Chest and Lung

pleural friction rub

continuous, dry grating sound caused by inflammation of pleural surfaces and loss of lubricating pleural fluid

Which finding is considered unusual for a newborn?

coughing

Bronchovisicular sounds are heard

over the sternum

Excessive non-purulent fluid in the pleural space

pleural effusion

tracheomalacia

a "floppiness" or lack of rigidity of the trachea or airway

Cheyne-Stokes respiration

a regular periodic pattern of breathing, with intervals of apnea followed by a crescendo-decrescendo sequence of respiration; often associated with serious illnesses.

wheeze

(sibilant wheeze) musical noise sounding similar to a squeak; most often heard continuously during inspiration or expiration; usually louder during expiration.

Crackles

abnormal lung sounds, more often heard on inspiration' characterized by discrete discontinuous sounds; also called rales.

To diagnosis Bronchiatis, how many months out of two years must someone have a cough?

3 months

The examiner should expect the ratio of respiratory rate to heart rate in the adult to be approximately:

1:4

Apnea

absence of spontaneous respiration; it may have it's origin in the respiratory system or a variety of central nervous system and cardiac abnormality

Which of the following patients demonstrates the highest risk factor for respiratory disability?

A patient with parapalegia

pectoriloquy

A whisper that can be clearly heard through the stethoscope; associated with consolidation of lungs.

As the chest of a newborn is examined, bowel sounds are auscultated in the chest. Which of the following best describes the significance of this finding?

Abnormal and possibly indicating a diaphragmatic hernia

Airway reactivity triggered by allergens, anxiety or upper respiratory infection

Asthma

In an older adult, which finding can occur in the absence of disease as a result of age related changes of the chest or lungs?

Barrel Chest

Pulmonary finding with Inspection

Biot Respirations - seen with ^ICP Cheyne-Stokes Resp - associated with serious illness/death Barrel Chest - Emphysema or COPD Dyspnea - SOB Kussmaul Breathing - Rapid breathing with Metabolic Acidosis

Rhonchi in the

Bronchi - more wheezing @ large airways, continuous caused from inflammation. Think Asthma

Chronic dilation of the bronchi or bronchioles caused by pulmonary infection

Bronchiectasis

Inflammation of the mucous membranes of the bronchial tubes

Bronchitis

In which of the following conditions should the examiner expect the costal angle to be greater than 90 degrees?

COPD

Hamman's sign

Crunching sound on auscultation with mediastinal emphysema; a variety of sounds include loud crackles, clicking and gurgling sounds heard over the precordium; they are synchronous with the heartbeat and not particularly so with respiration.

Autosomal recessive disorder of the exocrine glands in children younger than 5 yrs of age

Cystic Fibrosis

Which examination finding is consistent with emphysema?

Decreased tactile fremitus

Pulmonary findings with Percussion

Dullness - think pneumonia, atelectasis, plural effusion or asthma Hyper-resonance - hyperinflation, emphysema, pneumothorax or asthma Tympany - air in the chest, such as may occur with pneumothorax. Diaphragmatic excursion - measurement usually 3-5 cm

Purulent exudate collected in the pleural spaces

Empyema

During percussion the patient is asked "Fold your arms in front of you" in order to ?

Expose maximum lung area

Symtoms of TB

Fever Night Sweats Cough Hemoptosis Weight loss

Stidor

High pitched, piercing sound heard during inspiration; it is the result of an obstruction high in the respiratory tree

A newborn infant has a small chest to head size ratio. This finding is usually associated with

Intrauterine growth retardation

What are concerns and questions you should ask if there is concern of environmental allergies?

Is there carpet? Is there forced air? Central air? Pets? Smoke? Blinds or curtains? What's been a new exposure? Do you use mattress and pillow covers?

A mother tells the examiner that her 2 year old child has a cough that sounds just like a bark, given this history, what other finding should the examiner anticipate during respiratory examination?

Labored breathing and inspiratory stridor

Which of the following findings may indicate a pulmonary infection?

Malodorous breath

What indicates respiratory distress in an infant or toddler?

Observation of sternal retractions with breathing

Pack year history

PPD x # of years smoked (ie 2PPD x30 years = 60 or 1/2 PPD x10 years=5)

Which of the following examination techniques is not typically done when examining the chest and lungs of a new born?

Percussion

Inflammatory process involving the visceral and parietal pleura

Pleurisy

Infection of the pulmonary parenchyma

Pneumonia

Embolic occlusion of the pulmonary arteries

Pulmonary embolism

Rhonci

Sonorous wheeze, loud, low course sounds similar to the snore; most often heard continuously during inspiration or expiration

Vocal Resonance

Sound of the spoken word as transmitted through the lung fields; usually muffled and indistinct in quality.

Which symptoms indicate the need for immediate intervention because of sever upper airway obstruction?

Stridor Cyanosis Retraction Barking cough

Pulmonary findings with Palpation

Tactile Fremitus - if decreased think excess air in lungs - emphysema. If increased think solid mass or consolidation. Vibration Tracheal Tug - think atelectasis, mass or pneumothorax Crepitus - air in the SQ tissue from rupture i the resp system or by infection with gas producing organism

Rales in the

Tails - crackles @ the alveolus, discontinuous sound- fluid related - think fluid overload

A healthcare professional is examining the chest of a 22 year old woman, who is 8 months pregnant. The patient has a wide thoracic cage. Which of the following best explains this finding?

This is considered a normal finding with advanced pregnancy.

In addition to severe respiratory distress, which of the following findings may be indicative of a pneumothorax with mediastinal shift?

Tracheal deviation away from midline position

chronic infectious disease beginning in the lung with the tubercle bacillus

Tuberculosis

Pulmonary findings with Auscultation

Vesicular - heard over healthy lung tissue over most of lung fields (WELL) Bronchial - normal sounds over trachea (WELL) Bronchovesicular - normal over bronchus area and RUP lung field (WELL) Rhonchi - think mucus accumulation in trachea or large bronchi (ILL) - Bronchitis, Asthma Wheezes - think inflammation in the bronchus (ILL) - Asthma Bronchophony - is the abnormal transmission of sounds from the lungs or bronchi. "Increased lung sounds" - think pneumonia or consolidation. Crackles - heard during inspiration, not cleared by cough. (RALES IN THE TAILS) - fluid overload

Angle of Louis (sternal angle)

What is a good marker for the 2nd intercostal space?

The patient tells the examiner, "I have been coughing up a lot of yellowish green phlegm." The examiner should suspect --

bacterial pneumonia

Kussmaul breathing

deep and usually rapid respiration. The eponym applied to the respiratory effort associated with metabolic acidosis.

Bronchophony

greater clarity and increased loudness of spoken sounds

Sounds associated with mediastinal emphysema are synchronous with:

heartbeat

Fine Crackles

high-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough

Egophony

increased intensity of spoken sound with accompanying nasal quality

Biot Respirations

irregular respiration varying in depth and interrupted by intervals of apnea that lacks repetitive pattern: associated with increased inter-cranial pressure, respiratory compromise, or brain damage at the level of the medulla

course crackels

loud, bubbly noise heard during inspiration not cleared by a cough

vesicular breath sounds

low pitched soft and short expiration heard over most lung fields.

Medium crackles

lower, more moist sound heard during the middle stage of inspiration and not cleared by a cough

Hamman sign can best be heard when the patient is--

lying on the left side

To best visualize subtle retractions on a patient the examiner should ensure...

that the light source angles toward the patient.

costal angle

the angle between the ribs at the costal margins

bronchovesicular breath sounds

typically moderate pitch and intensity heard over major bronchi