Question Answer
Define Palpation. The process whereby the examiner uses the hands to feel for body movement, lumps, masses, and skin characteristics.
True or False : Palpation is always deep but never light. False – Palpation can be either light or deep.
Define Percussion. Requires the examiner to place a finger firmly against a body part and strike that finger with a fingertip from the other hand.
Name the 5 percussion tones that are commonly recognized. Flat, dull, resonant, hyperressonant, and tympanic.
Describe a flat percussion note. It is soft, high pitched, and of short duration.
Describe a dull percussion note. Is of medium intensity, pitch, and duration.
Where can a dull percussion be heard? Over the liver or a tumor.
Describe a resonant note. It is loud, low in pitch, and has a long duration.
What type of tone will you hear when percussing over bone? Dull
Describe a hyperresonant percussion note? It is very loud, lower in pitch, longer in duration, and commonly heard over an emphysematous lung.
Describe a tympanic percussion note? It is loud and drumlike, with a high pitch.
What are the four techniques for chest assessment used by RT’s? Inspection, Palpation, Percussion, and Auscultation.
Is auscultation a visual or physical technique? It is most commonly a physical technique.
While performing a percussion assessment on a patient you hear a short and high pitch sound. What type of tone would you note in the patients chart? A flat tone.
Observing respiration pattern of a patient is done in what step of the chest assessment process? Inspection.
While palpating a patient you roll your fingers over the neck area and feel bubbles. The patient is in pain and you notice the neck is swollen. Based on this information what is your diagnosis? Subcutaneous Emphysema.
During auscultation what sound is heard over most normal lung fields? Vesicular
While doing your inspection on a patient you notice his chest bows out at the sternum, similar to that of a pigeon. You would chart this as what kind of abnormality? Pectus Carinatum
Scoliosis is most often seen during an inspection of a patient. What is scoliosis? It is a lateral curvature of the spine.
What are the lung sounds assessed by auscultation? Vesicular, Bronchovesicular, and Bronchial/tracheal (tubular)
Define tactile fremitus. The palpation of the vibrations of the chest wall as a patient speaks.
After doing a chest assessment your results are: Resonant percussion note, decreased fremitus, breathing includes a prolonged exhalation, and you can hear crackles. What condition of respiratory diseases would you chart based on the above information? Bronchitis
What are the adventitious breath sounds most commonly heard during auscultation? crackles, rhonchi, wheezes, stridor, and pleural friction rubs.
What does the use of accessory muscles imply? An increased work of breathing (WOB).
A patients level of consciousness is assessed using what scale? The Glasgow Coma Scale
If a patient is at a level 5 on the Ramsay Sedation Scale what type of responses will they have? Asleep, sluggish response to stimulus.
A score of 3 on the Glasgow Coma Scale suggest? Brain death
A score of 15 on the Glasgow Coma Scale suggest? Full consciousness.
What does P.E.A.R.L.A. stand for? Pupils Equal And Reacting to Light Accommodation
What is the first finding that suggest neurologic impairment? A decreasing level of consciousness.
Define Decerebrate Posturing. Resulting from a painful stimulus of a comatose patient with a low-level brain stem compression.
Define Decorticate Posturing. Results when a painful stimulus is applied to a comatose patient with a lesion in the mesencephalic region of the brain.
Can medication cause pupils to dilate or constrict? Yes
Name to main causes of pupillary dilation. Cerebral edema and brain stem compression.
When light hits normal pupils how do they react? They constrict.
True or False: Dilation of the pupils will occur in both eyes equally, but constriction of the pupils happens in one eye only. FALSE, Dilation and constriction happens in both eyes equally.
What are 3 main cardiac auscultation sounds you should listen for? Heart rate and rhythm, extra sounds, and murmurs.
True or False: Clubbing of fingers occurs with COP. FALSE, it can occur with lung tumors, bronchiectasis, cystic fibrosis, congenital heart disease, and liver / gastrointestinal disease. In some cases it is hereditary.
In what condition does the chest wall move outward on expiration and inward on inspiration? Flail Chest and Paradoxical Respiration.
Why do individuals in respiratory distress commonly exhibit nasal flaring? They are attempting to decrease the resistance to airflow through the nostrils.
