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Clinical Skills Resp

A -- Clinical Skills Chest and Lungs

QuestionAnswer
The tonguelike projection known as the lingula is an inferior part of what lung lobe? the left upper lobe
The horizontal fissue divides the right upper portion of the lung into upper and middle lobes at what level anteriorly and mid-axillarily? 4th rib anteriorly 5th rib in the axilla
Upon forced expiration the lungs rise to what vertebral level? T9
What are the dimensions of the trachea (length and diameter)? 11cm long 2 cm in diameter
At what anatomical level does the trachea divide into right and left bronchi? T4-T5 just below the manubriosternal joint
Why is the right bronchus more susceptible to aspiration? it is shorter, wider and more vertical
The terminal unit of respiration, that consists of bronchioles, alveolar ducts, alveolar sacs, and alveoli is known as what? acinus
The level of this in the blood, primarily controls rate and depth of respirations. carbon dioxide
What is the sequence of steps in the examination of the chest and lungs? inspection, palpation, percussion, auscultation
Clinical findings of dullness on percussion of the lungs, absent breath sounds, and abscent tactile fremitus would likely indicate what condition? pleural effusion
Clinical findings of dullness on percussion, tubular breath sounds, and increased tactile fremitus may be indicative of? lobar pneumonia
This is characterised by increased AP diameter of the chest with ribs more horizontal, spine somewhat kyphotic, and a prominent sternal angle. barrel chest
Structural problem of chest where there is a prominent sternal protrusion? pectus carinatum
Structural problem of chest where there is an indentation of the lower sternum above the xiphoid process? pectus excavatum
Difficult and labored breathing with shortness of breath.... dyspnea
Shortness of breath that begins or increases when the patient is lying down... orthopnea
A sudden onset of shortness of breath after a period of sleep, sitting upright is helpful.. paraoxysmal nocturnal dyspnea
Dyspnea that increases when sitting upright.. platypnea
A respiratory rate of greater than 20 breaths per minute (in adult) that is persistent... tachypnea
Respirations that are greater than 20 per minute and increased in depth of respiration.. hyperpnea
Respiratory rate slower than 12 per minute (in adult) bradypnea
This respiratory pattern is rapid, deep, and labored, and is the eponymic description applied to respiratory effort associated with metabolic acidosis. Kussmal breathing
This respiratory pattern is characterised by abnormally shallow respirations (e.g. when pleuritic pain limits excursion) hypopnea
A regular periodic pattern of breathing, with intervals of apnea followed by crescendo/decrescendo seqence of respiration. Cheyne-Stokes
This is increasing difficulty in expelling air from lungs, respiration rate becomes increased and effort more shallow. air trapping
Irregular respirations varying in depth and interrupted by intervals of apnea, but lacking the repetitive pattern of periodic respiration. biot respirations
Respiratory pattern with significant disorganization with irregular and varying depths of respiration. ataxic respirations
This respiratory abnormal action suggests an obstruction to inspiration at any point in the respiratory tract; as intrapleural pressure becomes increasingly negative, the musculature "pulls back" in an effort to overcome blockage. retractions
When an obstruction is high in the respiratory tree (with tracheal and laryngeal involvement) this characteristic sound is heard. stridor
Seeing unilateral retractions without involvement of substernal notch is indicative of what? foreign body in one or the other of the bronchi
This crackly or crinkly sensation, which can be both palpated and heard indicates air in the subcutaneous tissue from a rupture somwhere in the respiratory system or by infectin with a gas producing organism. crepitus
A palpable, coarse, grating vibration, usually on inspiration suggests this, caused by inflammation of the pleural surfaces. pleural friction rub
Explain how to evaluate thoracic expansion, posteriorly, during palpation. Thumbs along spinous processed at the level of the 10th rib, with palms slightly in contact with the posteriolateral surfaces. Watch thumbs diverge during quiet and deep inspiration.
