Thorax and Lungs Evaluation

Question 1

Left Upper Lobe Apicoposterior Segment

Answer 1

Above the clavicle along the midclavicular line

Question 2

Left Upper Lobe Anterior Segment

Answer 2

Somewhere between the 1st and 2nd intercostal space medially

Question 3

Left Upper Lobe Superior Lingula Segment

Answer 3

In the 3rd intercostal space between the midclavicular and axillary lines

Question 4

Left Upper Lobe Inferior Lingula Segment

Answer 4

Somewhere between the 4th intercostal space and the 5th rib near the apex of the heart

Question 5

Left Lower Lobe Anteromedial Basal Segment

Answer 5

Somewhere between the 5th intercostal space and the 6th rib along the midclavicular line

Question 6

Left Lower Lobe Superior Segment

Answer 6

Somewhere between 1” below the spine of the scapula and 1” above the inferior angle medially

Question 7

Left Lower Lobe Lateral Basal Segment

Answer 7

Somewhere between 1” above/below the inferior angle of the scapula and the 10th intercostal space laterally

Question 8

Left Lower Lobe Posterior Basal Segment

Answer 8

Somewhere between 1” above the inferior angle of the scapula and the 10th intercostal space medially

Question 9

Right Upper Lobe Apicoposterior Segment

Answer 9

Above the clavicle along the midclavicular line

Question 10

Right Upper Lobe Anterior Segment

Answer 10

Somewhere between the 1st and 2nd intercostal spaces medially

Question 11

Right Upper Lobe Posterior Segment

Answer 11

1” above the spine of the scapula medially

Question 12

Right Middle Lobe Lateral Segment

Answer 12

Somewhere between the 3rd intercostal space and the 5th rib laterally

Question 13

Right Middle Lobe Medial Segment

Answer 13

Somewhere between the 3rd and 5th intercostal spaces medially

Question 14

Right Lower Lobe Superior Segment

Answer 14

Somewhere between 1” below the spine of the scapula and 1” above the inferior angle of the scapula medially

Question 15

Right Lower Lobe Anterior Basal Segment

Answer 15

In the 5th intercostal space or 6th rib area between the midclavicular and axillary lines

Question 16

Right Lower Lobe Lateral Basal Segment

Answer 16

Somewhere between 1” above/below the inferior angle of the scapula and the 10th intercostal space laterally

Question 17

Right Lower Lobe Posterior Basal Segment

Answer 17

Somewhere between 1” above the inferior angle and the 10th rib medially

Question 18

When inspecting rate, rhythm, and depth of breathing you would typically expect RR to be __-__ breaths per minute.

Answer 18

12-20

Question 19

What are a few indications of respiratory distress?

Answer 19

• Increased RR
• Nasal flaring
• Intercostal and sternal retracftions
• Visible expression of distress
• Increased use of neck accessories
• Paradoxic breathing

Question 20

What are 2 chest abnormalities to look for?

Answer 20

Pectus excavatum (funnel chest)

Pectus carinatrum (pigeon chested)

Question 21

Assessment of the neck reveals jugular vein distention, what does this indicate?

Answer 21

cor pulmonae (R side heart failure)

Question 22

What things should you look for in regards to chest dimensions?

Answer 22

• scoliosis
• barrel chest (hyperinflation)
• kyphosis
• professorial positioning

Question 23

The normal AP dimension of the chest is how big?

How big is the transverse dimension?

Answer 23

1/2 the size of the transverse dimension, which is usually the width of the shoulder

Question 24

Why is important to ask about couch production?

Answer 24

Weak and ineffective cough production is indicative ofweak respiratory musculature

Question 25

Why should you assess the digits?

Answer 25

Digital clubbing indicates chronic tissue hypoxia

Question 26

Evaluation of the mediastinum assesses tracheal shift that is due to what?

Answer 26

disproportionate intrathoracic pressures of lung volumes between the 2 sides of the thorax

Question 27

What may be the cause if the contents of the thorax shift toward the affected side?

