Respiratory Lab

Question 1

Needle Thoracentesis (decompression)

Answer 1

2nd intercostal space just superior to 3rd rib margin at the midclavicular line for emergent decompression of tension pneumothorax, followed by chest tube placement

Question 2

Where does the neurovascular bundle run?

Answer 2

inferior to each rib, so needles should be placed superior to the rib margins

Question 3

Chest tube insertion

Answer 3

4th intercostal space at mid or anterior axillary line just superior to the margin of the 5th rib

Question 4

Where is the lower margin of the endotracheal tube after insertion seen on a chest x-ray?

Answer 4

T4

Question 5

Healthy adult Respiration Rate

Answer 5

14-20x a minute

Question 6

Pursed lips indicate

Answer 6

COPD

Question 7

Asymmetrical movement indicates

Answer 7

pleural effusion

Question 8

Intercostal retractions indicate

Answer 8

severe asthma, COPD, upper airway obstruction

Question 9

Tripoding

Answer 9

obstructive lung disorders

Question 10

Barrel chest

Answer 10

COPD

Question 11

contraction of accessory muscles

Answer 11

scm, scalenes, supraclavicular retraction

Question 12

lateral displacement of trachea

Answer 12

tension pneumothorax

Question 13

Clubbing

Answer 13

• bulbous swelling of soft tissue at nail base
• loss of normal angle between nail and proximal nail fold leading to spongy or floating feeling
• mechanism involves vasodilation with increased blood flow to distal portion of digits and changes in hypoxia, changes in innervation, or a platelet derived growth factor

Question 14

Conditions in which clubbing is seen

Answer 14

• congenital heart disease
• interstitial lung disease
• bronchiesctasis
• pulm fibrosis
• lung abscess
• IBD
• malignancies
• cystic fibrosis

Question 15

Focus of palpation

Answer 15

• areas of tenderness
• abnormalities overlying skin
• respiratory expansion
• tactile fremitus

Question 16

Tactile fremitus

Answer 16

• palpable vibrations transmitted through bronchopulm tree to the chest wall as the patient speaks
• perform on anterior and posterior chest
• use ball or ulnar surface of hands
• often more prominent in interscapular area than in the lower lung fields
• more prominent on the right side than the left
• disappears below the diaphragm

Question 17

Decreased/absent fremitus

Answer 17

COPD, pleural effusions, fibrosis, pneumothorax, thick chest wall, infiltrating tumor

Question 18

Increased fremitus

Answer 18

pneumonia (increased transmission through consolidated tissue)

Question 19

Percussion technique

Answer 19

• hyperextend middle finger and firmly contact skin
• strike extended finger aiming for DIP with quick wrist motion
• start superiorly percussing both dies of chest, working toward base in a ladder like pattern
• done on posterior and anterior chest
• percussion penetrates 5-7cm into chest, so may miss deep seated lesions
• percuss 4 posts on the back and on the right middle post for the lower right lobe
• patient seated with arms crossed in front of chest

Question 20

Flat sound

Answer 20

• soft, high pitch, short duration

- ex) thigh

Question 21

Dull sound

Answer 21

• medium intensity, medium pitch, medium duration

- ex) liver

Question 22

Resonant sound

Answer 22

• loud intensity, low pitch, long duration

- ex) healthy lung

Question 23

Hyperresonant sound

Answer 23

• very loud, lower pitch, longer duration

- ex) usually none

Question 24

Tympanic sound

Answer 24

• loud intensity, lower pitch, longer duration

- ex) gastric air bubble or puffed out cheek

Question 25

When does dullness replace resonance?

Answer 25

when fluid or solid tissue replaces air containing lung or occupies space beneath percussing fingers - lobar pneumonia - pleural accumulations

Question 26

Generalized hyperresonance

Answer 26

- hyper inflated lungs - COPD/emphysema - asthma

Question 27

Unilateral hyperresonance

Answer 27

- large pneumothorax | - large air filled bulla in lung

Question 28

Diaphragmatic Excursion

Answer 28

- determine distance between level of dullness on full expiration and level of dullness on full inspiration by progressive percussion down from resonance to dullness - normal excursion = 3-5.5 cm - dullness at a higher level than expected suggests a pleural effusion or a high diaphragm (atelectasis or phrenic nerve paralysis)

Question 29

Vesicular Breath Sound

Answer 29

- soft and low pitched - heard through inspiration and about 1/3 of expiration - heard over most of lungs

Question 30

Bronchovesicular sound

Answer 30

- intermediate in intensity and pitch - heard equally in inspiration and expiration - heard best in 1st and 2nd interspaces anteriorly and between the scapulae posteriorly

Question 31

Bronchial

Answer 31

- loud and high pitched - expiratory sounds heard longer than inspiratory - heard over manubrium

Question 32

Tracheal sound

Answer 32

- very loud and high pitched - heard equally in inspiration and expiration - heard best over trachea in neck

Question 33

Crackles

Answer 33

- discontinuous, intermittenet, nonmusical - fine: soft, high pitched, brief - coarse: louder, lower pitch, brief - timing in respiratory cycle - seen in pneumonia, fibrosis, early heart failure, bronchitis, bronchiectasis

Question 34

Wheezes

Answer 34

- continuous, musical quality, prolonged - relatively high pitched - suggest narrowed airways (asthma, COPD, bronchitis, heart failure)

Question 35

Rhonchi

Answer 35

- relatively low pitched, snoring quality | - suggest secretions in large airways

Question 36

Stridor

Answer 36

- high pitched wheeze that is entirely or predominantly inspiratory - often louder in neck than over chest wall - indicated partial obstruction of larynx or trachea (medical emergency)

Question 37

Pleural friction rub

Answer 37

- inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction - sounds like cracking, usually during expiration - usually confined to small area of the chest wall

Question 38

Bronchophony

Answer 38

spoken words become louder and clearer | indicates consolidation

Question 39

Egophony

Answer 39

"ee" sounds like "A" | pneumonia

Question 40

Whispered Pectoriloquy

Answer 40

whispers head louder and clearer during auscultation