RESP

Question 1

What is the sternal angle?

Answer 1

2nd Rib

Question 2

What is the needle insertion for pneumothorax?

Answer 2

2ICS (MCL)

Question 3

Chest Tube insertion point?

Answer 3

4ICS (MAL)

Question 4

Where are the nipples?

Answer 4

4ICS, just lateral to MCL

Question 5

Inferior tip of Scapula?

Answer 5

7th rib or ICS

Question 6

Anterior Lungs- apex rises ____ above the clavicle

Lower border crosses the ____ rib at MCL and the ____ rib at the MAL

Answer 6

2-4 cm

6th rib

8th rib

Question 7

Posterior lungs- lower border lies about ____

Answer 7

T10 Spinous process

*descends on inspiration

Question 8

Posterior lung fissure sits at approx ______

Answer 8

T3 Spinous process

*no right-middle lobe shown posteriorly

Question 9

Where does the trachea bifurcate

Answer 9

Bifurcates at the sternal angle anteriorly and T4 posteriorly

Question 10

What are the accessory muscles that help with heavy breathing or with certain disease or injuries?

Answer 10

Parasternals
Scalenes
Sternomastoids
Abdominal muscles

Question 11

normal breathing rate
What can influence it?
Inspiration/expiration time?

Answer 11

12-20 in adult (F slightly higher rates than M).

20-30 in child.

30-60 in newborn.

metabolic rate, emotional state, neurological disorders, obstructive disease

*Insp: 1.5-2 s.
Pause: 2 s.
Exp: 1.5-2 s.

Question 12

DEF:

Simply - increased respiratory rate

Answer 12

Tachypnea

Question 13

DEF:

Any breathing pattern that reduces CO2 in the blood due to the increased rate and depth of respiration.

Answer 13

Hyperventilation

Question 14

Is Bradypnea a problem?

Answer 14

Not if perfusion is preserved as demonstrated by ABG

Question 15

__________ : deep, labored sighing respirations, whether rate be normal, slow, or fast
What causes it?

Answer 15

Kussmaul Breathing:

A compensatory response to metabolic acidosis (MEG’s LARD).

Question 16

________________ cyclic hyperventilation followed by compensatory apnea

Answer 16

Periodic (Cheyne-Stokes) Breathing:
Respirations are interrupted by periods of apnea.
In each cycle, the rate and amplitude of successive breaths increase to maximum, then progressively
diminish into the next apneic period.

Question 17

If chest pain is said to be pleuritic, it means that it is caused by ____________

Answer 17

The movement of breathing

Question 18

Def:
Dyspnea worse with upright posture
What can cause it?

Answer 18

Platypnea:

Pericarditis.

Question 19

What might cause a normal chest to be wider than it is deep

Answer 19

aging or COPD (AP > L)

Question 20

clubbing of fingernails can signal ….

Answer 20

Chronic lung disease

Question 21

What is pectin excavated?

What does it do to organs inside?

Answer 21

Funnel chest
depression in lower sternum

compresses heart and great vessels and may cause murmurs

Question 22

Name for pigeon chest

Answer 22

Pectus Carinatum

Sternum displaced anteriorly, increasing the AP diameter, while the adjacent costal cartilages are depressed.

Question 23

Thoracic Kyphoscoliosis

Answer 23

Abnormal spinal curvatures and vertebral rotation deforming the chest

Kyphosis is a condition of over-curvature of the thoracic vertebrae

Scoliosis is a condition in which a person’s spine curves laterally

Question 24

Signs of Respiratory Compromise

Answer 24

Retractions of the interspaces and use of accessory muscles (SCM and scalenes) during inspiration.

Pursing or cyanosis of the lips.

Nasal flaring.

Question 25

Pay particular attention to the ____________ in patients reporting anterior chest pain to evaluate the possibility of ________

Answer 25

costochondral junctions costochondritis

Question 26

chest expansion exam should take place at what rib level?

Answer 26

10th

Question 27

Why would tactile femitus be decreased or absent? | Increased?

Answer 27

areas of plural effusion or pneumothorax areas of consolidation (pneumonia)

Question 28

percussion only penetrates how far

Answer 28

5-7cm into the chest

Question 29

Where should you percuss the 6th and 7th posterior

Answer 29

4th and 5th ICS along the PAL

Question 30

CVAT | Tenderness suggest...

Answer 30

renal malady such as pyelonephritis or kidney stones

Question 31

_______: Soft and low-pitched sounds heard through inspiration, fade away about one-third of the way through expiration, heard over most of both lungs Duration: Inspiratory longer than expiratory.

Answer 31

Vesicular

Question 32

________: Louder and high in pitch with a short silence between inspiration and expiration; heard over the manubrium (if at all) Duration: Expiratory longer than inspiratory.

Answer 32

Bronchial

Question 33

______: Very loud and high in pitch, heard over the trachea in the neck (Darth Vader) Duration: Inspiratory = Expiratory.

Answer 33

Tracheal

Question 34

_________ is the phenomenon of the patient's voice remaining loud (bronchial) at the periphery of the lungs or sounding louder than usual over a distinct area of consolidation, such as in pneumonia.

Answer 34

Bronchophony May be caused by a solidification of lung tissue around the bronchii - which may indicate lung cancer - or by fluid in the alveoli, such as with pneumonia

Question 35

An exaggerated form of bronchophony. Patient whispers “ninety nine” as you auscultate different areas. Pulmonary consolidation transmits whispered syllables distinctly, even when the pathologic process is too small to produce bronchial breathing. This sign is valuable in detecting ______________

Answer 35

Whispered Pectoriloquy early pneumonia, infarction, and atelectasis.

Question 36

A form of bronchophony in which the spoken “Eee” is changed to “Ay,” which has a nasal or “bleating” quality E to A transition. Most commonly this indicates ________

Answer 36

Egophony | pneumonia

Question 37

adventitious sounds include: | What do they mean?

Answer 37

Crackles- nonmusical May be from abnormalities of the lungs (pneumonia, fibrosis, early CHF) or of the airways (bronchitis, bronchiectasis). Wheezes and Rhonchi- musical Wheezes relatively high-pitched with shrill quality suggest narrowed airways from asthma, COPD, or bronchitis. Rhonchi are lower-pitched with a snoring quality suggesting secretions in the larger airways. Friction Rub- grating sound made from 2 plural surfaces rubbing

Question 38

Clearing of sounds after coughing suggest.....

Answer 38

inspissated (thickened) secretions such as bronchitis.

Question 39

What causes most cases of pneumococcal pneumonia?

Answer 39

Streptococcus pneumoniae

Question 40

CDC recommends immunizations for:

Answer 40

All adults > 65. People ages 2-64 with chronic illnesses, esp if at increased risk for pneumococcal infection (sickle-cell anemia, cardiovascular and pulmonary disease, diabetes, cirrhosis, or leaks of CSF). Anyone with or about to receive a cochlear implant. Immunosuppressed > 2 yo including those receiving steroids, radiation, or chemotherapy.