Assessment of the Thorax and Lungs Flashcards
ASSESSMENT TECHNIQUE
This is the first step of the examination. This is a very important part of the exam, since many abnormalities can be detected by merely inspecting the thorax as the patient is breathing.
Visual Inspection
ASSESSMENT TECHNIQUE
This is the second step of the assessment, where we will touch the patient. Many breathing difficulties can be assessed during this step. Some systemic problems can be detected during this part of the exam as well as just mechanical breathing problems.
Palpation
ASSESSMENT TECHNIQUE
This is usually helpful only in a limited capacity to the examiner.
Percussing
ASSESSMENT TECHNIQUE
This is the process of listening to the breath sounds with the use of a stethoscope. In this text, we will describe the characteristics of normal and common abnormal breath sounds.
Auscultation
This identifies the portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly.
Thorax
The lungs, distal portion of the trachea, and the bronchi are located in the thorax and constitutes the _______________.
Lower respiratory system
The outer structure of the thorax is referred to as the ________.
Thoracic cage
The ____________ contains the respiratory components.
Thoracic cavity
The sternum lies in the center of the chest anteriorly and is divided into 3 parts. What are these?
- Manubrium
- Body
- Xiphoid process
VERTICAL REFERENCE LINES
ANTERIOR (Front side)
- Anterior Median Line (Midsternal)
- Right Midclavicular line
- Left Midclavicular line
VERTICAL REFERENCE LINES
LATERAL (Side)
- Anterior axillary line
- Midaxillary line
- Posterior axillary line
VERTICAL REFERENCE LINES
POSTERIOR (Back)
- Posterior Midspinal Line (Vertebral Line)
- Posterior Left Scapular Line
- Posterior Right Scapular Line
These are 2 cone-shaped organs located in the pleural spaces in the right and left sides of the bony thorax.
Lungs
The right lung is divided into how many lobes?
3 Lobes
- Superior lobe
- Middle lobe
- Inferior lobe
The left lung is divided into how many lobes?
- Superior lobe
- Inferior lobe
What do you call the tip on the top of the lungs?
Apex
What do you call the tip of the bottom of the lungs?
Base
The purpose of the lungs is most importantly the _______________ in the body.
exchange of gases
This is most important in breathing.
Diaphragm
The lungs expand during Inspiration and this causes the diaphram to _________.
Lower
The lungs deflate during expiration which causes the diaphragm to ___________.
rise
Abnormal breathing is also known as ___________.
Diaphragmatic breathing
- The amount of air inhaled and exhaled during a normal breath.
- Approx. 500 mL
- Example: The air you breathe in and out while sitting quietly.
Tidal Volume (TV)
- The air that remains in the lungs even after a forceful exhalation.
- Approx. 1200 mL
- Example: Even after exhaling deeply, some air remains in your lungs to keep them from collapsing.
Residual Volume (RV)
- The extra air you can inhale after taking a normal breath (forced inspiration).
- Approx. 3000 mL
- Example: Taking a deep breath before diving into a pool.
Inspiratory Reserve Volume (IRV)
- The extra air you can exhale after a normal breath (forced expiration).
- Approx. 1100 mL
- Example: Blowing out candles forcefully after exhaling normally.
Expiratory Reserve Volume (ERV)
- The maximum amount of air you can inhale after taking a normal breath.
- Formula: Tidal Volume + Inspiratory Reserve Volume
- Approx. 3500 mL
- Example: Taking a deep breath before shouting or singing loudly.
Inspiratory Capacity (IC)
- The amount of air left in the lungs after a normal exhalation.
- Formula: Expiratory Reserve Volume + Residual Volume
- Approx. 2300 mL
- Example: The air remaining in your lungs after normal breathing, ensuring gas exchange continues.
Functional Residual Capacity (FRC)
- The total amount of air you can forcibly inhale and exhale.
- Formula: IRV + TV + ERV
- Approx. 4600 mL
- Example: The maximum breath capacity when taking in as much air as possible and then forcefully exhaling.
Vital Capacity (VC)
- The total amount of air the lungs can hold with maximum inhalation.