Why may you see individuals with emphysema using pursed-lip breathing during the expiratory phase? They are trying to maintain airway patency and better control of expiratory flow.
A teenager that has been in a car accident is admitted to the hospital. The first thing you notice is that her right pupil is dilated and the left is constricted. What can you determine may be wrong with her from this? There may be a brain injury, increased cranial pressure (ICP), or some type of neurologic problem.
What is the purpose of measuring diaphragmatic excursion? To make sure the lungs are expanding equally.
Define stridor. It is a crowing sound commonly caused by inflammation and edema of the larynx and trachea.
What kind of sound can crackles be classified as? A discontinuous sound, meaning that they wax and wane during each respiratory cycle.
The chest wall over laying the heart is known as what? The Precordium
The cartilaginous structures lying between the ribs are the spaces used for auscultation and percussion. What is the correct term for these spaces? Interspaces
How are normal heart sounds classified? As S1 and S2
When you hear S1 (lub) what exactly is happening to the heart? The closure of the atrioventricular (mitral and tricuspid) valves.
The heart sound S2 is also known as what? Dub
Define a grade 1 cardiac murmur sound. Is very faint and may not be heard in all positions.
To describe the quality of a cardiac murmur what few words would you use? Blowing, rasping, harsh, coarse, grating, whistling, or musical.
What breath sound is most often heard in individuals with CHF (congestive heart failure)? Crackles (Rales)
Why does consolidation occur? The lung tissue that is normally aerated is “made solid” by filling with fluid, mucus, pus, or cellular debris.
Define the term Bronchophony. A voice sound that is elicited when the examiner auscultates over as area of suspected consolidation and asks the patient to say the words ninety-nine.
While you are auscultating for breath sounds you ask the patient to say ninety-nine. The words are clearly audible, what does this suggest? There is consolidation in the lungs, because normally this sound is muffled.
You ask a patient to say the letter “e” during your auscultation, and you hear the letter “a”. Why did you hear “a” instead of “e”? There is consolidation in the lungs.
A respiration pattern faster than 20 breaths per minute is clinically called what? Tachypnea
In children stridor is commonly associated with what? Croup
Asymmetry of lung expansion may be present with what conditions? Pneumothorax, atelectasis, lung resection, or main stem intubation.
Where should an examiner place their hands on a patient to exam for lung expansion? Examiner should place their thumbs along each coastal margin at the patients back.
What is the term used to describe diminished skin color accompanying anemia? Pallor
While examining a patient you notice plethora at the skin surface. Why would plethora occur and what can you assume the patients condition is? May occur with vasodilation in individuals who could be hypercapnic.
Where is jaundice first apparent in an individual? In the sclera of the eyes.
Define kyphosis. Forward curvature of the spine.
A 3 year old boy is walking on the tips of his toes and looks sway back. When you ask him to stand with his feet flat on the floor while standing up straight he can’t. What condition is this? Lordosis
An 80 year old women is having a hard time breathing. She has been diagnosed with Osteoporosis, and has a major forward curvature to her back. What condition associated with these details? Kyphosis
You are asked to do an auscultation on the posterior chest wall, where can you find the apex of the lungs? They extend above above the scapulae on both sides of the thorax. (Not on scapulae, listen between scapulae and spine)
Abnormalities of the thorax can be significant factors in what kinda of disease? Lung Disease
How many lobes does the right lung have? 3
How many lobes does the left lung have? 2
How many segments does each lung have? 10
Name the segments of the right upper lobe of the lung? Apical, posterior, and anterior
You over hear a Dr. say the word Lingula. You can assume he is talking about which lung? The left lung.
Where is the 4th intercostal space in a male? At the nipple.
What muscles are normally used for ventilation? Diaphragm and external intercostals
A combination of scoliosis and kyphosis is clinically called? Kyphoscoliosis
While doing palpation for tracheal positioning you notice the trachea is shifted. What can be the reasoning for this shift? A tension pneumothorax or massive atelectasis.
How many TRUE ribs does the normal human body have? 7
Which ribs are considered the FALSE ribs? Ribs 8-12
Which ribs are called the FLOATING ribs? Ribs 11 and 12.
Why will an examiner measure for jugular venous distention? Helps to detect pressure changes within the right atrium.
