respiratory

Question 1

lung lobes

Answer 1

3 right lobes, 2 left

Question 2

red flag respiratory symptoms

Answer 2

hemoptysis
apnea
respiratory distress
chest pain
absent breath sounds
hypertensive crisis

Question 3

normal AP to lateral ratio

Answer 3

1:2
childen 1:1

Question 4

normal lung percussion

Answer 4

resonant

Question 5

what does dull percussion indicate

Answer 5

infection or tumor

Question 6

what does hyperresonant percussion indicate

Answer 6

hyperinflation - COPD, pneumothorax, asthma

normally heard in children or thin adults

Question 7

what does flatness percussion indicate

Answer 7

fluid in the pleural space

effusion

Question 8

pregnancy considerations

Answer 8

diaphragm displaced upward
dyspnea is common

costal angle increases
increased vital capacity
tidal volume increased 40%
increased ventilation

Question 9

geriatric considerations

Answer 9

dry mucous membranes
slight hyperresonance with percussion
difficulty breathing gand holding breath
decreased chest expansion
AP diameter increased

fatigue more easily
decreased lung elasticity & muscle mass

Question 10

pediatric considerations

Answer 10

modify physical exam order
shorter airway, upper airway sounds transmitted to lower airway
RR variable

Question 11

premature infant considerations

Answer 11

weak respiratory muscles
hypoxia and apnea common
alveoli collapse easily
obligatory nose breathers

Question 12

newborn/infant considerations

Answer 12

large tongue
obligatory nose breathers
small airways
flat diaphragm, abdominal breathers

Question 13

toddler considerations

Answer 13

increased growth and maturation of alveoli
decreased RR
consider foreign body aspiration

Question 14

school age considerations

Answer 14

complete lung development by 8 yrs

Question 15

5 A’s model

Answer 15

for tobaccos cesation

ask
advise
assess
assist
arrange

Question 16

cause of inspiratory stridor

Answer 16

inflammation in eppiglottitis, larynx, trachea

Question 17

cause of inspiratory stridor

Answer 17

swelling in larynx, trachea, bronchi

Question 18

pack per year history

Answer 18

packs per day * number of years

Question 19

tactile fremitus

Answer 19

say “ninety nine” and feel vibrations

vibrations should be stronger anteriorly and symmetric

increase in tactile fremutis indicates air trapping - asthma, pneumonia, emphysema

denser or inflamed lung tissue

Question 20

bronchophony

Answer 20

“ninety nine” is distinct and not muffled when auscultating

clear indicates consolidation

Question 21

egophony

Answer 21

say “e” while auscultating

sound changes to A

clear indicates consolidation

Question 22

whisper pectoriloquy

Answer 22

whisper “1,2,3” continously while auscultating

clear indicates consolidation

Question 23

who should be screened for lung cancer?

Answer 23

55-77 smoking hx

low dose CT

especially currently or >30yr pack hx

Question 24

pack year hx

Answer 24

packs per day * years

Question 25

order of exam

Answer 25

inspection palpation percussion auscultation

Question 26

anterior/posterior auscultation points

Answer 26

12 anterior 14 posterior

Question 27

tracheal breath sounds

Answer 27

loudest and high pitched, usually heard over the upper aspect of the trachea, best heard on the anterior aspect of the neck

Question 28

bronchial breath sounds

Answer 28

louder and higher in pitch, usually heard over the lower aspect of the trachea, best heard over the manubrium

Question 29

bronchovesicular breath sounds

Answer 29

intermediate intensity and pitch, usually heard over the major bronchi in the midchest area anteriorly or between the scapulae posteriorly

Question 30

vesicular breath sounds

Answer 30

soft intensity, low pitched, with a rustling quality during inspiration and softer with expiration, usually heard bilaterally over most of the peripheral fields