FULL REVIEW CRT/RRT (NBRC) EXAM
QUESTIONS WITH COMPLETE
ANSWERS
Bronchophony / whisphered pectoriloquy - ANSWER--increased intensity or
transmission of the spoken voice and indicate CONSOLIDATION or PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales - ANSWER--crackles
-secretions/fluid
Coarse rales - ANSWER--rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER--middle airway secretions
-needs CPT
Fine rales - ANSWER--fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER--due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER--upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub - ANSWER--coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER--closure of the mitral and tricuspid valves at the beginning
of ventricular contraction
,Heart Sound S₂ - ANSWER--closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER--abnormal and may suggest CHF
Heart Sound S₄ - ANSWER--abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
Heart murmurs - ANSWER--sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits - ANSWER--sounds made in an artery or vein when blood flow becomes
turbulent or flows at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
Blood pressure - ANSWER--systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER--angle made by the outer curve of the diaphragm and
the chest wall
-obliterated by pleural effusions and pneumonia
Diaphragm - ANSWER--dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER--patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER--taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER--tip should be positioned below the vocal
chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before CXR is
taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER--pacemaker should be positioned in the right
ventricle
,-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein and
should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER--viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
Epiglottitis - ANSWER--bacterial infection
-supraglottic swelling with an enlraged and flattened epiglottis and swollen aryepiglottic
folds
-Thumb sign
-Rapid onset
-pediatrics
-provide airway and antibiotics
Computerized Tomography (CT scan) - ANSWER--X-ray through a specific plane and
appear as slices of organs/body parts
-diagnosis of bronchiectasis
-spiral CT scan w/ contrast dye for PE
Magnetic Resonance Imaging (MRI) - ANSWER--2D view without use of radiation
-used for determining thoracic aneurysms, congenital abnormalities of the aorta and
major thoracic vessels esp. the hilar area
-able to locate precise position of tumors
V/Q scan - ANSWER-Ventilation scan
-Radioisotope (xenon) gas is inhaled
-and obstruction to airflow will allow little gas to enter
Perfusion scan
-albumin, tagged with radioactive iodine is injected into a peripheral vein and lodges in
the pulmonary capillaries
-scanned over chest and shows distribution and volume of perfusion
Ventilation with no perfusion = PE (deadspace disease)
Ascites - ANSWER-accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention - ANSWER--occurs with CHF
, -seen with obstructive patients (seen in exhalation phase)
Capillary refill - ANSWER--indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color - ANSWER--increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) - ANSWER--decreased respiratory rate (<12bpm) variable depth
and irregular rhythm
Hyperpnea - ANSWER--increased rate, depth, with regular rhythm
Cheyne-Stokes - ANSWER--gradually increasing then decreasing rate and depth in a
cycle lasting from 30 - 180 secs, with apnea up to 60 secs
-increased ICP, meningitis, overdose
Biots - ANSWER--increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's - ANSWER--increased rate, depth, irregular rhythm, breathing sounds
labored
-Raspy voice
Apneustic - ANSWER-prolonged gasping inspiration followed by extremely short,
insufficient expiration
-respiratory center problems, trauma, tumor
cachectic - ANSWER-muscle atrophy/loss of muscle tone
retractions - ANSWER--chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
Character of cough - ANSWER--dry, non-productive cough may indicate tumor in the
lungs or asthma
-productive cough may indicate infection
evidence of difficult airway - ANSWER--short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
QUESTIONS WITH COMPLETE
ANSWERS
Bronchophony / whisphered pectoriloquy - ANSWER--increased intensity or
transmission of the spoken voice and indicate CONSOLIDATION or PNEUMONIA
-increase in spoken voice = consolidation
-decrease in spoken voice = obstructon, pneumo, emphysema
Rales - ANSWER--crackles
-secretions/fluid
Coarse rales - ANSWER--rhonchi
-LARGE airway secretions
-needs suctioning
medium rales - ANSWER--middle airway secretions
-needs CPT
Fine rales - ANSWER--fluid in alveoli
-CHF, pulmonary edema
-IPPB, heart drugs, diuretics and O2
Wheeze - ANSWER--due to bronchospasm
-bronchodilator Tx
-unilateral wheeze indicative of a foreign body obstruction
stridor - ANSWER--upper airway obstruction
-supraglottic swelling (epiglottitis) (thumb sign)
-subglottic swelling (croup, postextubation) (steeple sign)
-foreign body aspiration
-Racemic epinephrine
-intubation if MARKED stridor
-Lateral neck Xray for confirmation
Pleural friction rub - ANSWER--coarse grating or crunching sound
-visceral and parietal pleura rubbing together
-associated with TB, pneumonia, pulmonary infarction, cancer
-steroids and antibiotics
Heart Sound S₁ - ANSWER--closure of the mitral and tricuspid valves at the beginning
of ventricular contraction
,Heart Sound S₂ - ANSWER--closure of pulmonic and aortic valves
-occurs when systole ends; ventricles relax
Heart Sound S₃ - ANSWER--abnormal and may suggest CHF
Heart Sound S₄ - ANSWER--abnormal and indicative of cardiac abnormality such as
myocardial infarction or cardiomegaly
Heart murmurs - ANSWER--sounds caused by turbulent blood flow
-heart valve defects or congenital heart abnormalities
-can occur when blood is pushed through an abnormal opening (ASD, PDA)
Bruits - ANSWER--sounds made in an artery or vein when blood flow becomes
turbulent or flows at an abnormal speed.
