CVR case studies points Flashcards
What 3 areas do we auscultate?
Anterior, mid-axilla lining and posterior
Where is the apex anteriorly?
2cm above the medial third of the clavicle
What do the upper lobes start on and end with right side?
It starts where the apex is (clavicle) and end around rib 4, so auscultate at rib2 on right and left
Where is the middle lobe on the right side anteriorly?
Horizontal fissure (start) is rib 4 and the oblique fissure (end) is rib 6
What do we call the equivalent to the middle lobe on the left and why?
The lingula as the left only has an upper and lower lobe
Where are the inferior lobes of the lungs anteriorly?
The lower lobes start under the fissure at rib 7 and end rib 9/10
Where is the mid axilla lining?
Down the side of the body
Where does the upper lobe run to on the side?
Rib 5
Where does the lower lobe run to on the side?
Rib 8
Where are the apices lobes on the posterior aspect?
Top of the scapula around in line with T1
Where are the superior lobes on the posterior aspect?
The middle (medial border) of the scapula
Where are the inferior lobes posteriorly?
Bottom of the scapula in line with T4 and finishing around T10
Where is the base of lungs posteriorly?
In line with T10/T11 off centre (mid lats pretty much)
What are the 4 key points to pick up on for Carter’s (consolidation) x-ray?
Increased opacity particularly the right middle and lower lobes, loss of normal lung markings, bronchus contrast in colour, no rib crowding/trachea shift
What does the increased whiteness show?
Shows consolidation of potentially pus as it seems he has pneumonia in the right middle lobe or in some cases can be a sign of fluid exudate
What normal lung marking is missing on Carters (consolidation x-ray)?
Loss of both costophrenic angles show the accumulation of consolidation and could also be seen in pleural effusion if the pneumonia worsens (will see visible fluid lines)
What does air bronchograms mean in relation to carter?
Carter’s bronchus is black and white showing normal presence of air in contrast to the opacity around showing a consolidation
Where is the reduced costophrenic angle on Leon’s (atelectasis) x-ray?
Left side
How is Leon showing signs of left lower lobe collapse on the x-ray?
Increased opacity and a mediastinal shift of the heart towards the left which is the side of collapse
What is happening to Leon’s diaphragm in the CXR?
His diaphragm is raised overall showing the loss of lung volume
Is there any rib crowding and tracheal shift in Leon’s CXR?
Yes there is rib crowding on the lateral aspect left side and some slight trachea deviation towards left side?
What are Carter’s acute problems?
Loss of thoracic volume, impaired airway clearance, impaired gas exchange and dyspnea
Why does Carter have reduced thoracic volume?
Due to consolidation causing a build up of fluid and/or pus. Also Carter’s high BMI reduces functional residual capacity from excess fat around the respiratory system
Why does Carter have reduced airway clearance shown by tactile fremitus?
He has stage 2 (moderate COPD) and a pack year history of 40 which will impair his mucociliary escalator leading to mucoplugging
