What position should you place someone in a resp exam?
45 degrees
What position should you place someone when examining posterior chest wall or lymph nodes?
Posterior chest wall - lean forwards
Lymph nodes - across the couch with legs dangling off
At what level does the trachea divide?
T4/T5
Where is the trachea palpated from and to?
Extends from larynx into thorax
palpated from larynx to suprasternal notch
What causes the trachea to displace towards the site of a lesion?
- Upper lobe collapse
- Upper lobe fibrosis
- Pneumonectomy
What causes the trachea to displace away from the site of a lesion?
- extensive pleural effusion
- tension pneumothorax
- chest expansion
How much do the tip of your thumbs move apart in normal chest expansion?
At least 5cm
At what level do you do chest expansion both anterior and posterior?
Anterior - below 5/6th rib
Posterior - 10th thoracic vertebrae
What does chest expansion in the front give you an idea about?
Expansion of upper and middle lobes (check for symmetry)
What does posterior chest expansion give you an idea about?
Expansion of lower lobes
(check for symmetry)
What are causes of unilateral decreased chest expansion?
- Pneumothorax
- Pleural effusion
- Collapsed lung
- consolidation
What are causes of bilateral decreased chest expansion?
Asthma or COPD (difficult to detect)
When percussing posterior chest wall what must you make sure the patient does?
Rotates scapulae anteriorly (crosses arms in front of themselves)
What are the causes of hyper-resonant sounds on chest percussion?
- Pneumothorax
- Hollow bowels
- COPD
What are the causes of hypo-resonant sounds on chest percussion?
- Pleural effusion (stony dull)
- Lung tumour (flat/dull)
- Consolidation (flat/dull)
- Collapse (flat/dull)
What are the two types of sounds on airway auscultation?
Vesicular
Bronchial
What type of sounds are bronchial sounds and where can they be heard?
Where can they be listened to clinically?
High pitch notes
Over:
trachea
suprasternal notch
manubrium
sternal angle
sternoclavicular joints
(airways not covered by alveolar tissue)
Listened to
- anteriorly over manubrium
- posteriorly between C7 and T3 vertebrae
What are the characteristics of bronchial breathing sounds?
- Hollow and high pitched
- Expiratory phase > inspiratory phase (time and intensity)
- Distinct pause between inspiration and expiration
- Heard over areas of pathology - consolidation, localised pulmonary fibrosis, pleural effusion and collapsed lung
(indicates pathology if found outside of its normal anatomical areas)
What are the characteristics of vesicular breathing sounds?
- Low pitch notes present over area of healthy lung tissue
- inspiratory sound = lobar/segmental airways
- expiratory sound = central airways
- Inspiratory phase > expiratory phase (time and intensity)
- No pause in-between
What causes reduction in the intensity of vesicular sounds?
- shallow breathing
- airway obstruction
- pneumothorax
- hyperinflation
- pleural effusion
- obesity
- pleural thickening
What causes prolongation of the expiratory phase in breathing?
Obstructive lung disease - asthma and chronic bronchitis
How is the middle lobe and lower lobe of the lung accessed to listen to in females?
Middle lobe - below right axilla
Lower lobe - below base of breast at 6th rib level
What are the sites of auscultation on the anterior chest?
- Apex (supraclavicular - above 1st rib)
- Infra clavicular
- 2nd intercostal space
- 6th intercostal space
- Axilla (ask patient to raise arms and percuss in mid-axillary line)
Where and what do you auscultate for at the hilum of the lung?
Mid point of scapular and posterior median line opposite the spines of T4-T6
Whether the sound is bronchial or vesicular
