Posterior And Anterior Chest Assessment

Front 1

consists of the nasophaynx, oropharynx, laryngopharynx, and larynx

Back 1

upper airway

Front 2

consists of the trachea, bronchi, bronchioles, and alveoli

Back 2

lower airway

Front 3

How many lobes does the right lung have?

Back 3

3

Front 4

How many lobes does the left lung have?

Back 4

2

Front 5

How do women breathe?

Back 5

thoracically

Front 6

How do men and infants breathe?

Back 6

abdominally

Front 7

abnormality of the chest characterized by a rounded appearance, horizontal ribs, slight kyphosis of the thorax, and a prominent sternal angle

the chest appears in constant inspiration

Ex. infant's chest or an adult with pulmonary disease

Back 7

barrel chest

Front 8

abnormality of the chest in which the sternum projects foward

there is an increase in the AP diameter

Back 8

pectus carinatum (pigeon chest)

Front 9

abnormality of the chest in which the sternum points posteriorly and may cause abnormal pressure on the heart

if severe, it can cause respiratory failure

Back 9

pectus excavatum (funnel chest)

Front 10

an exaggerated curvature of the thoracic vertebrae

can cause significant backpain and limited mobility

Back 10

kyphosis (humpback)

Front 11

What has been found to decrease kyphosis?

Back 11

adequate exercise

Front 12

a lateral curvature of the thoracic and lumbar spine

reduces chest wall compliance

Back 12

scoliosis

Front 13

an exaggerated curvature of the lumbar vertebrae

Back 13

lordosis

Front 14

What angle should the ribs insert into the spine?

Back 14

45 degrees

Front 15

A horizontal slope of the ribs will be assessed on a person with:

Back 15

emphysema

Front 16

What can cause retraction or bulging of the interspaces during inspiration or expiration?

Back 16

asthma
emphysema
pleural effusion
tension pneumothorax

Front 17

What can cause tachypnea?

Back 17

fever
pain
anxiety
anemia
pneumonia
pleurisy
lesion in the pons

Front 18

Respirations increase about ____ breaths per minute for every 1 degree increase in temp above normal.

Back 18

4

Front 19

What can cause bradypnea?

Back 19

increased intracranial pressure
diabetic coma
opiate narcotic overdose
brain tumor

Front 20

total absence of breathing; may be periodic

Back 20

apnea

Front 21

increased depth of respirations

Back 21

hyperpnea

Front 22

What can cause hyperpnea?

Back 22

strenuous exercise
diabetic ketoacidosis

Front 23

increased rate and depth of respirations

offsets the O2-CO2 balance

often stress related

Back 23

hyperventilation

Front 24

What causes Cheyne-Stokes respirations?

Back 24

increased intracranial pressure
severe congestive heart failure
renal failure
drug overdose

Front 25

interrupted breathing like Cheyne-Stokes except that each breath is of the same depth

Back 25

biots

Front 26

What causes biots?

Back 26

spinal meningitis
heat stroke
head trauma
encephalitis

Front 27

a panting, labored kind of respiration with increased rate and depth

Back 27

Kussmaul's respirations

Front 28

tube-like structures opening onto the skin

Back 28

sinus tracts

Front 29

indicates subcutaneous air in the chest

feels like puffed rice cereal crackling under the skin

indicates air leaking from the airways/lungs

Back 29

crepitus

Front 30

performed to assess range and symmetry of respiratory movement

Back 30

respiratory excursion

Front 31

Where do you place your thumbs to assess for respiratory excursion?

Back 31

at the level of and parallel to the 10th ribs

Front 32

When testing for respiratory excursion, the thumbs should move _________ as the person inhales and __________ as the person exhales.

Back 32

outward
inward

Front 33

What can cause unequal chest expansion (as noted by respiratory excursion test)?

Back 33

pleural effusion
rib fractures
pneumothorax
tumors

Front 34

a vibration transmitted through the chest wall as the person speaks

Back 34

fremitis

Front 35

To assess for fremitis, what part of your hand do you touch the chest with?

Back 35

the palmar surface (of your dominant hand)

Front 36

With fremitis, where should vibrations be the strongest?

Back 36

between the scapulae on the posterior chest
on either side of the sternum on the anterior chest

Front 37

What causes decreased fremitis?

Back 37

anything that obstructs the vibration:

obstructed bronchus
COPD
pleural thickening
pneumothorax
emphysema
pleural effusion

Front 38

What causes increased fremitis?

Back 38

Compression or consolidation of lung tissue caused by:

mass (tumor
consolidated area such as with pneumonia or other inflammatory processes

Front 39

Where is fremitus no longer felt?

Back 39

at the level of the diaphragm

Front 40

What is the normal sound you will hear when you percuss the lung tissue?

Back 40

resonance

Front 41

Why do we percuss the posterior chest?

Back 41

to determine whether the underlying tissue is air-filled, fluid-filled, or solid

(the normal lung should be air-filled)

Front 42

What does resonance sound like?

Back 42

loud intensity and low pitched

Front 43

What does a dull sound indicate when you percuss the posterior chest?

Back 43

abnormal density in the lung

(caused by lung tumor, pneumonia, pleural effusion, and atelectasis)

Front 44

What does a hyperresonant sound indicate when you percuss the posterior chest?

Back 44

too much air is present

(caused by emphysema or pneumothorax)

Front 45

When you percuss the posterior chest, when the sound changes from ________ to _________, you are at the estimated level of the diaphragm.