Answer 27

Lung volume on that side is decreased * lobectomy * peneumonectomy * large degree of atelectasis

Question 28

What may be the cause if the contents of the thorax are shifted towards the unaffected side?

Answer 28

There is increased pressure on the same side * Pleural effusion * Tumor * Untreated Pneumothorax

Question 29

In what position should you palpate the mediastinum for tracheal deviation?

Answer 29

while the patient is sitting upright with the neck flexed slightly to allow the SCM muscles to relax

Question 30

In what position should you palpate the scalenes during quite breathing

Answer 30

Question 31

Describe the positioning to assess motion of the upper, middle, and lower lung lobes

Answer 31

Question 32

In what position should you assess diaphragmatic motion? Describe the process for assessment

Answer 32

In supine, palpate the anterior chest wall with the thumbs over the costal margins and thumb tips meeting at the xyphoid. Instruct the patient to inhale deeply. Assess the movement of the hands; they should travel equally apart with a total circumferential diameter increase of at least 2-3 inches

Question 33

What can be defined as the vibration that is produced by the voice or by the presence of secretions in the airways and is transmitted to the chest wall and palpated by the hand

Answer 33

Fremitus

Question 34

Describe the procedure for assessing fremitus

Answer 34

Place the palms of your hands lightly on the posterior chest wall and instruct the patient to say the word "99"

Question 35

What is indicated if there is increased resonance palpated while testing for resonance?

Answer 35

the presence of an increase in secretions in a particular area (consolidation)

Question 36

What is indicated if there is decreased resonance palpated while testing for resonance?

Answer 36

There is an increase in air in the particular area (air pocketing)

Question 37

In what positon should you perform percussion?

Answer 37

anterior supine, posterior seated

Question 38

Describe the process of percussion Explain the sounds you may hear

Answer 38

* Place the middle finger between 2 ribs, while all other fingers are lifted off the chest * Proceeds in a cephalocaudal direction and back and forth between the left and right sides * Normal sound is when normal lung tissue is percussed and normal resonance is produced * A dull sound is produced with percussion over the liver or other dense tissue and is described as a “thud” * A tympanic sound is loud, long, and hollow and may be heard over an empty stomach or hyperinflated chest

Question 39

Describe the process of determining excursion of the diaphragm

Answer 39

* Position the patient in sitting with the back exposed * Precuss from the apex of the lungs to the bases of the lungs while the patient is quietly breathing * Draw a line at the point where the resonance becomes dull * Then ask the patient to take a maximal inspiration and hold that breath * Percuss caudally until you agian hear the dullness and mark this spot * This distance between the 2 lines represents diaphragmatic excursion

Question 40

What is normal diaphragmatic excursion?

Answer 40

3-5 cm

Question 41

In what patient population will diaphragmatic excursion be reduced?

Answer 41

hyperinflated chests (COPD)

Question 42

What does normal bronchial lung sound sound like? Where can it be heard?

Answer 42

They sound hollow, tubular sounds that are lower pitched. They can be auscultated over the trachea where they are considered normal

Question 43

Describe bronchovesicular lung sounds. Where can they be heard?

Answer 43

Inspiration to expiration periods are equal with bronchovesicular lung sounds. These are normal sounds in the mid-chest area or in the posterior chest between the scapula. They reflect a mixture of the pitch of the bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound.

Question 44

Describe vesicular breath sounds

Answer 44

They are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface

Question 45

Describe what wheezes sound like. What do they indicate?

Answer 45

continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality narrowing of the airways

Question 46

Describe what crackles sound like What is the difference between fine and coarse crackles?

Answer 46

brief, discontinuous, popping lung sounds that are high-pitched Coarse crackles are louder, lower in pitch and last longer

Question 47

What may crackles be casued by?

Answer 47

restrictive or obstructive respiratory disorders

Question 48

What does pleural rub sound like?

Answer 48

like two pieces of leather or sandpaper rubbing together

Question 49

Where should you assess for pleural rub?

Answer 49

in the lower lateral chest areas