Lungs

Question 1

Inspection

Answer 1

Done standing
Uncover upper body, keep bra on.
Look healthy/ill (complexion:color, facial expression, eyes, color lips), symmetry
Thorax move symmetrically
Chest or abdomen mainly moving: chest is more superficial then abdomen
Look if breathing is regular: depth
look from face and sides: ask patient to rotate
Assess: skeleton, muscle contour, thoracic subcutis

Measure
Ratio 5:6, expiration a lil longer
Respiration rate: 14-20
Exercise -> RR and depth goes up but ratio stays the same

Question 2

Measuring thorax

Answer 2

Done standing
raise both arms
at nipple height for men
above breast for women
during normal respiration shouldnt chage 
during deep should increase by 5-10cm

Question 3

Respiratory excursion

Answer 3

palpation
Done standing
Done if suspicions after inspection
Done in 5 positions and each time normal and deep breathing:
-Upper anterior thorax: both hand on pectoralis with fingers towards clavicles
-Anterior thorax: both hands under breasts, finger towards outside and thumb thowards sternum
-Lateral thorax: both hands on either side of the flanks,under breast
- 1 hand on sternum, 1 on spine
- low posterior thorax, hands vertical under shoulder blade / scapula

Question 4

Topographic percussion

Answer 4

Resonant: air -> lung
dull: no air -> liver
tympanic: some air
Sit with back towards you
Lung border with percussion on scapular line ( pertrusion scapular) : T10-11 right a bit higher than left because of liver
Deep breath: move down 4-6cm
Patient lie down
Fingers parallel to ribs
Percuss on midclavicular line every 1cm
Move breast up with pleximeter finger
Relative lung-liver border: 5th intercoastal space. Diaphragram close to liver, still a bit of air but less resonance
Absolute lung-liver border: complete dullness, no more air, liver.
Left lung border cannot be determined because of the heart.

Question 5

comparative percussion

Answer 5

Patient sit
Anterior
Compare left and right by alternating, go along midclavicular line, start at supraclavicular fossa and finish at lung border
Flank
Ask to cross arms. 1 side then the other
Posterior
Ask to cross arms, alternate left and right, clavicle level then along shoulder blades

Question 6

Auscultation

Answer 6

Patient sit on examination table
Listen below clavicle with diaphragm
Deep breath with mouth open
Vesicular breath sounds
Ratio is 3:1, inspiration longer, because most too soft t hear through thoracic wall

Comparative: anterior, flanks and back
Cross arm for flank and back

Question 7

Examination

Answer 7

Inspection
Palpation
Percussion
Auscultation