general inspection

Question 1

static inspection of chest

Answer 1

assesment of supra and infraclavicular fossae
position of clavicle
direction of ribs
intercostal spaces
sternal(louis) costal(epigastric) angle
description of scapulars
symmetry of chest and sizes (forms of chest)

Question 2

normal forms of chest

Answer 2

ASTHENIC  : elongated narrow plane.
supra and infraclavicular fossae good marked and deep
louis angle subtle
costal angle <90
direction of ribs more vertical 
ratio of ant-post diameter <0.65
scapula not closely adjoined to chest
diaphragm is low 
HYPERSTHENIC: wide
supra and infraclavicular fossae not apparent 
louis angle well marked
costal angle >90
ribs interspaces narrow 
ratio ant-post diameter >0.75
scapula closely adjoined 
diaphragm high
NORMOSTHENIC : intermediate 
costal angle 90 
ration ant-post diameter 0.65-0.75
direction of ribs in lateral side is slightly slanting interspace is 1cm
scapula closely adjoined to chest 
supra and infraclavicular fossae marked

Question 3

pathological forms of chest

Answer 3

barrel chest (emphysematous): ratio ant-post 1,wide interspace, protruded infra and supraclavicular fossa
obstructive pul diseases + emphysema . involvement of accessory muscles
paralytic chest: flat long more plane than asthenic
dissymmetric, atrophy of chest m. asymmetry of clavicle and scapula . Tb and pleural sclerosis
funnel chest : depression of lower part of sternum
pigeon chest: sternum protruded ant and adjacent costal angle depressed. rickets
thoracic kyphoscoliosis: abnormal spinal curvature. tb of spine
scoliosis: lat deviation of vertical lines of spine. shoulder asymmetry

Question 4

dynamic inspection

Answer 4

rate (14-20 normal - 40 newborns 12-14 sleeping)
rhythm,
depth: determined by volume of air 400-800ml
shallow/ deep
rapid shallow(tachypnea): bronchospasm, restrictive lung diseases( pneumonia infract lungs), chest pain
rapid deep(hyperpnea): exercise anxiety metabolic acidosis , hypoxia
slow breathing(dradypnea): secondary to diabetic coma drug induced resp depression increased intracranial pressure

effort of breathing

Question 5

types of breathing

Answer 5

thoracic
abdominal
mixed

Question 6

rhythm of breathing (pathological types)

Answer 6

cheyne-strokes breathing : deep breathing with apnea
children in sleep, HF, uremia, drug induced resp depression brain damage( gradual increase max 7-8 breaths and then decrease and apnea )
kussmauls breating: deep bretahing due to met acidosis.
obstructive: exp longer. copd, chronic bronchitis asthma
grocco breathing: same as cheyne but no apnea
biots: same and then apnea

Question 7

stridor

Answer 7

harsh high pitched musical vibratory noise mostly in insp by obstruction of trachea larynx and pharynx

Question 8

wheeze

Answer 8

high pitched musical noise by high velocity air passage through narrow bronchioles. ususally heard during the entire exp or end of exp in emphysema and chronic bronchitis