Where should thumbs and palms be placed during anterior palpation to assess thoracic expansion for symmetry? thumbs on costal margin and xiphoid process, palms touching the anterolateral chest
This is the palpable vibration of the chest wall that results from speech or other verbalization. Tactile fremitus
Where is fremitus best assessed on the chest? parasternally at the level of the 2nd intercostal space, at the level of the bifurcation of the bronchi.
Under what conditions would you expect to see decreased fremitus? emphysema, pleural thickening or effusion, massive pulmonay edema, or bronchial obstruction
Under what conditions would you expect to see increased fremitus? the presence of fluids or a solid mass
Hyperresonance may be indicative of what conditions? emphysema, pneumothorax, or asthma
Dullness of flatness on percusion may be associated with? atelectasis, pleural effusion, pneumothorax, or asthma
Descent of diaphagmatic excursion may be limited by what conditions? pulmonary, as a result of emphysema, abdominal, as in massive ascites or tumor, or superficial pain.
What is the normal diaphragmatic excursion? 3-5cm
Total or partial collapse of the lung or a congenital condition characterized by the incomplete expansion of the lungs at birth atelectasis
The best place to listen to the middle lobe is in this location? axilla
This type of breath sound is low-pitched, low-intensity sound heard over normal lung tissue? vesicular
These sounds are heard over the major bronchi and are typically moderate in pitch and intensity. bronchovesicular
These sounds are high in pitch and intensity and are usually heard over the trachea. bronchial
sweet and fruity breath usually seen in what condition. diabetic ketoacidosis
Fishy, stale breath usually seen in what conditions. uremia (trimethylamines)
Ammonia-like usually seen in what conditions uremia (ammonia)
musty fish, clover breath usually seen in what conditions hepatic failure, portal vein thrombosis, protacaval shunts
foul putrid breath usually seen in what conditions – nasal/sinus pathology: infection, foreign body; respiratory infection: empyema, lung abscess, bronchiectasis.
halitosis usually seen in what conditions. tonsilitis, gingivitis, respiratory infection
Cinnamon breath usually seen in what condition. Pulmonary tuberculosis
A displaced trachea noted on palpation may be indicative of what conditions? atelectasis, enlarged thyroid, significant parenchymal and/or pleural fibrosis
This sound of percussion is loud, low pitch, long, and hollow resonant
This sound of percussion is soft, high pitch, short duration, and very dull flat
This sound of percussion is medium intensity, medium to high pitch, medium duration, and has a dull thud quality. dull
This sound of percussion is loud, high pitched, medium duration, and drumlike. tympanic
This sound of percussion is very loud, very loud pitch, long duration, and booms at you. hyperresonant
This adventitious breath sound is characterised by high-pitched, discrete, discontinuous crackling. fine crackles
Persistent or progressive dilation of the bronchi or bronchioles as a consequence of inflammatory disease, obstruction, or congenital abnormality. bronchiectasis
This adventitious breath sound is characterized by medium pitch, moist crackling sound heard during midstage of inspiration. Medium crackles
This adventitious breath sound is characterized by loud, bubbly sound heard inspiration. Coarse crackles
This is a loud, low, coarse sounds like a snore most often on expiration; coughing may clear. Rhonchi
This musical like noise sounding like a squeak is most often heard during both inspiration and expiration; usually louder on expiration. Wheeze
This is a dry, rubbing, or grating sound, usually caused by inflammatin of pleural surfaces; heard during both inspiration and expiration. pleural friction rub
This is defined by greater clarity and increased loudness of spoken sounds Bronchophony
More extreme bronchophony, where even a whisper can be heard clearly upon ausculation. Whispered pectoriloquy
When intensity of spoken word is increased upon ausculation and the sound has a nasal quality. egophony
Vocal resonance upon ausculation is decreased in what type on conditions? those where there is blockage of the respiratory tree for any reason
A regular, paroxysmal cough followed an inspiratory whoop is most characteristic of what condition? pertussis
If a patient presents with a cough producing large amounts of blood or clotted blood one should suspect what life threatening condition? And what 2 other condition may produce this? infarction of the lung; Tuberculous cavity, carinoma
Created by: justice2