Lungs & Thorax Flashcards by Eric Rozman

How are the intercostalspaces numbered

numbered for rib above (ex: 2nd ICS is b/w ribs 2 and 3)

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Number the ribs:
True ribs =
False ribs =
Floating ribs =

True ribs = 1-7
False ribs = 8-10
Floating ribs = 11 & 12

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The costocartial junction is…

Between the ribs and cartilage

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Intercostal space used for needle insertion for tension pneumothorax

2nd intercostal space

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Chest tube placement occurs in which intercostal space

4th intercostal space

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The scapula usually ends around rib ____ or ICS _____

Rib #7; ICS #7

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Angle of Louis or Sternal angle is….

The point where the 2nd rib attaches to the sternum

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Angle of Louis also corresponds to…

Point where the primary bronchi split & to vertebrae T4

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Midsternal line

Down the middle of the chest

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Right and left midclavicular lines

Down the chest, mid-way through the clavicle

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Vertebral line AKA midspinal line

Line down center of back following the spine

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Scapular lines

Synonymous to the mid-clavicular line of the chest; posterior side, mid-way through the scapula

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Where is the apex of the lung

It extends 2-4 cm above the clavicle

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Where is the horizontal fissure of the right lung

~ level of 4th rib

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On the right or left lateral views, where is the lung

It ranges from peak of axilla (apex) to ~ the 7th or 8th rib (base)

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The left lung actually has a 3rd small lobe called the…

Left lingualar lobe

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On the posterior, where is the lower border of the lung

~ T10 spinous process but decends farther with breath

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Where does the trachea bifurcate at

At vertebrae T4 (on back) and rib 2 (on front)

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How do the right and left main stem bronchi differ?

Right main stem bronchus is wider and shorter, and more verticle than left one; it is more likely to have a foreign body lodged in this one

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Mucoid sputum is clear and is most likely from what type of cause

Viral cause

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Purulent sputum is green/yellowish, and may indicate what type of infection

A bacterial infection

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If someone is coughing up or spitting up blood how do you tell if it is a GI or respiratory source?

Blood from the GI tract is darker rather than from pulmonary system (much more red and bright colored)

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You see hemoptysis in a patient. Is it normal or abnormal?

Small amount (teaspoon or less) of hemoptysis is normal with URIs

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Which is worse central or peripheral cyanosis?

Central is worse

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What are possible causes of clubbing

Bronchiectasis, malignancy, congenital heart disease, pulmonary fibrosis, cystic fibrosis

What is a barrel chest? Who is it seen in?

It is an increase in Anterior/Posterior diameter | Seen with aging and COPD

What is pectus excavatum? Why is it a problem?

It is a funnel chest (caved in) and can compress mediastinal structures; may become a surgical emergency

What is another name for pigeon chest

Pectus Carinatum

What is traumatic flail chest? Why is it a problem?

It is when part of rib cage is disconnected from the rest of the ribs/sternum; can’t oxygenate lungs when breathing due to disconnection and change in pressure

Dorsal curvature of thoracic spine

Kyphosis

Back is completely contorted, curvature to the right with hunching forward; widely separated ribs on one side and very close together on the other; causes intense pain

Kyphoscoliosis

Removal of a breast

Mastectomy

Anatomic variant seen in many mammals occuring along the “milk line” and often mistaken as moles

Supernumerary nipples

What are the accessory breathing muscles?

Abdominal SCM Trapezius Scalens

Hyperpnea (hyperventilation) of variable rate seen in DKA (due to metabolic acidosis); very rapid and deep breaths

Kussmal’s respirations

Breathing associated with pts who have brain lesions; periods of normal breathing with periods of lack of breathing

Cheyne-Stokes

Normal breathing rate

14 to 20/min

Bradypnea (breathing rate)

< 12/min

Tachypnea (breathing rate)

> 20/min, normal depth

Hyperpnea (hyperventilation)

> 20/min, and very deep

Cheyne-Stokes (breathing rate)

Gradual increasing depth with periods of apnea

Difference b/w tachypnea and hyperpnea?

