Resp Flashcards
How would you ascultate the right lung antieriorly?
Apex - 1 inch above the medial 3rd of clavical (use the bell)
Upper lobe - 2nd ICS
Middle lobe - 4th ICS medial to nipple and base of the axilla MAL
Lower lobe - 6 ICS anterior axillary line
How would you ascultate the lungs posteriorly?
1st 3rd and 8th ICS
What is the surface marking of the right lung?
(A) The apex of the lung (in the root of the neck above the medial 1/3 of the clavicle)
(B) Just over the sterno clavicular joint
(C) Straight line to just right of AML at level of 6th CC (xiphoid process)
From here, the lower border of the lung follows two ribs above the pleural reflection around the chest wall.
(B) MCL at 6th rib (anteriorly)
(C) MAL at 8th rib (laterally)
(D) Scapular line (verticle line through the inferior angle of the scapular) at 10th rib (posteriorly) - inferior border of scapular = T7
What are the surface markings for the fissures of the left lung?
Oblique fissure
Mark 2 points and draw line between
1) Posteriorly - lung border at level of T3
2) Anteriorly - lower border of lung at 6th CC
*fissure closley follows the medial border of the scapular when the arm is raised above the head
What is a normal breathing rate?
12-20 breaths per minute
Breath = one inhalation + one exhalation
What are the surface markings for the right parietal pleura?
(A) The apex of the pleura (in the root of the neck above the medial 1/3 of the clavicle)
(B) Just over the sterno clavicular joint
(C) Straight line to just right of AML at level of 6th CC (xiphoid process)
(D) Just lateral to MCL at level of 8th rib (just above costal margin)
(E) MAL at level of 10th rib (lowest point of costal margin)
(F) Straight line across to the transverse process of L1 vertebra (subcostal pleura below 12th rib)
(G) Straight line up to transverse process T1 vertebra (first palpate spine of T1)
How would you percuss the left lung?
How would you investigate symmetrical lung inflation?
- Stand in front of the subject and ask the patient to take a deep breath out
- Place hands firmly on the anterior chest wall (just below 5th or 6th ribs, beneath the breast in female subject) with fingers extended around the sides of the chest
- The thumbs should just meet in the anterior midline (mid-sternal line), resting lightly on the chest wall, to allow its movement during respiration
- Ask subject to take a deep breath in and observe how far the tips of the thumbs move apart- should be at least 5cm
- Repeat this examination on the posterior chest wall, with thumbs meeting in the posterior midline T10 (T7 is at the level of inferior angle of the scapula)
Note:
Make sure to say the inflation is symmetrical and normal
What are the surface markings for the fissures of the right lung?
Oblique fissure
Mark 2 points and draw line between
1) Posteriorly - lung border at level of T3
2) Anteriorly - lower border of lung at 6th CC
*fissure closley follows the medial border of the scapular when the arm is raised above the head
Horizontal fissure
Follows the 4th rib
meets the oblique fissue in the mid axillary line
What is the traingle of saftey for a chest drain?
1) posterior - lattissimus dorsi
2) anterior - pec major
3) inferior - 5th ICS MAL
4) superior -base of axilla
Insert needle above 4th rib
Whats the surface marking of the left lung?
(A) The apex of the lung (in the root of the neck above the medial 1/3 of the clavicle)
(B) Just over the sterno clavicular joint
(C) Below the 4th costal cartilage, the cardiac notch deviates by 2-3 cm lateral at the level of 5th costal cartilage.
From here, the lower border of the lung follows two ribs above the pleural reflection around the chest wall.
(D) MCL at 6th rib (anteriorly)
(E) MAL at 8th rib (laterally)
(F) Scapular line at 10th rib (posteriorly) - inferior border of scapular = T7
How would you percuss the right lung?
For upper lobe:
2nd ICS
For the middle lobe - percuss at 2 locations
The 4th/5th ICS MCL
AND
Just below the base of the axilla at the MAL
For the inferior lobe:
Posterior 7 ICS
How would you ascultate the left lung?
Anteriorly
Apex - 1 inch above the medial 3rd of clavical
Upper lobe - 2nd ICS
Posteriorly
7th ICS
Where should you auscultate the middle right lobe?
Percuss at 2 locations
The 4th/5th ICS MCL
AND
Just below the base of the axilla at the MAL
What are the surface markings for the left parietal pleura?
Draw them
(A) The apex of the pleura (in the root of the neck above the medial 1/3 of the clavicle)
(B) Just over the sterno clavicular joint
(C) Manubriosternal joint 2nd CC
(D) Deflection to the left between 4th and 6th CC for cardiac notch
(E) Just lateral to MCL at level of 8th rib (just above costal margin)
(F) MAL at level of 10th rib (lowest point of costal margin)
(G) Straight line across to the transverse process of L1 vertebra (subcostal pleura below 12th rib)
(H) Straight line up to transverse process T1 vertebra (first palpate spine of T1)
