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115 Cards in this Set
- Front
- Back
the inferior tip of the scapula usually lies at what rib/interspace
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7th
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when the neck is flexed forward what vertebra is most prominent
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C7
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how many lobes does the right lung have? the left?
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3, 2
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the lower border of the lung crosses the __th rib at the midclavicular line and the __th rib at the midaxillary line
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6th, 8th
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the trachea bifurcates into its mainstem bronchi at the _____ anteriorly and the ___ spinous process posteriorly
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sternal angle, T4
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the _____ pleura cover the outer surface of the lung while the ____pleura line the inner rib cage and upper surface of the diaphragm
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visceral, parietal
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when laying supine, breathing movements are more visible in the ______ and when sitting they are more visible in the ____
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abdomen, thorax
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the ____ fissure divides the lungs in half and can be estimated by running a string from ___ to ____
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oblique, T3 spinous process, 6th rib at the midclavicular line
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the right lung has a _____ fissure that runs close to the ____ and meets the oblique fissure in the _____ line near the _____
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horizontal, 4th rib, midaxillary, 5th rib
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the ____ lungs and thorax should be inspected with the patient sitting
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posterior
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the ____ lungs and thorax should be inspected with the patient laying supine
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anterior
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a normal resting adult breathes how many times per minute?
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14-20
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cyanosis signals ____
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hypoxia
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clubbing of the nails is seen in ___
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lung abscesses or malignancy and congenital heart disease
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stridor is ____ and is a sign of ____
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a high-pitched wheeze, and ominous sign of airway obstruction in the larynx or trachea
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inspiratory contraction of the sternocleidomastoids at rest signals...
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severe difficulty breathing
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lateral displacement of the trachea during inspiration signals...
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pneumothorax, pleural effusion or atelectasis
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Anteroposterior (AP) diameter of the chest may increase in....
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chronic obstructive pulmonary disease (COPD)
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T/F in a normal adult, the lateral diameter of the thorax is smaller than the anteroposterior diameter?
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False
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funnel chest is also known as...
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pectus excavatum
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funnel chest leads to compression of the heart and great vessels which may cause...
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murmurs
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an increased anteroposterior chest diameter is called
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barrel chest
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barrel chest shape is normal in what phases of life?
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during infancy and often accompanies normal aging and COPD
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pigeon chest is AKA
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pectus carinatum
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the sternum is displaced anteriorly, increasing AP diameter and costal cartilages adjacent to the protruding sternum are depressed in...
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pigeon chest
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multiple rib fractures may result in paradoxical movements of the thorax called...
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traumatic flail chest
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name the condition where on inspiration the injured area caves inward and on expiration it moves outward
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traumatic flail chest
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thoracic kyphoscoliosis
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abnormal spinal curvatures and vertebral rotation deform the chest in...
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this distortion of the underlying lungs may make interpretation of lung findings very difficult
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thoracic kyphoscoliosis
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abnormal retraction of the interspaces during inspiration is seen in these conditions and in the ____ interspaces
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severe asthma, COPD, or upper airway obstruction, lower
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unilateral impairment or lagging of respiratory movements suggests...
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disease of the underlying lung or pleura
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intercostal tenderness upon palpation indicates...
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inflamed pleura
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T/F bruises are normally found over a fractured rib?
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true
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what is a sinus tract on the chest?
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blind, imflammatory, tubelike structure opening onto the skin
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sinus tracts usually indicate ...
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infection of the underlying pleura and lung (as in tuberculosis and actinomycosis)
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causes of unilateral decrease or delay in chest expansion include...
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chronic fibrotic disease of the underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain with associated splinting and unilateral bronchial obstruction
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fremitus is decreased or absent when...
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voice is soft or transmission of vibrations from the larynx to the surface of the chest is impeded
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causes of decreased tactile fremitus include...
