Lungs & Thorax Flashcards
How are the intercostalspaces numbered
numbered for rib above (ex: 2nd ICS is b/w ribs 2 and 3)
Number the ribs:
True ribs =
False ribs =
Floating ribs =
True ribs = 1-7
False ribs = 8-10
Floating ribs = 11 & 12
The costocartial junction is…
Between the ribs and cartilage
Intercostal space used for needle insertion for tension pneumothorax
2nd intercostal space
Chest tube placement occurs in which intercostal space
4th intercostal space
The scapula usually ends around rib ____ or ICS _____
Rib #7; ICS #7
Angle of Louis or Sternal angle is….
The point where the 2nd rib attaches to the sternum
Angle of Louis also corresponds to…
Point where the primary bronchi split & to vertebrae T4
Midsternal line
Down the middle of the chest
Right and left midclavicular lines
Down the chest, mid-way through the clavicle
Vertebral line AKA midspinal line
Line down center of back following the spine
Scapular lines
Synonymous to the mid-clavicular line of the chest; posterior side, mid-way through the scapula
Where is the apex of the lung
It extends 2-4 cm above the clavicle
Where is the horizontal fissure of the right lung
~ level of 4th rib
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)
The left lung actually has a 3rd small lobe called the…
Left lingualar lobe
On the posterior, where is the lower border of the lung
~ T10 spinous process but decends farther with breath
Where does the trachea bifurcate at
At vertebrae T4 (on back) and rib 2 (on front)
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
Mucoid sputum is clear and is most likely from what type of cause
Viral cause
Purulent sputum is green/yellowish, and may indicate what type of infection
A bacterial infection
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)
You see hemoptysis in a patient. Is it normal or abnormal?
Small amount (teaspoon or less) of hemoptysis is normal with URIs
Which is worse central or peripheral cyanosis?
Central is worse
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)
