Practical 2

Question 1

What does a mediastinal shift indicate?

Answer 1

Changes in pressure in the pleural cavity

Question 2

Where does the mediastinum usually shift?

Answer 2

Shift is usually to the unaffected side & may cause compression of the lung on that side

Question 3

Interventions for limitations in chest and diaphragm motion?

Answer 3

Directed breathing, manual cues/resistance, lateral costal breathing, thoracic chest exercises

Question 4

What does increased vibration (fremitus) indicate?

Answer 4

increased secretions

Question 5

What does decrease vibration (fremitus) indicate?

Answer 5

decreased secretions

Question 6

Dull sounds with percussion?

Answer 6

normal if heard over liver, sternum, heart and visceral organs (posteriorly)

Question 7

Where are tympanic sounds heard?

Answer 7

over the stomach

Question 8

Normal diaphragmatic excursion?

Answer 8

3-5 cm

Question 9

What conditions would diaphragmatic excursion be less?

Answer 9

Obstructive disease where the pt has hyperinflated lungs, flattened diaphragm, & barrel chest

Question 10

Sternal precautions:

Answer 10

i. No Pulling, No pushing, & no lifting more than 5 pounds
ii. Limit arm motion if pain is present
iii. Do not sleep with hands behind head
iv. Hug pillow to chest to help remind them not to use arms and help with coughing

Question 11

Apical segment (Right upper lobe)

Answer 11

a. Anterioinferior border: clavicle
b. Posterior Inferior border: a horizontal line drawn at the level of the upper lateral border of the spine of the scapula

Question 12

Apicoposterior Segment (Left upper lobe)

Answer 12

a. Anterioinferior border: clavicle
b. Posterior Inferior border: a horizontal line drawn at the level of the upper lateral border of the spine of the scapula

Question 13

Posterior Segment (Right upper lobe)

Answer 13

a. Upper border: a horizontal line at the level of the upper lateral border of the spine of the scapula
b. Lower border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula

Question 14

Anterior Segment (right upper lobe)

Answer 14

a. Upper Border: Clavicle

b. Lower border: horizontal line at level of 3rd intercostal space, or 4th rib anteriorly

Question 15

Anterior Segment (left upper lobe)

Answer 15

a. Upper Border: Clavicle

b. Lower border: horizontal line at level of 3rd intercostal space, or 4th rib anteriorly

Question 16

MIddle lobe R (lateral and medial segments)

Answer 16

a. Upper border: a horizontal line at the level of the 3rd ICS or 4th rib anteriorly
b. Lower and lateral borders: the oblique fissure ( a horizontal line at the level of the 6th rib anteriorly) extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 4th rib at the posterior axillary line
c. The midclavicular line separates the medial and lateral segments of the right middle lobe
d. A horizontal line at the level of the 5th rib, anteriorly, separates the superior and inferior lingular segments

Question 17

Lingula (Left superior)

Answer 17

a. Upper border: a horizontal line at the level of the 3rd ICS or 4th rib anteriorly
b. Lower and lateral borders: the oblique fissure ( a horizontal line at the level of the 6th rib anteriorly) extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 4th rib at the posterior axillary line
c. The midclavicular line separates the medial and lateral segments of the right middle lobe
d. A horizontal line at the level of the 5th rib, anteriorly, separates the superior and inferior lingular segments

Question 18

Anterior basal (right lower lobe)

Answer 18

a. Upper border: the oblique fissure (horizontal line at the level of the 6th rib anteriorly, extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 5th fib at the midaxillary line
b. Lateral Border: the midaxillary line

Question 19

Anteriomedial Basal (left lower lobe)

Answer 19

a. anteriorly, extending to the anterior axillary line; from the anterior axillary line, angling upward to approximately the 5th fib at the midaxillary line
b. Lateral Border: the midaxillary line

Question 20

Superior Basal Segment (Right lower lobe):

Answer 20

a. Upper border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula (T4)
b. Lower border: a horizontal line at or approximately 1 inch above, the inferior angle of the scapula (T7)

Question 21

Superior Basal Segment (Left lower lobe)

Answer 21

a. Upper border: a horizontal line at, or approximately 1 inch below the inferomedial aspect of the spine of the scapula (T4)
b. Lower border: a horizontal line at or approximately 1 inch above, the inferior angle of the scapula (T7)

Question 22

Lateral basal segment (right lower lobe)

Answer 22

a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Medial Border: a “plumb line” bisecting the inferior angle of the scapula
c. Lateral border: the midaxillary line
d. Lower border: a horizontal line at the level of the 10th ICS posteriorly

Question 23

Lateral Basal Segment (left lower lobe)

Answer 23

a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Medial Border: a “plumb line” bisecting the inferior angle of the scapula
c. Lateral border: the midaxillary line
d. Lower border: a horizontal line at the level of the 10th ICS posteriorly

Question 24

Posterior Basal segment (right lower lobe)

Answer 24

a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Lateral border: a “plumb line” biscecting the inferior angle of the scapula
c. Lower border: a horizontal line line at the level of the 10th ICS posteriorly

Question 25

Posterior Basal Segment (Left lower lobe)

Answer 25

a. Upper border: a horizontal line at or approximately 1 inch above the inferior angle of the scapula
b. Lateral border: a “plumb line” biscecting the inferior angle of the scapula
c. Lower border: a horizontal line line at the level of the 10th ICS posteriorly