- Formula: VC + RV
- Approx. 5800 mL
- Example: The maximum lung expansion possible, like when preparing for deep-sea diving.
Total Lung Capacity (TLC)
It is a structural deformity where the sternum (breastbone) is abnormally depressed inward, creating a sunken appearance in the chest.
Funnel Chest (Pectus Excavatum)
It is a deformity characterized by a rounded, expanded chest shape, where the ribs are elevated, spaced farther apart than normal, and positioned more horizontally rather than sloping downward.
Barrel Chest
Commonly known as pigeon chest, is a chest wall deformity where the sternum (breastbone) and ribs push outward, creating a protruding or convex appearance of the chest.
Pectus Carinatum (Pigeon Chest)
It is a condition in which the spine curves sideways rather than remaining straight when viewed from the front. While a normal spine has natural curves when seen from the side, causes an abnormal lateral (side-to-side) curvature of the spine.
Scoliosis
It is a forward curvature of the spine, causing a rounded or hunched back appearance.
Kyphosis
A mild kyphotic curve is normal in the thoracic spine (middle back), but an excessive curve can lead to postural problems, discomfort, and breathing difficulties in severe cases.
RESPIRATION PATTERNS
Regular and comfortable. 12-20 breaths per minute
Normal
RESPIRATION PATTERNS
Significant disorganization with irregular and varying depths of respiration.
Ataxic
RESPIRATION PATTERNS
Slower than 12 breaths per minute.
Bradypnea
RESPIRATION PATTERNS
Faster than 20 breaths per minute, deep breathing.
Hyperpnea
RESPIRATION PATTERNS
Frequently interspersed deeper breaths.
Sighing
RESPIRATION PATTERNS
Increasing difficulty in getting breath out.
Air trapping
RESPIRATION PATTERNS
Irregularly interspersed periods of apnea in a disorganized sequence of breaths.
Blot respirations
RESPIRATION PATTERNS
Varying periods of increasing depth interspersed with apnea.
Cheyne-Strokes breathing
RESPIRATION PATTERNS
Rapid, deep, labored breathing.
Kussmaul respirations
RESPIRATION PATTERNS
Faster than 20 breaths per minute
Tachypnea
WHAT IS THE SOUND?
Normal lung
Resonance
WHAT IS THE SOUND?
Lung with emphysema
Hyper-resonance
WHAT IS THE SOUND?
Puffed-out cheek, gastric bubble
Tympany
WHAT IS THE SOUND?
Diaphragm, pleural effusion
Dullness
WHAT IS THE SOUND?
Muscle, bone, thigh
Flatness
NORMAL BREATH SOUNDS
- Duration of Sounds: Inspiratory sounds last longer than expiratory sounds.
- Location: Over most of both lungs.
Vesicular
NORMAL BREATH SOUNDS
- Duration of Sounds: Inspiratory and expiratory sounds are about equal.
- Location: Often in the 1st and 2nd interspaces anteriorly and between the scapulae.
Broncho-vesicular
NORMAL BREATH SOUNDS
- Duration of Sounds: Expiratory sounds last longer than inspiratory ones.
- Location: Over the manubrium (larger proximal airways)
Bronchial
BREATH SOUND TEST
Procedure:
- Ask the patient to say “ninety-nine” while auscultating.
Normal Finding:
- Sound is faint & muffled.
Abnormal Finding (Indicates Consolidation):
- Sound is clear & loud (due to sound transmission through dense lung tissue).
Bronchophony
BREATH SOUND TEST
Procedure:
- Ask the patient to say “ee” while auscultating.
Normal Finding:
- Sounds like a prolonged “ee”.
Abnormal Finding (Indicates Consolidation):
- Sounds like “ay” (fluid or lung collapse present).
Egophony
BREATH SOUND TEST
Procedure:
- Ask the patient to whisper “1, 2, 3” while auscultating.
Normal Finding:
- Whispered voice is very faint or distant.
Abnormal Finding (Indicates Consolidation):
- Whispered voice sounds unusually clear & loud (suggests consolidation).
Whispered Pectoriloquy
