Clinical Chest

Question 0

TRUE or FALSE

Ribs on the left are more projected anteriorly than the right

Answer 0

True

Question 1

Guide to needling of cavity, auscultation of valves (in different intercostal spaces)

Answer 1

Manubriosternal joint

Sternal angle of Louis

Question 2

What intercostal space can we palpate the apex beat?

Answer 2

Normally placed on 5th intercostal space, midclavicular line

Question 3

TRUE or FALSE

The <3 can be palpated in the 6th intercostal space, left side of the body, midaxillary line

Answer 3

False

Heart is enlarged
The condition is called ‘cardiomegaly’

Question 4

During percussion, the ff. sounds indicate what the pleural cavity is filled of (air, fluid, solid)

1. Resonant like a drum
2. Dull
3. Flat

Answer 4

Resonant like a drum - Air-filled
Dull - Fluid-filled
Flat - Solid

Question 5

A hyperresonant sound during percussion may be indicative of…

A flat sound?

Answer 5

Pneumothorax

Pneumonia

Question 6

What to do to relieve pneumothorax?

Answer 6

Thoracentesis
2nd intercostal space

How?
Point the needle to the rib
Walk the rib

Danger?
Just below the inferior border of the rib is the neurovascular bundle
If compromised: Numbness of the anterior abdominal wall

Question 7

TRUE or FALSE

T10 - Level of the umbilicus

Answer 7

True

Question 8

What is the lowest limit in the mid-axillary line/midclavicular/paravertebral line you can do a thoracentesis?

Hint: You are not going to enter the pleural cavtiy here (Lines of Pleural Deflection)

Answer 8

Level of midclavicular line - 8th rib
Midaxillary - 10th rib
Paravertebral - 12th rib (11th intercostal space, hindi na pwede)

Question 9

What to do when an X-ray reveals a density. How can you tell if it is fluid or solid? (No ultrasound is available)

Answer 9

Tusukin lang

If the density moves the mediastinum: liquid
Doesn’t move: solid

Question 10

What happens if the mediastinum shifts to the contralateral side? How are structures involved affected?

Answer 10

Mediastinal shift

• cardiac output affected
• hemodynamic changes: blood and airflow

Question 11

TRUE or FALSE

During chronic effusion, you can drain more than 1500 cc at one time

Answer 11

False
Lungs should expand gradually (if there is acute pulmonary congestion)

Hemodynamic changes:
There will be congestion (rush of blood~edema~malulunod)

Question 12

There is fluid in the pericardium
What to do?
How?
Why?

Answer 12

What: Pericardiocentesis

How: Parasternal approach in the left side

• 5th or 6th ICS
• needle is directed to the shoulder 30 degrees to horizontal

Why: There is no pleura (bare end)

Question 13

A woman who has breast cancer would likely palpate tumors in what quadrant of her breast? Why?

Answer 13

Where: Upper outer

Why: Maraming breast tissue (Axillary tail of ______)
Not just the presence of lymph nodes
Breast cancer first before lymph nodes

Question 14

What are the levels of lymph nodes?

Answer 14

Level 1 Below pectoralis minor
Level 2 Behind pectoralis minor
Level 3 Above pectoralis minor

Point of reference: PecMin

Question 15

There seems to be a mass in the anterior mediastinum behind the sternum

What is the differential diagnosis?

Answer 15

…

Know structures!

Question 16

Tumor of the thymus

Tumor in the posterior mediastinum

Answer 16

Thymoma

Question 17

Structures in the walls of the thoracic cavity

List 4

Answer 17

Thoracic duct
Sympathetic trunk
Intercostal vessels
Phrenic nerve - always parallel to the pericardial sac