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obstructed bronchus, COPD, separation of the pleural surfaces by fluid (pleural effusion), fibrosis (pleural thickening), air (pneumothorax), infiltrating tumor, or very thick chest wall
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percussion helps establish whether a underlying tissues are .... and penetrates about ____ cm.
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air-filled, fluid-filled or solid; 5-7
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the finger that is hyperextended and hit during percussion is called the ....
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pleximeter finger
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the finger that taps the other finger in contact with the body is caled the...
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plexor finger
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t/f the other fingers of the hand should be touching the pt during percussion
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false
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to create a louder percussion sound you should increase the pressure you apply on the _____ finger
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pleximeter
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the normal percussion note for the lungs is...
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resonant
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normal percussion note for the liver is..
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dull
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which percussion note is not found normally in the body
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hyperresonance
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what percussion note would be found in over a gastric air bubble?
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tympany
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what percussion note is normal for the thigh?
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flat
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_____ replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers
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dullness
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dullness would replace the normal lung sound of resonance in what conditions?
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lobar pneumonia (alveoli fill with fluid and blood cells, pleural effusion (pleural accumulations of serous fluid), blood (hemothorax), pus (empyema), fibrous tissue or tumor
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generalized hyperresonance may be heard over the ______ lungs of _____
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overinflated, emphysema or asthma
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unilateral hyperresonance suggests...
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large pneumothorax or possibly a large air-filled bulla in the lung
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what area of the posterior chest do you not percuss?
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over the scapulae
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an abnormally high diaphragm level suggests...
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pleural effusion, or a high diaphragm as in atelectasis or diaphragmatic paralysis
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general hyperresonance would be heard over _______ lungs, as in _______
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hyperinflated; emphysema or asthma
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unilateral hyperresonance sugests....
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large pneumothorax or possibly a large air-filled bulla in the lung
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abnormally high diaphragm suggests...
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pleural effusion, or atelectasis or diaphragmatic paralysis
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the normal extent of diaphragmatic excursion is ...
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5-6 cm
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what should you do eliminate sounds made by hair during auscultation?
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press harder or wet the hair
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t/f a cold or tense pt can create muscle contraction sounds that can be heard during auscultation?
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true
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what breath sounds are soft and low pitched, heard over most of both lungs?
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vesicular
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____ breath sounds have inspiratory sounds that last longer than expiratory and are continuous from insp. to exp.
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vesicular
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broncho-vesicular breath sounds are heard where and sound like what?
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heard in the 1st and 2nd interspaces anteriorly and between the scapulae; inspiratory/expiratory sounds are equal with a silent interval between; intermediate intensity and pitch
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these breath sounds are heard over the manubrium
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bronchial
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_____ breath sounds are loud, high pitched and expiratory sounds last longer than inspiratory
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bronchial
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these breath sounds are very loud, high, heard over the trachea and insp. and exp. are about equal
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tracheal
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***know the chart on p. 259
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just do it
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breath sounds may be _____ when air flow is decreased, as in obstructive lung disease or muscular weakness
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decreased
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a gap between inspiratory and expiratory breath sounds suggests.....
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bronchial breath sounds
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if bronchovesicular or bronchial breath sounds are heard in locations distant from normal suspect...
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that air-filled lung has been replaced by fluid-filled/solid lung tissue
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in lobar pneumonia the alveoli fill with fluid and blood cells in a process called...
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(lobar) consolidation
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in a normal air-filled lung the predominant breath sound is...
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vesicular
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in a normal air-filled lung spoken words sound...and "ee" is heard as .... and tactile fremitus is....
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muffled, "ee", normal
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in an airless lung (i.e. lobar pneumonia) the predominant breath sound is...
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bronchial or bronchovesicular over involved area
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in an airless lung (i.e. lobar pneumonia)spoken and whipered words are.... and "ee" is heard as .... while tactile fremitus is...
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louder/clearer, "ay", increased
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bronchophony is...
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when spoken words sound louder during auscultation due to an airless lung
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egophony is...
