(ACCN 5531) Final Review Exam Questions
With Complete Answers
Agonal respirations - ANSWER Gasping sound followed by apnea
Cerebral ischemia, extreme hypoxia, anoxia
Apneustric breathing - ANSWER Prolonged inspiratory hold; slow rate + expiratory
pauses
Midbrain or low ppns condition
Ataxic respirations - ANSWER Irregular and random w/ no pattern; severa; short breaths
of equal depeth w/ long irregular periods of apnea
Lesions at midbrain or medulla
Central neurogenic hyperventilation - ANSWER Sustained regular rapid resps w/ forced
inspiration/expiration > 60 breaths/min
Lesions in low midbrain or pons
Cheyne-Stokes respirations - ANSWER Initial shalow resps that increase in depth, reach
a peak, then declines
Gives CO2 to build up again after being blown off by rapid repsiration and triggers
breahting pattern to start again
Upper brainstem involvement, bilateral deep cerebral lesions
Cluster breathing - ANSWER Periods of iregular resps alternate w/ periods of apnea
Lesions in pons or upper medulla
Kussmaul's respirations - ANSWER Deep, regular, sighing resps w/ increased resp rate
Caused by metabolic acidosis
flail chest - ANSWER Serious condition caused by trauma to the chest wall
Integrity of thoracic cage is compromised due to >2 distant sites on the same rib that
lead to impairment of negative pleural pressure generation
Causes decreased lung expansion on inspiration
During spontaneous expiration, the flail segment moves outward because of positive
pleural pressure while the rib cage is moving inward.
,Presents w/ asymmetric chest movement + pain due to fracture sites
May also have respiratory distress due to increased work of breathing + decreased tidal
volumes
On palpitation, crepitus may be felt around fractured areas
Most common cause is motor vehicle accidents
Crepitus (Subcutaneous emphysema) - ANSWER Described as the feeling of "rice
krispies" when skin is lightly palpated (face , neck, upper chest)
Occurs when air has moved into the tissues beneath the skin
Sources of air leaks:
Alveolar rupture
Blunt or penetrating chest wall trauma
Chest tube leak
Pneumothorax
Bronchial sounds - ANSWER Heard on large airways (trachea, mainstem bronchus)
Shortened inspiration (slightly shorter) + lengthened expiration
Inspiratory + expiratory phase are audibly separated by a pause
High pitched, loud w/ hollow or tubular quality (like blowing into a pipe)
Abnormal if heard peripherally
Indicated pathology (pneumonia, consolidation)
Note: consolidation refers to following of alveoli w/ exudate (fluid, RBCs, WBCs)
Vesicular sound - ANSWER Heard over peripheral lung fields + small airways
Best heard lobes
Low pitched - soft inspiration, soft expiration
Blowing or rustling sound - quiet, soft in quality
Inspiration is longer than expiration
Inspiration is louder than expiration
,No pause between inspiration and expiration
Expiration is quiet; almost inaudible
Bronchovesicular - ANSWER Heard over medium size airways (mainstem bronchi, major
bronchioles)
Auscultated anteriorly along sternal borders @ 1st + 2nd ICS
Auscultated posteriorly @ T4 - T7 interscapular space
Inspiration + expiration equal in length, no pause
Moderate pitch + moderate intensity
Combined quality of bronchial + vesicular breath sounds
Fine crackles - ANSWER Predominantly heard during inspiration
Occurs when deflated or collapsed (during expiration) alveoli are suddenly re-inflated
Heard in small airways + do not clear w/ cough
Commonly in COPD, CHF, pneumonia, pulmonary fibrosis, atelectasis
Coarse crackles - ANSWER Heard during inspiration
Also occurs when deflated or collapsed alveoli are suddenly re-inflated
"Brief, continuous, popping sounds"; lower pitched, longer duration compared to fine
crackles
Heard in large airways + MAY clear w/ cough
Commonly in pneumonia, pulmonary edema, bronchitis, atelectasis
, Sonorus wheezes - ANSWER Low pitched + snoring sound
Low pitched whistling tune or whine; monophonic
Mainly in expiration
Commonly in asthma, bronchitis, airway edema, tumor,. Bronchiolar spasm, foreign
body obstructions
Sibilant Wheezes - ANSWER High pitched, musical quality; polyphonic
Mainly in expiration
Commonly in asthma, chronic bronchitis, emphysema, tumor, foreign body obstructions
Stridor wheezes - ANSWER Predominantly inspiratory + continuous sound
High-pitched whistling or gasping sound w/ harsh sound quality
Crowing like sound + louder in large airways (trachea or larynx) than over chest
Indicate partial obstruction of larynx or trachea
Does not clear w/ cough
Commonly in croup, foreign body obstruction, large airway tumours
Potentially life threatening finding; communicate to RT + MD ASAP
Pleural friction rub - ANSWER Occurs when pleural surfaces become inflamed + edges
rub together during resp cycle
Characteristics:
Grating or squeaking sound (rubbing 2 balloons together); low-pitched
Can be heard during inspiration + expiration or only with inspiration; often loudest at the
end of inspiration due to max expansion
With Complete Answers
Agonal respirations - ANSWER Gasping sound followed by apnea
Cerebral ischemia, extreme hypoxia, anoxia
Apneustric breathing - ANSWER Prolonged inspiratory hold; slow rate + expiratory
pauses
Midbrain or low ppns condition
Ataxic respirations - ANSWER Irregular and random w/ no pattern; severa; short breaths
of equal depeth w/ long irregular periods of apnea
Lesions at midbrain or medulla
Central neurogenic hyperventilation - ANSWER Sustained regular rapid resps w/ forced
inspiration/expiration > 60 breaths/min
Lesions in low midbrain or pons
Cheyne-Stokes respirations - ANSWER Initial shalow resps that increase in depth, reach
a peak, then declines
Gives CO2 to build up again after being blown off by rapid repsiration and triggers
breahting pattern to start again
Upper brainstem involvement, bilateral deep cerebral lesions
Cluster breathing - ANSWER Periods of iregular resps alternate w/ periods of apnea
Lesions in pons or upper medulla
Kussmaul's respirations - ANSWER Deep, regular, sighing resps w/ increased resp rate
Caused by metabolic acidosis
flail chest - ANSWER Serious condition caused by trauma to the chest wall
Integrity of thoracic cage is compromised due to >2 distant sites on the same rib that
lead to impairment of negative pleural pressure generation
Causes decreased lung expansion on inspiration
During spontaneous expiration, the flail segment moves outward because of positive
pleural pressure while the rib cage is moving inward.
