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Question 1

What are the steps for examining the respiratory system (full assessment)?

Answer 1

71. Verbalizes exam findings and anatomical landmarks throughout
72. Inspect shape, spine, respiratory movement, thoracic cage
73. Palpate for thoracic excursion and expansion
74. Palpate spine, ribs, and muscles for tenderness
75. Palpate for tactile fremitus
76. Check for CVA tenderness
77. Percuss posterior lung fields
78. Auscultate posterior lung fields
79. Auscultate anterior lung fields
80. Bronchophony, Egophony, or Whispered Pectoriloquy (one only)

Question 2

What is bronchophony and what does it indicate?

Answer 2

Ask patient to say 99 in a clear voice. Listen to chest with a stethoscope. A normal finding will have the words sound indistinct. If they sound clear, it may indicate consolidation or fluid.

Question 3

What is egophony and what does it indicate?

Answer 3

While listening to the chest with a stethoscope, ask the patient to say the vowel “e”. Over normal lung tissues, the same “e” (as in “beet”) will be heard. If the lung tissue is consolidated, the “e” sound will change to a nasal “a” (as in “say”).

Question 4

What is whispered pectoriloquy and what does it indicate?

Answer 4

Whispered pectoriloquy: Ask the patient to whisper a sequence of words such as “one-two-three,” and listen with a stethoscope. Normally, only faint sounds are heard. However, over areas of tissue abnormality, the whispered sounds will be clear and distinct.

Question 5

What is special about the 11th and 12th ribs?

Answer 5

They are only attached posteriorly (often referred to as floating ribs).

Question 6

Why is aspiration pneumonia more common in the right middle and right lower lobes?

Answer 6

The right bronchus is more vertical.

Question 7

Does the visceral pleura or parietal pleura have nerve endings?

Answer 7

the parietal pleura has intercostal and phrenic nerves, the visceral has none.

Question 8

When would you see transudate pleural effusions?

Answer 8

heart failure, cirrhosis, nephrotic syndrome

Question 9

When would you see exudate pleural effusions?

Answer 9

pancreatitis, pneumonia, malignancy, tuberculosis, pulmonary embolism

Question 10

What should a health history include for a respiratory complaint?

Answer 10

1. Respiratory symptoms may be manifestations of hematological or cardiovascular complaints.
2. Because of its relevance and importance in the evaluation of patients with known or suspected pulmonary diseases, the social history - tobacco and recreational drug use, occupational and
   environmental exposures, and travel history.

Question 11

What are common respiratory complaints?

Answer 11

dyspnea, wheezing, cough, hemoptysis, chest pain, daytime sleepiness (snoring)

Question 12

What are some guiding questions you would want to know about a cough?

Answer 12

• Length of time (acute, subacute, chronic)
• productive?
  -Sputum colour, size, frequency

Question 13

What are some differentials for hemoptysis?

Answer 13

bronchitis; malignancy; cystic fibrosis; and, less commonly, bronchiectasis, mitral stenosis,
Goodpasture syndrome, and granulomatosis with
polyangiitis (formerly Wegener granulomatosis).

Question 14

What is orthopnea?

Answer 14

SOB when laying supine

Question 15

What is paroxysmal nocturnal dyspnea?

Answer 15

SOB at night usually after 1-2 hours of sleep, relieved by sitting upright.

Question 16

What is costochondritis?

Answer 16

An inflammation of the cartilage that connects a rib to the breastbone (sternum). Pain caused by costochondritis might mimic that of a heart attack or other heart conditions.

Question 17

During your respiratory assessment, what are you inspecting for?

Answer 17

-Clubbing of the fingers, cyanosis, pallor
-barrel chest
-symmetrical chest movements, rate, rhythm, WOB (ie. retractions)

Question 18

During your respiratory assessment, what are you palpating for?

Answer 18

-lung excursion
-tactile fremitus
-tenderness/pain

Question 19

How do you perform lung excursion?

Answer 19

Place your thumbs at about the
level of the 10th ribs, with your fingers loosely grasping
and parallel to the lateral rib cage .As you position your hands, slide them medially just enough to
raise a loose fold of skin between your thumbs over the
spine. Ask the patient to inhale deeply. Watch the
distance between your thumbs as they move apart during
inspiration and feel for the range and symmetry of the rib
cage as it expands and contracts. This movement is
sometimes called lung excursion.

Question 20

How do you perform tactile fremitus?

Answer 20

Tactile fremitus is decreased or absent when the voice is higher pitched or soft or when the transmission of vibrations from the larynx to the surface of the chest is
impeded by a thick chest wall, an obstructed bronchus, COPD, pleural effusion, fibrosis, air (pneumothorax), or an infiltrating tumor.

To detect fremitus, use either the ball (the bony part of the palm at the base of the fingers) or the ulnar surface of your hand to optimize the vibratory sensitivity of the bones in
your hand. Ask the patient to repeat the words “ninetynine” or “one-one-one.” Initially practice with one hand
until you feel the transmitted vibrations. Use both hands to
palpate and compare symmetric areas of the lungs in the
pattern. Identify and locate any
areas of increased, decreased, or absent fremitus.