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"ee" to "ay" changes in auscultation
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whispered pectoriloquy is...
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when whispered words sound louder and clearer during auscultation
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crackles may be due to ...
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abnormalities of the lungs (esp. pneumonia, fibrosis, early congestive heart failure) or of the airways (bronchitis, bronchiectasis)
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wheezes suggest...
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narrowed airways (as in asthma, COPD, or bronchitis)
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rhonchi suggest...
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secretions in large airways
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crackles are also called
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rales
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crackles sound like...
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discontinuous, intermittent, non-musical, brief
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fine crackles sound____ and last for ______ while coarse crackles sound ____ and last for ____
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soft, high-pitched; very brief; louder and lower-pitched; brief
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wheezes sound like
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continuous, more than a quarter second, relatively high-pitched with hissing/shrill quality
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rhonchi sound like
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relatively low-pitched with snoring quality
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2 explanations for crackles are
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1. result from tiny explosions when small airways pop open during inspiration
2. from air bubbles flowing through secretions/lightly closed airways |
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late inspiratory crackles
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may start in firt half of insp. but must continue into late insp., are usually fine, persist from breath to breath, appear first at bases of lungs
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causes of late insp. crackles
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interstitial lung disease (like fibrosis) and early congestive heart failure
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early insp. crackles appear ____ and sound like..
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soon after the start of insp. and do not continue into late insp.; often, not always coarse, and few in number
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early insp. crackles are caused by ______and associated with_____
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chronic bronchitis and asthma; expiratory crackles
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midinspiratory and expiratory crackles are heard in ... and may be associated with...
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bronchiectasis; wheezes and rhonchi
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wheezes occur when...
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air flows rapidly through bronchi that are narrowed nearly to the point of closure
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t/f wheezes are often audible at the mouth as well as through the chest wall
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true
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causes of wheezes generalized throughout the chest include...
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asthma, chronic bronchitis, COPD and congestive heart failure (cardiac asthma)
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in asthma, wheezes may be heard only during ____ or in both phases of resp. cycle
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expiration
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a persistent localized wheeze suggests...
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partial obstruction of a bronchus, as by a tumor or foreign body and may be insp., exp or both
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some times in severe obstructive pulmonary disease wheezing may stop due to...
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not enough air getting through to create sound, not an improvement
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a wheeze that is predominantly or entirely inspiratory is called...
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stridor
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t/f stridor does not require immediate attention
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false
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stridor is normally louder in the ____ than in the chest wall
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neck
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stridor indicates..
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a partial obstruction of the larynx or trachea
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pleural rubs are a creaking chest sound produced when...
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inflamed and roughened pleural surfaces grate against each other during resp.
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t/f pleural rubs are normally present in both phases of the resp. cycle
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true
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a mediastinal crunch is...
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series of precordial crackles synchronous with the heart beat NOT with respiration
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mediastinal crunch is also known as.... and is best heard in the ____ position
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hamman's sign; left lateral
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mediastinal crunch is due to ...
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mediastinal emphysema (pneumomediastinum)
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fine late inspiratory crackles that persist from breath to breath suggest...
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abnormal lung tissue
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clearing of crackles, wheezes or rhonchi after cough or position change suggests...
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inspissated (thickened by evaporation) secretions as in bronchitis or atelectasis
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tender pectoral muscles or costal cartilages tend to corroborate that chest pain has...
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musculoskeletal origin
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t/f the hyperresonance of COPD may totally replace cardiac dullness
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true
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dullness of right middle lobe pneumonia typically occurs behind the _____ and you may miss the abnormal percussion note if you don't displace the _____
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right breast
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a lung with COPD will displace the liver and diaphragm _____
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inferiorly
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a forced expiration test time of 6 seconds or more indicates...
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obstructive pulmonary disease
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how to id a fractured rib?
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place one hand on sternum and other on thoracic spine and squeeze, if pain is local (distant from your hand) then they got it
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