Back 45

resonance
dullness

Front 46

the movement of the diaphragm as it descends on inspiration and rises on expiration

Back 46

diaphragmatic excursion

Front 47

With diaphragmatic excursion, the 2 lines on the right side may be slightly higher due to:

Back 47

the presence of the liver

Front 48

The normal range for diaphragmatic excursion in females is:

Back 48

3-5 cm

Front 49

The normal range for diaphragmatic excursion in males is:

Back 49

5-7 cm

Front 50

When auscultating the lungs posteriorly, what part of the stethoscope do you use?

Back 50

diaphragm

Front 51

soft, low-pitched fine rustling sounds located over the periphery of the lungs

they are loud on inspiration and soft/absent on expiration

Back 51

vesicular breath sounds

Front 52

most predominant breath sounds

Back 52

vesicular breath sounds

Front 53

Decreased vesicular breath sounds over the periphery may indicate:

Back 53

pneumonia
emphysema
pleural effusion
atelectasis

Front 54

loud, high-pitched tubular sounds located over the trachea (suprasternal area) and major bronchi

they are louder and longer during EXPIRATION

Back 54

bronchial/tracheal breath sounds

Front 55

If bronchial/tracheal breath sounds are heard over the periphery, this may indicate:

Back 55

consolidation or atelectasis

Front 56

moderately pitched breath sounds located between the scapulae posteriorly and on either side of the sternum at the first and second intercostal space anteriorly

no pause between inspiration and expiration

Back 56

bronchovesicular breath sounds

Front 57

If bronchovesicular breath sounds are heard over the periphery, it may indicate:

Back 57

consolidation (lungs are filled with exudate)

Front 58

Which breath sounds are heard on the posterior chest?

Back 58

bronchovesicular
vesicular

Front 59

Which breath sounds are heard on the anterior chest?

Back 59

bronchial
bronchovesicular
vesicular

Front 60

Inaudible breath sounds may indicate:

Back 60

atelectasis
pneumothorax

Front 61

adventitious breath sound created when air is traveling through vessels containing abnormal moisture

more pronounced on inspiration

Back 61

crackles (rales)

Front 62

What are the 2 types of crackles?

Back 62

fine
coarse

Front 63

type of crackle that is soft and high pitched

it sounds like 2 hairs being rubbed together

Back 63

fine

Front 64

type of crackle that is louder and lower pitched

has a bubbly quality

Back 64

coarse

Front 65

high pitched sound produced by air passing through a narrowed passageway in the small airways

may occur during inspiration, expiration, or both

Back 65

wheezes (sibilant rhonchi)

Front 66

What causes wheezes?

Back 66

mucous plug
bronchospasms
tumor

Front 67

coarse rattling sounds more like a snore, moan, or groan

louder and lower in pitch than crackles and caused by narrowed or constricted large airways

more pronounced on EXPIRATION

Back 67

rhonchi (sonorous rhonchi)

Front 68

What causes rhonchi (sonorous rhonchi)?

Back 68

asthma
bronchitis
bronchospasm

Front 69

high pitched sound produced by air passing through a narrowed passageway in the small airways

may occur during inspiration, expiration, or both

Back 69

wheezes (sibilant rhonchi)

Front 70

What causes wheezes?

Back 70

mucous plug
bronchospasms
tumor

Front 71

coarse rattling sounds more like a snore, moan, or groan

louder and lower in pitch than crackles and caused by narrowed or constricted arge airways

more pronounced on EXPIRATION

Back 71

rhonchi (sonorous rhonchi)

Front 72

What causes rhonchi (sonorous rhonchi)?

Back 72

asthma
bronchitis
bronchospasm

Front 73

crackling, grating sounds produced when 2 roughened or inflamed pleural spaces rub across each other during respiration

heard on both inspiration and expiration

sounds like sand paper

Back 73

friction rub

Front 74

loud high-pitched crowing sound heard usually without a stethescope during inspiration

requires immediate attention!

Back 74

stridor

Front 75

What causes stridor?

Back 75

upper airway obstruction

Front 76

What are the S/S of upper airway obstruction?

Back 76

anxiety
dyspnea
stridor
wheezes
decreased/absent breath sounds
use of accessory muscles
inability to speak
cyanosis
seesaw movement of chest

Front 77

Sound carries best through __________, not as well through _________, and poorly through _________.

Back 77

solid
fluid
air

Front 78

Instruct the person to say 99 while you auscultate the posterior chest. Normally the sound should be muffled and indistinct. If the sound is clear, it is called:

Back 78

bronchophony

Front 79

Instruct the person to say "ee" while you auscultate the posterior chest. Normally the sound should be muffled and indistinct. If the sound is heard as "ay", this is called:

Back 79

egophony

Front 80

Instruct the person to WHISPER 99 while you auscultate. The sound should be faint and indistinct. If the sound is louder and clear, it is called:

Back 80

whispered pectoriloquy

Front 81

What should the width of the costal angle be?

Back 81

less than 90 degrees

Front 82

When you inspect for the use of accessory muscles, which muscles are you looking at?

Back 82

trapezius
sternocleidomastoid
abdominal muscles

Front 83

In a normal adult, what is the ratio of the anterioposterior (AP) diameter to the lateral diameter?

Back 83

1:2

Front 84

Does the AP diameter usually increase or decrease in the older adult?

Back 84

increase (b/c of barrel chest or pectus carinatum)

Front 85

When palpating the anterior chest for respiratory excursion, where do you place your thumbs?

Back 85

along the costal margins pointing toward the xyphoid process

Front 86

The assessment of fremitis differs anteriorly due to the decreased or absent vibration over the _____________.

Back 86

precordium

Front 87

When you percuss over the liver and heart, what sound will you hear?

Back 87

dull

Front 88

When you percuss over the stomach, what sound will you hear?

Back 88

tympany