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