Question Answer
Atelectasis (collapsed alveoli) Hypo-resonance, trachea shifts towards, unilateral chest expansion, increased tactile fremitus, crackles/rales BS on I
Pleural Effusion (fluid in pleural cavity) trachea moves towards, hypo-resonance dull, unilateral chest expansion, decreased tactile fremitus, pleural friction rub on I & E (clicking)
Massive Atelectasis (collapsed lung) trachea moves away, hypo- resonance-flat
Large Pleural Effusion Trachea moves away, Hypo-resonance flat.
Pneumothorax Trachea shifting moves toward, hyper-resonance, unilateral chest expansion, decreased tactile fremitus, diminished breath sounds
tension Pneumothorax trachea shifts away, hyperresonance tympany
spontaneous pneumothorax trachea shifts towards
asthma hyperresonance, rhonchi on E and wheeze on E
Emphysema hyperresonance, decreased tactile fremitus, crackle/rale breath sounds on inspiration, rhonchi on E
Airway constriction strider (barking) on I
COPD Hyperresonance, bilateral chest expansion, decreased tactile fremitus, (end stage = diminished breath sounds)
CHF (congestive heart failure) wheeze on E
Neuromuscular bilateral chest expansion
pulmonary fibrosis crackles/rales bs on I
air fill stomach hyperresonance
consolidation hyporesonance-dullness, unilateral chest expansion, increased tactile fremitus.
pleural thickening hyporesonance-dullness
pneumonia increased tactile fremitus, crackles/rales on I
fluid decreased tactile fremitus
pulmonary edema hyporesonance-dullness, crackles/rales on I
lung mass increased tactile fremitus.
pleurisy pleural friction rub, painful clicking on I & E
Mucus plug rhonchi (rumble on E that clears with cough)
epiglottis strider-barking on I
croup strider barking on I
stenosis rhonchi (rumble on E)
post extubation strider (barking on I)
pneumonectomy hyporesonance-flatness
Questions Answer
What does a PT look like if they are cachectic/ wasted in appearance
Increased A-P chest diameter (barrel chested) is seen in PT with what problem? chronic air trapping
When doing a PFT and the PT cannot stand to get an accurate height, what can you do? Measure the PT arm span
Hyperpnea – what does it sound like and what could it mean? increased rate and depth of breathing (exercise breaths) It may be associated with metabolic disturbances or disorders.
Kussmaul breathing is associated with what problems? diabetic ketoacidosis or metabolic acidosis
Biots breathing is similar to hyperpnea, except Biots has unpredictable periods of _______? apnea…associated with CNS problems
What is apneustic breathing? prolonged gasping inspirations followed by short insufficient expirations
Venous distension associated with what problem? CHF and COPD
Diaphoresis could present with what problems? CHF, TB, Myocardial infarction (order 12 lead ECG) feverish
What is ascites? Accumulation of fluid in abdomen generally caused by liver failure.
If a PT says “e”, and it sounds like “a”, (egophony), what could be the problem? consolidation of lung tissue (pneumonia like condition)
Pt has a unilateral wheeze, how would you treat it? rigid bronchoscope…. could be foreign body obstruction or mass
PT has bilateral wheeze, how would you treat it? chest x-ray, then bronchodilator
Rhonchi (coarse rales) can often be remedied by _____ Secretions in large airways can be suctioned.
Rales (crackles) are _______. Secretions in the middle sized airways…treat with chest physiotherapy, including postural drainage
Moist crepitant rales indicate________ CHF … treat with diuresis
Fine crackles or rales indicate________ atelectasis…treat with hyperinflation therapy
What is pulsus paradoxus and what is it associated with? BP rises and falls during inspiratory and expiratory efforts…associated with significant air-trapping such as severe asthma
Spontaneous Tidal volume ( VT ) should be at least______ 5ml/kg….Less than 5 they need ventilator assistance…less than 3 EMERGENCY!!!
S3 and S4 heart sounds are called gallop sounds and indicate cardiac dysfunction…..need echocardiogram
What is Jim’s pack years if he has smoked 20 years, 4 packs daily??? 80
What is orthopnea and what could it mean? inability to sleep flat ….related to fluid problems…CHF
The axis (general angle the electricity flows through the heart) may deviate for 2 reasons. What are they? Hypertrophy (heart size has increased) and infarction (tissue is dead)
Myocardial ischemia means….. there is a current lack of oxygen (blood flow) to the cardiac muscle…will show flipped T wave on ECG
On PFT..if SVC is lower than FVC value, what should happen PT needs to take test again
during a PFT, the SVC and FVC values of less than 80% means the PT probably has restrictive disease
Question Answer
State the pulse rate increase or % increase in pulse rate at which therapy should be stopped when it increases by 20 or by 20%
What is the best position for chest auscultation Fowlers
5 important reasons for chest auscultation 1. access for pt. for adequate ventilation 2. identify areas of lung that are abnormal 3. identify abnormal sounds 4. assess effectiveness therapy 5. assess adverse reactions to therapy and change in condition
When should you perform chest auscultation before, during, and after therapy
3 normal breath sounds 1. bronchial 2. bronchial vesicular 3. vesicular
Where is the bronchial breath sounds over trachea
Where is the bronchial vesicular breath sounds upper half of sternum
Where is the vesicular breath sounds lung peripheral area (majority of lung parenchyma)
Why is deep breathing helpful during auscultation normal breath is soft and quiet
Why do you listen on the same location on opposite sides of the chest during ausultation to compare
Define adventitious sounds abnormal or foreign
What sound effect does fluid have on the chest wall dull/flat decreased resonance
What sound effect does air have on the chest wall tympany increased resonance
tactile fremitus sense of vibration in hand when it is positioned on the chest wall and patient speaks (99) (cat purring)
What diseases increase vibration with tactile fremitus (solid tissue) pneumonia or tumor
What diseases decrease vibrations with tactile fremitus obesity, pneumothorax, fluid, muscular, emphysema
Tymphany MUSICAL DRUM LIKE, airfilled stomach, abnormal if found in chest, (Emphysema, and pneumothorax)
flatness dull, SHORT DEAD SOUND (large amount of solid material)
dullness less dense, THUD, (pneumonia -consolidation from atelectasis)
resonance normal lung tissue, easily heard low pitch sound
hyperresonance low in pitch, BOOMING, heard in children
How to check level of consciousness call by name, gently touch, shake, squeeze trapezius muscle, pressure on bone above eye, pressure of base of fingernail, rub sternum with knuckles,
Sensorium Ask time, place, and person if asked 3 questions you can mark oriented x 3