CVR anatomy

Question 1

How many lobes do the lungs have and where are they?

Answer 1

Right lung has 3 lobes:
 - upper lobe
 - middle lobe
 - lower lobe
Left lung has 2 lobes:
 - upper lobe
 - lower lobe

Question 2

What separates the lobes of the lungs?

Answer 2

Lobes of the lungs are separated by fissures made from visceral pleura:
- horizontal fissure
separates upper and middle lobe, right lung only
- oblique fissure
separates upper and lower lobes in the left lung
separates middle and lower lobes in the right lung

Question 3

What makes up the sternum?

Answer 3

Manubrium
Body
Xiphoid process

Question 4

Name and describe the different types of ribs

Answer 4

12 pairs of ribs in total
- true ribs (1-7)
articulate with vertebrae and sternum directly
- false ribs (8-10)
articulate with vertebrae and indirectly to the sternum
- floating ribs (11-12)
articulate with vertebrae, no attachment anteriorely to the sternum

Question 5

Describe how to find the lobes of the right lung on the anterior of a person

Answer 5

apex = 2.5cm above medial 1/3 of clavicle
upper lobe = between ribs 2 and 4. (sternal angle of the sternum = rib 2)
middle lobe = between ribs 4 and 6 (under bra strap for women)
lower lobe = between ribs 6 & 7

Question 6

Describe how to find the lobes of the left lung on the anterior of a person

Answer 6

apex = 2.5cm above medial 1/3 of clavicle
upper lobe = between apex and rib 6
lower lobe = between ribs 6 and 7

Question 7

Describe how to find the lobes of the right lung on the mid-axilla

Answer 7

upper lobe = between apex and horizontal fissure, approx rib 5
middle lobe = between horizontal and oblique fissure infront of mid-axilla line, approx rib 5
lower lobe = oblique fissure to the base of the lung, approx rib 5 to 8

Question 8

Describe how to find the lobes of the left lung on the mid-axilla

Answer 8

upper lobe = between apex and oblique fissure, approx rib 5

lower lobe = between oblique fissure and base of the lung, approx rib 5 to 8

Question 9

Describe how to find the lobes of the right lung on the posterior

Answer 9

upper lobe = between T1 and oblique fissure T4
middle lobe = N/A
lower lobe = oblique fissure to base of the lung, approx T4 to T10

Question 10

Describe how to find the lobes of the left lung on the posterior

Answer 10

upper lobe = between T1 and oblique fissure T4

lower lobe = between oblique fissure and base of the lung, approx T4 to T10

Question 11

Describe the auscultation technique for lung examination

Answer 11

1. Clean stethoscope with sterilising wipes
2. Ask the patient to undress
3. Warn the patient to inform you if they start to feel dizzy
4. Ask them to breathe through their mouth
5. Place stethoscope directly onto the skin
6. Listen during inspiration and expiration of each lobe on alternate sides, listening to one or 2 full breaths in and out

Question 12

What causes breath sounds and how can they be categorised?

Answer 12

Breath sounds arise in the trachea and bronchi and are caused by the turbulence of the air as it flows in and out of these large airways.
Breath sounds can be described as normal, bronchial or quiet

Question 13

Describe what normal breath sounds would be like

Answer 13

More prominent at the tops of the lungs with the volume decreasing towards the bases
Expiration is quieter than inspiration and follows without a pause

Question 14

Describe what causes bronchial breathing sounds and what they would be like

Answer 14

Caused by air being replaced by solid tissue, which transmits sound more clearly, caused by areas of collapse, tumour, etc
Typically loud and harsh breaths. Expiration is louder and longer than inspiration and there is a pause between the 2

Question 15

Describe what causes quiet or diminished breathing sounds and what they would be like

Answer 15

Caused by an obstruction or decreased airflow, such as pleural effusion and obesity
Breath sound will be reduced or absent if air entry is compromised by either an obstruction or a decrease in airflow

Question 16

Describe what causes crackle breathing sounds and what they would be like

Answer 16

Fine crackle: caused by airways that have been narrowed are suddenly forced open on inspiration. Sounds like rubbing hair next to your ear
Coarse crackle: caused by obstruction of more proximal and larger airways with sputum. Sounds like pouring milk onto rice crispies

Question 17

Describe what causes wheezy breathing sounds and what they would be like

Answer 17

Caused by airflow vibrating in narrowed or compressed airways. Sounds like musical tones

Question 18

Describe what causes a pleural rub breathing sound and what they would be like

Answer 18

Caused by inflamed pleural surfaces that become rough and rub together.
Sounds like creaking or grating sound, like walking through fresh snow

Question 19

Describe what causes a stridor breathing sound and what they would be like

Answer 19

Caused by an upper airway obstruction.

Sounds like a constant pitch on inspiration and expiration