Thorax & Lungs

Question 1

Atopic allergies

Answer 1

Genetic predisposition to hypersensitivity reactions to common allergens, including rhinitis, eczema, asthma, food allergies

Question 2

5 A’s of tobacco cessation

Answer 2

Ask about smoking
Advise pts to stop
Assess readiness to quit
Assist pts to set up plan 
Arrange for follow up visits, referrals

Question 3

Tripod positioning

Answer 3

Gravity helps diaphragm

Question 4

Pursed lip breathing

Answer 4

Elongates respirations and helps forcefully blow of CO2

Question 5

Respiratory Muscles/ Muscles used for breathing

Answer 5

Diaphragm- vertical expansion/down

Parasternal/scalene- expand thorax/out

Question 6

Accessory muscles of inspiration

Answer 6

Sternomastoid

Scalene

Question 7

Accessory muscles of expiration

Answer 7

Abdominal

Internal intercostals

Question 8

Pectus excavatum

Answer 8

Sternum and adjacent cartilages appear sunken

Question 9

Pectus carinatum

Answer 9

“Pigeon chest”

Sternum protrudes and rubs slope back

Question 10

Barrel chest

• Describe
• Cause
• Assessment

Answer 10

Increased AP diameter d/t increased residual volume and air trapping from age-related changes of obstructive lung disease
Assess: distant heart sounds, pursed lip breathing, increased effort, hyper-resonance

Question 11

Normal adult chest ratio

Answer 11

A/P diameter < transverse (1:2)

Question 12

Systemic signs of poor oxygenation

Answer 12

Cyanosis (fingers, lips, nose, ears, toes)
Clubbing (enlargement of CT in terminal phalanges)
Poor physical endurance, activity intolerance, fatigue, DOE

Question 13

Palpation

Answer 13

Tenderness, pain
Crepitus (SC emphysema)
Respiratory expansion
Tactile fremitus

Question 14

Tactile fremitus: normal findings

Answer 14

Should feel more vibrations of apex

Question 15

Decreased tactile fremitus

Answer 15

Transmission of vibration from larynx to chest surface is impeded
Ex: pleural effusion, which displaces the lung upwards

Question 16

Increased tactile fremitus

Answer 16

Ex: consolidation, when lung becomes engorged with fluid or tissue (usually iso PNA)

Question 17

Hyper-resonance

Answer 17

Air is more abundant than usual

Ex: emphysema

Question 18

Dull

Answer 18

Tissue is rich in solid or fluid and poor in air

Ex: consolidation, bone, tumor, effusion

Question 19

Respiratory excursion

• Method
• Normal
• Causes of increased/decreased

Answer 19

Percuss during inspiration and expiration
Normal: 3.5-5 cm
Increased in well conditioned ppl
Decreased: pleural effusion, LL PNA, diaphragm paralysis, atelectasis, displaced by enlarged liver

Question 20

Bronchial breath sounds

Answer 20

Over trachea
Sounds like snoring
E>I

Question 21

Vesicular breath sounds

Answer 21

Over lesser bronchi, bronchioles, lobes
Softer sound
I>E

Question 22

Bronchovesicular breath sounds

Answer 22

Over main bronchus

I=E

Question 23

Reasons for decreased breath sounds (4)

Answer 23

• pt isn’t breathing deeply enough
• thick chest wall/obesity
• sounds are distant, e.g., COPD
• poor transmission, e.g., effusion, atelectasis

Question 24

Bronchial sounds where you should hear vesicular

Answer 24

Air-filled lung has been replaced with fluid or solid tissue

Question 25

Adventitious sounds that clear with coughing

Answer 25

Due to secretions, bronchitis, atelectasis

Question 26

Rales

Answer 26

Aka fine crackles Interrupted sounds Air filled lung replaced with consolidation or fluid Generated as alveoli pop open from collapsed state of air circulates in very moist areas

Question 27

Rhonchi

Answer 27

AKA coarse crackles Long continuous sounds Generated by obstruction to airways, ex. COPD Localized = obstruction of any etiology, ex. tumor, foreign body, mucous May disappear with coughing if d/t mucous

Question 28

Rales

Answer 28

AKA fine crackles Interrupted sounds Air-filled lung replaced with consolidations or fluid Generated as alveoli pop open from collapsed state or air circulates in very moist areas Ex. PNA, atelectasis, CHF, bronchitis

Question 29

Wheezes

Answer 29

Whistling-type noises produced during expiration (and sometimes inspiration) Generated when air is forced through narrow airways Ex. bronchoconstriction, secretions, mucosal edema

Question 30

Pleural Rub

Answer 30

Scratching, grating sound related to respiration Hear sound better by compressing harder with stethoscope and have pt take deep breaths D/t roughened pleura

Question 31

Bronchophony

Answer 31

Say "99" | Sounds become loud, sharp, distinct

Question 32

Whispering pectoriloquy

Answer 32

Whisper "99" | Whispered words sound clear and distinct

Question 33

Egophony

Answer 33

Say "E" | Sounds like "A"

Question 34

Alteration in transmitted voice sounds- cause

Answer 34

Lung has become consolidated

Question 35

Thorax/Respiratory PE

Answer 35

1. Inspect anterior and posterior chest- shape, AP diameter, symmetry, resp effort, retractions, accessory muscles 2. Palpate a&p for tenderness and tactile fremitus 3. Assess respiratory expansion and symmetry-- hands on back, take a deep breath 4. Percuss a&p 5. Percuss to assess diaphragmatic excursion 6. Auscultate a&p breath sounds and air exchange 7. Assess for egophony 8. Assess for bronchophony 9. Assess for whispered pectoriloquy