Lungs & Thorax Flashcards
What is the costal angle?
??
What rib is in intercostal space 2
Rib 2
How many ribs
1-7 true ribs
8-10 false ribs
11 & 12 floating ribs
12 total
What rib space is used for needle aspiration of tension pneumothorax
Intercostal space 2
What rib space is used for chest tube placement?
Intercostal space 4
Posteriorly where do the ribs articulate?
Facets on transverse process and vertebral body
Where do neurovascular structures of ribs run posteriorly?
Along lower side of rib
Near what rib does the scapula end posteriorly?
7th rib
T1 vertebrae articulates with what rib
Rib 1
What is the angle of Louis
point where 2nd rib attaches to sternum
What vertebrae is correlated with anterior attachment of rib2
T4
-also area where trachea bifurcates into right and left side
What landmark is superior to the angle of Louis
Supra-sternal notch
What line runs down sternum
Midsternal line
What line is lateral to the midsternal line?
Midclavicular line
What line runs through C7
Midspinal line
What lines run lateral to the midspinal line?
Scapula lines
What does infra-mammary mean?
Below the nipples
Anteriorly how far does the apex extend above the clavicle?
2-4cm
Where approx. is the horizontal fissure?
Level of 4th rib
Right laterally, lung extends from ___ to _____
Peak of axilla
to 7th or 8th rib
What lobes make up the left lung?
LUL, LLL, lingual
What is the lower border of the lungs posteriorly
T10 at rest
T12 on inspiration
What bronchus is wider?
Right main stem, is also shorter
Mucoid sputum is_____ in color and probably signifies______
Translucent
Viral URI
Purulent sputum is _______ in color and probably signifies_____
Yellow or Green
bacterial infection
When examining lungs/thorax posteriorly how should the patient sit?
Sitting up with arms crossed over each other
What are purplish/blue lips significant for
Cyanosis- sign of inadequate oxygenation of tissue
What main conditions appear with clubbing?
Bronchiectasis, malignancy, congenital heart disease, pulmonary fibrosis, CF
but NOT COPD
What is a barrel chest?
Increased A/P diameter
seen in aging and COPD
What is pectus excavatum?
Congenital funnel chest
can compress mediastinal structures
What is pectus carinatum
Congenital pigeon chest
What is traumatic flail chest?
Seen in traumatic injury
Paradoxical breathing from separation of part of the chest wall moving in opposition
-medical emergency
What is kyphosis
excess curvature of the back “hunch back”
dorsal curvature of thoracic spine
seen often in elderly women with osteoporosis
What is kyphoscoliosis?
Spinal convexity into other plane than normal
Forward hunching
Widely separated ribs on one side and other side has tight ribs
What accessory muscles participate in breathing
abdominal
SCM
trapezius
scalenus
What is the term for intercostal muscles working hard often seen in supraclavicular fossa
retractions
What is hyperpnea of variable rates seen in DKA?
Kussmal’s respirations
What breathing is associated with brain lesions and is increased with bouts of no breathing?
Cheyne-Stokes
What is bradypnea
<12 breaths/min
What is tachypnea
> 20/min with normal depth
What is a normal respiration rate?
14-20
What would cause asymmetry of respiratory excursion?
pain (splinting) paralysis pneumothorax Hemothorax pleural effusion
Would could decreased of absent tactile fremitus indicate?
Voice too soft COPD thick chest wall pneumothorax obstruction of any kind (air, fluid, tumor)
What is hyperresonant percussion over interspaces indate?
pneumothorax or COPD
What does a dull sound during percussion indicate?
Probably not in interspaces
tumor or pneumonia
What does a flat sound during percussion indicate?
Probably not in interspaces
pleural effusion
What sound is expected during percussion of lungs?
Resonance
What does abnormally high levels of diaphragmatic excursion mean?
diaphragm too high pleural effusion atelectasis phrenic nerve injury paralysis
If bronchovesicular or bronchial sounds are heard in locations distant from expected sites, suspect
that air filled lung has been replaced by fluid-filled or solid lung tissue
Decreased intesnsity of normal lungs sounds seen in
obesity
thick chest wall
shallow breaths
pathology
What are crackles?
brief discontinuous sounds, most often at end of inspiration
What are ronchi
Snoring or gurgling sound
indicates secretions in large airways
What are wheezes?
Musical sounds created when air flows rapidly through significantly narrowed bronchi
heard in expiation and sometimes on inspiration
What is stridor?
wheeze heard primarily during inspiration and mainly over large airways
What can stridor be a sign of?
Foreign body aspiration
croup
epiglottitis
What is a pleural rub?
Related to inflammation of pleural spaces
Coarse grating sound timed with lung movement
A increased intensity of transmitted voice sounds is indicative of
Consolidation
typical of pneumonia
A decreased intensity of transmitted voice sounds common in
normal
or when fluid or air pushes lung away from chest wall
What is bronchophony
Listening through chest wall as patient says number
What is egophony?
an E to A change demonstrating consolidation or mass