Using the Ramsay Sedation Scale you chart the patient’s response as responding to commands only. What level is this according to the scale? A level 3
What sound you listen for while performing a cardiac auscultation? Listen for rate and rhythm, extra heart sounds, and murmurs.
Where can extra heart sounds S3 and S4 be heard? Best heard at the left fifth intercostal space at the midclavicular line.
What conditions of skin color would you look for during your inspection of the patient? Cyanosis, Pallor, Plethora, and Jaundice.
A patient has a breathing rate lower than 12 breaths per min. the term for this is? Bradypnea
Define Platypnea. Difficulty breathing unless lying flat.
Define Orthopnea. When an individual must sit or stand in order to breath.
A patient tells you he is most comfortable sleeping in a chair. This is most likely associated with which breathing pattern? Orthopnea
What disease is often found with an Orthopnea breathing pattern? Chronic lung disease.
Cerebral disease and congestive heart failure individuals most often have what type of breathing pattern? Cheyne-Stokes breathing
What is the correct term for a pigeon-breasted sternum? Pectus Carinatum
Define Pectus Excavatum. It is depressed and deviated somewhat like a funnel. (A funnel shaped sternum.)
A tympanic tone has what kind of duration? Medium
During percussion how many blows should you use at each location? One or two blows.
During auscultation, stridor can be heard at what area of the body? Upper part. Larynx and trachea.
A fingers that appear full, fleshy, and vascular are termed? Clubbing of fingers
A yellowish skin color is associated with what condition? Jaundice
A blueish skin color is associated with what condition? Cyanosis
The midclavicular line can be found by locating which rib? It would be at the 6th rib
Question Answer
question 26 does not fit
Define Hypothermia?
What is the most common cause of hypothermia?
While listening to a patient’s posterior lung bases, you hear soft, muffled sounds occurring mainly during inspiration. What inference could you draw from this finding?
What is indicated by the activity of the accessory muscles of ventilation at rest?
While palpating the chest of the patient who repeats the words “ninety-nine”, there is an increased tactile fremitus over the left lower lobe. What could explain this finding? consolidation of the underlying lung tissues
While percussing a patient’s chest wall, you encounter an area that produces an abnormal increase in resonance. What could explain this finding?
Describe why you would find resonance during chest percussion?
Describe why you would find decreased resonance during chest percussions?
Describe why you would find increased resonance during chest percussions?
Describe what you would find during percussions, palpation, and auscultation with pneumonia, air in the plural space, and fluid in the pleural space.
The topographic term used to describe the center line of the body is: anatomical landmarks area of chest
The diaphragm contracts during inspiration
A normal pulse should feel: regular rhythm, strong and full
When taking a patient’s bloop pressure, the diagphragm of the stethescope is normally places over which arterty? brachial
When you record a blood pressure, the systolic pressure is written as which number? the top number between 95-140
When you use the palpation method to obtain a blood pressure, the measurement you obtain is the: indirectly
Describe signs that would indicate labored breathing?
Normal respirations for an adult should be between? 12-20 breaths per min
According to your text, normal adult heart rate is between; 60-100 beats per min
While observing a patient’s breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. which term would you use to describe this pattern? Cheyne-Stokes respiration
On a diagram identify the arteries where we can find pulses Carotid, brachial, radial, femoral,popliteal,dorsal pedal, posterial tibial
Question Answer
Hyporesonance tapping air increases fluid &solids decreasesFactorsPleural effusion, pulmonary edema, atelectasis,consolidations, pneumonectomy, pneumonia, pleural thickening.