-usually heard via stethoscope over the identified vessel (carotid artery)
Blood pressure - ANSWER--systolic and diastolic pressures
-sphygmomanometer to measure cuff pressures
-↑BP = cardiac stress = hypoxemia
-↓BP = poor perfusion = hypovolemia, CHF
Costophrenic Angle - ANSWER--angle made by the outer curve of the diaphragm and
the chest wall
-obliterated by pleural effusions and pneumonia
Diaphragm - ANSWER--dome shaped normally
-flattened with COPD
-hemidiaphragms may shift downward with pneumothorax
-right hemidiaphragm is level of 6th anterior rib and slightly higher than the left
-right lung: 55% and appear larger than left lung
Lateral decubitus CXR - ANSWER--patient lying on affected side
-detecting small pleural effusions
End expiratory film - ANSWER--taken when patient is at end-exhalation
-detecting small pneumothorax/foreign body aspiration (FBA)
Position of ET/Tracheostomy tube - ANSWER--tip should be positioned below the vocal
chords and no closer than 2 cm or 1 inch above the carina.
-approx same level of the aortic knob/arch
-observation and auscultation will quickly determine adequate ventilation before CXR is
taken
-cuff should not extend over the end of the ET or tracheostomy tube
Pacemaker, catheters, Etc. - ANSWER--pacemaker should be positioned in the right
ventricle
,-PAC should appear in right lower lung field
-central venous catheters are placed in the right or left subclavian or jugular vein and
should rest in the vena cava or right atrium
-chest tubes should be located in the pleural space surrounding the lung
-NG tubes should be in stomach 2-5 cm below the diaphragm
Croup (laryngotracheobronchitis) - ANSWER--viral disorder
-narrowing subglottic swelling
-steeple/picket fence/pencil sign
-gradual onset
-infants
-Mist tent, O2, Racemic epi, corticosteroids
-barking cough
Epiglottitis - ANSWER--bacterial infection
-supraglottic swelling with an enlraged and flattened epiglottis and swollen aryepiglottic
folds
-Thumb sign
-Rapid onset
-pediatrics
-provide airway and antibiotics
Computerized Tomography (CT scan) - ANSWER--X-ray through a specific plane and
appear as slices of organs/body parts
-diagnosis of bronchiectasis
-spiral CT scan w/ contrast dye for PE
Magnetic Resonance Imaging (MRI) - ANSWER--2D view without use of radiation
-used for determining thoracic aneurysms, congenital abnormalities of the aorta and
major thoracic vessels esp. the hilar area
-able to locate precise position of tumors
V/Q scan - ANSWER-Ventilation scan
-Radioisotope (xenon) gas is inhaled
-and obstruction to airflow will allow little gas to enter
Perfusion scan
-albumin, tagged with radioactive iodine is injected into a peripheral vein and lodges in
the pulmonary capillaries
-scanned over chest and shows distribution and volume of perfusion
Ventilation with no perfusion = PE (deadspace disease)
Ascites - ANSWER-accumulation of fluid in the abdomen caused by LIVER FAILURE
Venous distention - ANSWER--occurs with CHF
, -seen with obstructive patients (seen in exhalation phase)
Capillary refill - ANSWER--indication of peripheral circulation
-Normal < 3 seconds
Jaundice skin color - ANSWER--increase in bilirubin.
-mostly in face and trunk
Bradypnea (oligopnea) - ANSWER--decreased respiratory rate (<12bpm) variable depth
and irregular rhythm
Hyperpnea - ANSWER--increased rate, depth, with regular rhythm
Cheyne-Stokes - ANSWER--gradually increasing then decreasing rate and depth in a
cycle lasting from 30 - 180 secs, with apnea up to 60 secs
-increased ICP, meningitis, overdose
Biots - ANSWER--increased rate and depth with irregular periods of apnea
-CNS problem, head/brain injury
Kussmaul's - ANSWER--increased rate, depth, irregular rhythm, breathing sounds
labored
-Raspy voice
Apneustic - ANSWER-prolonged gasping inspiration followed by extremely short,
insufficient expiration
-respiratory center problems, trauma, tumor
cachectic - ANSWER-muscle atrophy/loss of muscle tone
retractions - ANSWER--chest moves inward during inspiratory efforts instead of outward
-blocked airway in adults = INTUBATE
-RDS in infants
Character of cough - ANSWER--dry, non-productive cough may indicate tumor in the
lungs or asthma
-productive cough may indicate infection
evidence of difficult airway - ANSWER--short receding mandible (chin)
-enlarged tongue (macroglossia)
-bull neck
-limited neck range-of-motion