,Presents w/ asymmetric chest movement + pain due to fracture sites
May also have respiratory distress due to increased work of breathing + decreased tidal
volumes
On palpitation, crepitus may be felt around fractured areas
Most common cause is motor vehicle accidents
Crepitus (Subcutaneous emphysema) - ANSWER Described as the feeling of "rice
krispies" when skin is lightly palpated (face , neck, upper chest)
Occurs when air has moved into the tissues beneath the skin
Sources of air leaks:
Alveolar rupture
Blunt or penetrating chest wall trauma
Chest tube leak
Pneumothorax
Bronchial sounds - ANSWER Heard on large airways (trachea, mainstem bronchus)
Shortened inspiration (slightly shorter) + lengthened expiration
Inspiratory + expiratory phase are audibly separated by a pause
High pitched, loud w/ hollow or tubular quality (like blowing into a pipe)
Abnormal if heard peripherally
Indicated pathology (pneumonia, consolidation)
Note: consolidation refers to following of alveoli w/ exudate (fluid, RBCs, WBCs)
Vesicular sound - ANSWER Heard over peripheral lung fields + small airways
Best heard lobes
Low pitched - soft inspiration, soft expiration
Blowing or rustling sound - quiet, soft in quality
Inspiration is longer than expiration
Inspiration is louder than expiration
,No pause between inspiration and expiration
Expiration is quiet; almost inaudible
Bronchovesicular - ANSWER Heard over medium size airways (mainstem bronchi, major
bronchioles)
Auscultated anteriorly along sternal borders @ 1st + 2nd ICS
Auscultated posteriorly @ T4 - T7 interscapular space
Inspiration + expiration equal in length, no pause
Moderate pitch + moderate intensity
Combined quality of bronchial + vesicular breath sounds
Fine crackles - ANSWER Predominantly heard during inspiration
Occurs when deflated or collapsed (during expiration) alveoli are suddenly re-inflated
Heard in small airways + do not clear w/ cough
Commonly in COPD, CHF, pneumonia, pulmonary fibrosis, atelectasis
Coarse crackles - ANSWER Heard during inspiration
Also occurs when deflated or collapsed alveoli are suddenly re-inflated
"Brief, continuous, popping sounds"; lower pitched, longer duration compared to fine
crackles
Heard in large airways + MAY clear w/ cough
Commonly in pneumonia, pulmonary edema, bronchitis, atelectasis
, Sonorus wheezes - ANSWER Low pitched + snoring sound
Low pitched whistling tune or whine; monophonic
Mainly in expiration
Commonly in asthma, bronchitis, airway edema, tumor,. Bronchiolar spasm, foreign
body obstructions
Sibilant Wheezes - ANSWER High pitched, musical quality; polyphonic
Mainly in expiration
Commonly in asthma, chronic bronchitis, emphysema, tumor, foreign body obstructions
Stridor wheezes - ANSWER Predominantly inspiratory + continuous sound
High-pitched whistling or gasping sound w/ harsh sound quality
Crowing like sound + louder in large airways (trachea or larynx) than over chest
Indicate partial obstruction of larynx or trachea
Does not clear w/ cough
Commonly in croup, foreign body obstruction, large airway tumours
Potentially life threatening finding; communicate to RT + MD ASAP
Pleural friction rub - ANSWER Occurs when pleural surfaces become inflamed + edges
rub together during resp cycle
Characteristics:
Grating or squeaking sound (rubbing 2 balloons together); low-pitched
Can be heard during inspiration + expiration or only with inspiration; often loudest at the
end of inspiration due to max expansion
