Pectus carinatum

Answer 11

Pigeon chest (convex)

Question 12

Pectus excavatum

Answer 12

Funnel chest (concave)

Question 13

Causes of asymmetric expansion:

Answer 13

Pneumonia
Bronchial obstruction
Pleural effusion
Pleural pain

Question 14

Tactile fremitus

Answer 14

Palpable vibrations transmitted from bronchial and lung tissue to chest wall
*Avoid bony areas

Question 15

Most sensitive part of hand to detect tactile fremitus:

Answer 15

Ulnar surface

Question 16

Decreased tactile fremitus occurs with:

Answer 16

Bronchial obstruction
Pleural effusion
COPD
PTX
Tumor
COPD

Question 17

Increased tactile fremitus occurs because:

Answer 17

• An increase in solid tissue will conduct the vibrations better
• Consolidation (caused by PNA) will increase TF

Question 18

Pleximeter

Answer 18

Finger placed onto the ICS for percussion

Question 19

Plexor

Answer 19

Finger making the motion of percussion onto the pleximeter

Question 20

Percussion is performed at which joint?

Answer 20

Distal Interphalangeal Joint (DIPJ)

Question 21

T/F: Percuss anteriorly AND posteriorly

Answer 21

FALSE, only percuss anteriorly if abnormal findings

Question 22

Percussion notes:

Answer 22

Flat
Dull
Resonant
Hyperresonant
Tympanic

Question 23

Flat percussion

Answer 23

High pitched, short

Thigh

Question 24

Dull percussion

Answer 24

Medium pitch & duration

Liver

Question 25

Resonant percussion

Answer 25

Low pitch, long duration | Normal lungs

Question 26

Hyperresonant percussion

Answer 26

Lower pitch, longer duration | COPD

Question 27

Tympanic percussion

Answer 27

``` Lowest pitch (almost musical), longest duration (PTX, empty stomach) ```

Question 28

Pleural effusion percussion

Answer 28

Dull or flat depending on size

Question 29

Consolidation percussion

Answer 29

Dull over area of decreased aeration (PNA, pulmonary edema)

Question 30

Atelectasis percussion

Answer 30

Dull - lobar collapse often due to mucus plug (airflow obstructed)

Question 31

Normal tissue percussion

Answer 31

Resonant

Question 32

Pneumothorax percussion

Answer 32

Hyperresonant or tympanic if large (air escapes lungs, fills chest cavity, closer to surface)

Question 33

COPD percussion

Answer 33

Hyperresonant - air trapped in alveoli become hyperinflated

Question 34

Asthma percussion

Answer 34

Resonant to hyperresonant depending on severity

Question 35

The diaphragm of the stethoscope picks up ____ pitched sounds, while the bell picks up ____ pitched sounds

Answer 35

High | Low

Question 36

Use ____ pressure when using diaphragm of stethoscope and ____ pressure when using bell

Answer 36

Higher | Lighter

Question 37

T/F: Auscultation can be done both lying down and sitting up

Answer 37

FALSE, every effort should be made to auscultate with patient sitting up

Question 38

How does chest hair interfere with auscultation and how can you improve this?

Answer 38

- Chest hair can sound like crackles | - Press harder or try moistening the hair

Question 39

What should you do if you hear an abnormal breath sound?

Answer 39

Ask pt to cough to clear any secretions. If the sound is still there, it's not from secretions

Question 40

Normal breath sounds:

Answer 40

Vesicular Bronchovesicular Bronchial

Question 41

Vesicular breath sounds

Answer 41

- Soft, low pitched - All of inspiration, fade out after about 1/3 of expiration - Heard thru all lung fields

Question 42

Bronchovesicular breath sounds

Answer 42

- Louder than vesicular | - Heard equally in inspiration and expiration

Question 43

Where are bronchovesicular sounds heard best?

Answer 43

Anteriorly: 1st/2nd ICS Posteriorly: between scapulae

Question 44

Bronchial breath sounds

Answer 44

Very loud, high pitched | Expiratory lasts longer

Question 45

Where are bronchial sounds heard best?

Answer 45

Over the manubrium

Question 46

Adventitious sounds:

Answer 46

Rhonchi Wheezes Crackles (rales)

Question 47

Rhonchi

Answer 47

- Low pitched - Sounds like snoring or geese honking - Represents secretions in large airways

Question 48

Wheezes

Answer 48

- High pitched (shrill) - Can be inspiratory or expiratory - Represents a narrow airway - A/w asthma, COPD, bronchitis

Question 49

Stridor

Answer 49

- Loud inspiratory wheeze - Heard best over trachea - Indicates partial tracheal obstruction

Question 50

Crackles

Answer 50

- Fine: high pitched, brief, arise from alveoli | - Coarse: low pitched, louder, longer, arise from alveoli

Question 51

Pleural friction rub

Answer 51

- Rarely heard - Brief and confined to small area - Disappears w/pleural effusion (fluid is interspersed between inflamed surfaces)

Question 52

When should vocal fremitus be performed?

Answer 52

If abnormal breath sounds are heard