Pulmonary Examination

Question 1

What is angle of Louis ?

Answer 1

It is the manubriostrenal joint at the level of the second ribs

Question 2

Anatomical significance of the angle of Louis?!

Answer 2

It is the level of the right atrium, the thoracic duct Cross over, the trachea bifurcates, and the azegous vein joins and is at the level of T4.

Question 3

The middle lobe of the right lung is between which intercostal spaces ?

Answer 3

4th and 6th

Question 4

Which is the anatomical landmark of right hemi-thorax where all the three lobes can be examined?

Answer 4

The axillary region

Question 5

What are the borders of liver on thoracic cage?

Answer 5

The 5th rib in the mid clavicular line, the 7th rib in the mid axillary line, and the 9th rib in the mid scapular line are the borders of the liver. Any dullness above these landmark are the signs of pathology in the lungs

Question 6

When percussing the left side of the thorax the 2nd intercostal space should have what type of note ?

Answer 6

Resonance of the lungs

Question 7

What are the anatomically significant structures at the Traubs space?

Answer 7

The lower end of the left lung, the anterior border of the spleen, the left costal margin, and the inferior margin of the left lobe of the liver.

Question 8

What are the surface markings of the Traubs space ?

Answer 8

The Left sixth rib superiorly at the midclavicular line, the left mid axillary line laterally, and the Left costal margin inferiorly.

Question 9

What is castle’s sign?

Answer 9

It is a physical examination finding of splenomegaly. It is elicited by percussing the 8th or 9th intercostal space in the anterior axillary Line with the patient in supine position. When percussed in full expiration the 🎶 is resonate and if it changes from resonate to dull on full inspiration. The castle sign is said to be positive.

Question 10

What is the sensitivity and specificity of castle sign ?

Answer 10

82% and 83%

Question 11

The anatomical borders of gastric bubble in the Traubs space are ?

Answer 11

It is the space that generates a tympanic note while percussing the area between the 6th and 9th rib between the midclavicular and mid axillary lines respectively

Question 12

What is the note of percussing the chest in the context of consolidation?

Answer 12

Dullness

Question 13

In plural effusion the note of percussion on the Traubs space is ?

Answer 13

Dull because the fluid filled lungs will obliterate the Traubs space

Question 14

Tripod posture is classically seen in what type of patients during pulmonary examination?

Answer 14

COPD

Question 15

Why do COPD patients assume tripod posture?

Answer 15

It helps their scalene muscles to lift the rib cage during inspiration

Question 16

Physical features of COPD patients?

Answer 16

They may have push breathing, they may have hollowing of the supraventricular area and hypertrophy of anterior and middle scalenes, downward excursion of trachea ( Adams apple)due to the flatbed diaphragm exerting a pull on the trachea. They may also have thoracic kyphosis, prominent angle of Louis, Harrison’s sulcus, and Hoover’s sign.

Question 17

Forwarded and backwards movement of trachea occurs synchronously with every hear beat is a sign of ?

Answer 17

Aortic aneurysm

Question 18

What is Harrison’s sulcus?

Answer 18

It is an indentation occurs at the sixth intercostal space bilaterally as a result of the abnormal pull of the diaphragm( inward contraction in lieu of downward). It is commonly seen in COPD

Question 19

What is Hoover’s sign?

Answer 19

It is the inward drawing of the costal margins during inspiration because of the inward pull of the diaphragm.