resp Flashcards
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
What are the sites of auscultation on the posterior chest?
Level of trapezius
Level of spine of scapulae
Level of 10th/11th rib
What causes a decrease in tactile vocal femitus?
Decrease in density
- air in pneumothorax
- COPD
Increase in distance between chest wall and lungs
- pleural effusion (due to fluid)
What causes an increase in tactile vocal femitus?
Increased density
- consolidation in pneumonia
- tumour tissue in cancer
What are the different lymph nodes to palpate ?
Submental
Submandibular
Preauricular
Post auricular
occipital
Superior deep cervical
Inferior deep cervical
Supraclavicular nodes
What are causes of cervical lymphadenopathy?
- lung cancer metastasising to lymph nodes
- tuberculosis
- sarcoidosis
- respiratory tract infection
What are the abnormal findings in a community acquired pneumonia respiratory examination?
Chest expansion - normal but gets sharp pain on deep inspiration
Percussion - dullness to percussion in right inferior axilla
Auscultation - vesicular breath sounds on left, crackles and reduced air entry in right inferior axilla (vesicular breathing sounds elsewhere on right)
Affects right lung more than left
What can cause consolidation in the lungs? How does this appear on X-rays?
Things denser than air
- pus
- pulmonary oedema
- haemorrhage
- cancer
Appears as increased opacification
What is the Air bronchogram sign?
In consolidated tissues, some airways are still filled with air
This appears darker and superimposed over increased opacification
What is the silhouette sign?
Loss of a normal border of a structure on chest X-ray
What is the triangle of safety for chest drains?
Base of axilla (top)
5th intercostal space (base)
Lateral edge of pectoralis major (anterior)
Lateral edge of latissimus dorsi (posterior)
What is the outline for the pleura?
ANTERIORLY
- 1 inch above medial 3rd clavicle
- Sternoclavicular joint
- Manubriosternal joint - 2nd CC
- 4th rib or Rib 4-6 (cardiac notch (left only))
- 6th rib - Xiphesternal joint
- 8th rib on mid clavicular line
POSTERIORLY
- 10th rib at mid-axillary line
- 12th rib at scapular line
- L1 vertebrae , below 12th rib
- T1
What is the outline for the lungs
ANTERIORLY
- 1 inch above medical 3rd clavicle
- Sternoclavicular joint
- Manubriosternal joint - 2nd CC
- Rib 4-6 = cardiac notch (left only)
- Xiphesternal joint
- 6th rib at mid-clavicular line
POSTERIORLY
- 8th rib at mid axillary line
- 10th rib at scapular line
- T10
- T1
Where is the cardiac notch?
Rib 4-6 (left only)
What are the surface markings for the bottom of the costal margin?
- Tip of 9th rib where lateral border of rectus abdominis meets costal margin
- 10th rib (lowest part of costal margin)
What is the surface marking for the horizontal fissure of the lung?
4th rib
What is the surface marking for the oblique fissure of the lung?
junction of 6th rib and mid clavicular line anteriorly
T3 level posteriorly