Hyperesonance tapping air increases fluid & solids decreasesfactors: Pneumothorax, COPD, Emphysema, Asthma
Decrease Tactile Fremitis/ Touching/ Feeling Air + Fluid decreases, solids increaseFactors: Pleural effusions, pneumothorax, COPD, Emphysema, Pulmonary edema,pneumonectomy, Pleural thickening, Asthma
Increase Tactile Fremitis Touching/ FeelingAir+fluid decreasesSolids increaseFactors: Atelectasis, Pneumonia, Consolidations
Decrease Vocal Fremtis Air+Fluid decrease solid increaseFactors: Pleural Thickening, Pulmonary edema, Pneumothorax, COPD,Emphysema, Asthma, Pleural effusion, pneumonectomy
Increase Vocal Fremitis Air+Fluid decrease solid increaseFactors: Consolidations, Pneumonia,Atelectasis
Vocal Fremitis refers to the vibration created by the vocal cords during speech
tactile fremtis pt. state ninety nine, increase vibration, consolidation
Hyperresonance loud low pitched long duration produced over area where is more air less tissue
Hyporesonance Dullnes- medium intensity and pitched of short duration more tissue than airFlat- low amplitude and pitch over areas of more tissue than air
Question Answer
what are the 4 technique of assessment? ascultations, palpations, percussion and inspection
define inspection. casual observation to visual scrutiny of the patient
what is the palpation technique? process whereby the examiner uses the hands to feel for body movement , lumps, masses and skin characteristics. can be light or deep.
what is the percussion technique? where examiner places a finger against a body part and strike that finger with a fingertip from the other hand. the results can suggest normal tissues or typical sounds assoc. w/ abnormalities
what are the 5 percussion tones? flat, dull, resonant, hyperresonant, and tympanic
What are auscultations? most commonly used technique, includes listening to vital signs w/ a stethoscope places on bare skin.
define a flat percussion tone soft , high pitch and short duration. can be heard over the thigh
define a dull percussion tone medium intensity, pitch and duration. commonly heard over liver or tumor
define a resonant percussion tone loud intensity , low pitch and long duration. commonly heard over normal lung tissue
define a hyperressonant percussion tone very loud intensity, very low pitch and longer duration. commonly heard over emphysematous lung.
define a tympanic percussion tone loud intensity, high pitch and medium duration may be heard over gastric bubble
define tactile fremitus palpation of vibrations of the chest wall as the patient speaks.
what are the adventitous breath sounds commonly heard during ascultations? crackles, wheezing, ronchi, stridor, pleural friction rubs.
what does the use of accessory muscles imply? an increased work of breathing or diaphragm weakness
describe a barrel chest chest configuration in which the individual’s anteroposterior chest is equal to the lateral diameter
describe flail chest and paradoxical respirations. apperarnace of thorax w/multiple rib fractures, causing the chest wall to move outward on expiration and inward on inspiration
what is scoliosis? lateral curvature of the spine.
what is Kyphosis? forward curvature of the spine.
What is Lordosis? backward curvature of the spine
what is the purpose of measuring diaphragmatic excursion? to ensure that the lungs are expanding equally
define stridor a crowning sound commonly caused by inflammation and edema of the larynx and trachea
what are crackles? discontinuous sounds heard at end of inspiration, usually associated w/ the accumulation of fluid.
how many lobes are in the right and left lung? R-3, L-2
how many segments are in each lung? 10
define pectus escavatum funnel shape sternum
term for pigeon breasted sternum pectus carinatum
fingers that appear full, fleshy and vascular are termed? clubbing of the fingers
what are the lung sounds assessed during ascultations? vesicular, bronchovesicular, bronchial/tracheal
describe characteristics of vesicular sounds low pitch, soft and short expirations; heard over most lung fields.
describe characteristics of bronchovesicular sounds medium pitch , expirations equaling inspirations; hear over main bronchus
describe characteristics of bronchial/tracheal sounds high pitch, loud and long expirations; heard only over trachea
describe decorticate posturing extension , internal rotation of arms and extending legs
describe decerebrate posturing flexing of arms at the elbow and wrists
what is the RSS & RASS and what does it assess? Richmond sedation scale & Richmond agitation sedation scale , measures the level of sedation in a patient
a patients level of consciousness is assessed using what scale Glasgow Coma Scale
describe the sequence for lung field ascultaions the examiner should first assess the apex of the lungs, listening to one side of the thorax and then moving to the corresponding area from posterior , anterior and laterial views.
describe ronchi. deep, rumbling sounds that are more pronounced on expirations
describe wheezing high pitched whistling caused by narrowing of he airways.
when are pleural friction rubs produced? when visceral ans parietal pleura become inflammed and no longer glide silently against eachother.
3 ways are pupils can change. dilation, constriction and unequal ( constricted and dilated)
how do we measure delirium ? CAM ( confusion assessment method) score.