Both are very fast but hyperpnea is fast with deeper breaths

Feeling for vibrations through the chest wall; testing for whether or not there is any solid or semi-solid pathology in the way

Tactile fremitus

Decreased or Absent Tactile Fremitus could indicate…

``` Voice too soft (have them say it louder) COPD Thick chest wall Pneumothorax Added air ```

Increased Tactile Fremitus could indicate…

Obstruction of any kind would increase the tactile femitus | Due to fluid or tumor (solid mass)

What may cause a flat, dull, or hyper-resonant sound upon percussion

Flat – pleural effusion Dull – tumor or pneumonia Hyperresonant – pneumothorax or COPD

What type of sound should you get upon percussion above the diaphram? What about below?

Should be resonant above and dull below

Normal excursion should be _______ cm and....

5-6cm and equal bilaterally

Abnormally high level of excursion may indicate...

Pleural effusion or elevated diaphragm

Abnormally high level of excursion may be due to...

Atelectasis, Phrenic nerve, Paralysis

What are vesicular lung sounds? Where are they heard and what do they sound like?

Inspiratory sounds last longer than expiratory, the intensity is soft, the pitch is relatively low, & they are heard over most healthy lung fields

What are broncho-vesicular lung sounds? Where are they heard and what do they sound like?

Inspiratory and expiratory sounds are about equal, are of intermediate intensity, intermediate pitch, heard over the 1st and 2nd interspaces anteriorly and between scapulae posteriorly

What are bronchial lung sounds? Where are they heard and what do they sound like?

Expiratory sounds are slightly longer than inspiratory sounds; they are loud, high pitched (tubular), and heard over the manubrium (if at all)

What are tracheal lung sounds? Where are they heard and what do they sound like?

Inspiration and expiration sound about equal; they are very loud, high pitched (tubular), and heard over the trachea in the neck

Decreased Intensity of Normal Lung Sounds with…

Obesity, Thick chest wall, Shallow breaths, Pathology

Brief discontinuous sounds, most often at end of inspiration

Crackles (rales)

With what conditions can you hear crackles?

CHF, pneumonia, bronchitis

Can have a snoring or gurgling quality, Indicate secretions in large airways (Main stem bronchi, trachea, etc)

Rhonchi

With what conditions can you hear Rhonchi?

CHF, bronchitis

Musical sounds created when air flows rapidly through bronchi that are narrowed significantly; Heard in expiration and sometimes on inspiration

Wheezes

With what conditions can you hear wheezes?

COPD, asthma, bronchitis, even CHF

Wheeze heard primarily during inspiration and mainly over larger airways

Stridor

Stridor can be sign of...

Airway obstruction, foreign body, croup, & epiglottitis

Related to inflammation of pleural surfaces; Coarse grating sound timed with lung movement; Evidence of local inflammation

Pleural rub

Occurs over areas of the lung in which the alveoli are filled with fluid or replaced by solid tissue

Bronchophony

Bronchophony can be heard with what conditions?

Pneumonia, atelectasis, or tumors.

If the patient says "E" and you hear "A" this is called...

Egophony

Egophony is a sign of...

Consolidation in the area

What is the normal result for the following: - Predominant lung sounds? - Spoken words? - Spoken “ee”? - Whispered words? - Tactile fremitus? - Percussion? - Respiratory rate?

- Predominant lung sounds? = Vessicular - Spoken words? = Distant - Spoken “ee”? = Hear e over normal lung - Whispered words? = Distant - Tactile fremitus? = Distant - Percussion? = Resonance - Respiratory rate? = 14 to 20

Expected sound with consolidation for the following: - Predominant lung sounds? - Spoken words? - Spoken “ee”? - Whispered words? - Tactile fremitus? - Percussion? - Respiratory rate?

- Predominant lung sounds? = Bronchial or broncho-vessicular - Spoken words? = Increased - Spoken “ee”? = E to A change - Whispered words? = Increased (i.e. would hear words) - Tactile fremitus? = Increased - Percussion? = Dull or flat - Respiratory rate? = variable

Differential for Crackles

Pneumonia

Differential for Rhonchi

CHF

Differential for Dullness/asymmetric excursion

Tumor

Differential for Tender ICS

Pleuritis (also might hear friction rub!)

Differential for Retractions

Respiratory distress (increased work of breathing)

Differential for Left supraclavicular adenopathy

Pancost tumor (apex of lung)

Differential for Pink Puffer

Emphysema (wheezing, not vessicular sounds)

Differential for Blue Bloater

Chronic bronchitis (blue/cyanotic, obese, rhonchi)