Respiratory Surface anatomy and Respiratory examination Flashcards
what are the 4 techniques when examining surface anatomy
Visual inspection
palpation
percussion
auscultation
landmarks of the thorax
where does the jugular notch corresponds to in males vs females
In MALES:
- 2rd thoracic vertebra
In females:
- 3rd thoracic vertebra
what 4 things does the sternal angle correspond with
correspondes with:
- connecting the 2nd costal cartilage laterally
- being the lower border of 4th thoracic vertebra
- the bifurcation of the trachea in adults
- the beginning of the aortic arch
what is the joint found in the xiphoid process what where does it lie
- Joint is xiphisternal synchondrosis
- lies opposite side of the body to the 9th thoracic vertebra
what can be palpated in the inferior fossa of the clavicle?
the coracoid process
what are the 2 angles in the costal arch
- intrasternal angle
- xiphocostal angle
organisation and functions of the respiratory system
what does the conducting portion of the respiratory system transport
air
what does the respiratory portion of the respiratory system carry out
carries out gaseous exchange
Tracheo-bronchial tree
what vertebral level is the Hila situated?
situated in T5/6
why is the hilum opaque on radiographs?
due to presence of fluid (blood vessels)
why is it clinically significant that the right bronchus is more vertical than the left
- this is clinically significant because foreign bodies are more likely to enter the right bronchus than the left
what is the only thing that occupies the costodiaphragmatic recess (it is otherwise empty), and when is the only time this occurs
- lungs occupy costadiaphragmatic recess
- only during deep inspiration
lungs: surface markings
where does the apex of the lungs lie
2cm superior medial third of the clavicle
what are the 2 lung fissures that have lung surface markings and outline how they run
oblique fissure:
- T3/T4 spinous process to the 6th costal cartilage
Horizontal fissure:
- follows the 4th intercostal space from the sternum to meet the oblique fissure at 5th rib
how does the oblique fissure run in the both of the lungs
T3/T4 spinous process to the 6th costal cartilage
how does the horizontal fissure run for the right lung
- follows the 4th intercostal space from the sternum to meet the oblique fissure at the 5th rib
pleura
why can’t the visceral pleura be separated from the lungs
visceral pleura tightly covers the lungs
what 4 places does the parietal pleura cover and what is the name of the parietal pleura in these areas
Thoracic cage:
- costal pleura
mediastinum:
- mediastinal pleura
cervical region:
- cervical pleura
diaphragm:
- diaphragmatic pleura
which pleura senses pain?
the parietal pleura
how much fluid is found between the pleural membranes and what is its protein concentration?
fluid volume: 10-20ml
protein concentration: less than 1.5g/dL
what holds the pleura together
- surface tension
END OF RESPIRATORY SURFACE ANATOMY
END OF RESP SURFACE ANATOMY
respiratory examination
what are the 4 steps of respiratory examination
- Inspect
- palpate
- percuss
- auscultate
examination: palpation
what 3 things can lateralisation of the trachea suggest in palpation during respiratory examination
- Pneumothorax
- Tumour (superior lobe)
- Atelectasis
outline what 6 things you would assess in visual inspection on a patient
assess:
- respiratory effort/rate
- if patient is using any accessory muscles of respiration
- if the patient’s cough is dry or productive
- if their breathing sounds are normal and if they have rhonchi sounds
- thoracic shape: is it normal, symmetrical or hyperinflated?
- colour: Cyanonsis? look at mucous membranes like lips gums around eyes nails
- finger clubbing
outline 3 steps for how palpation of the trachea and suprasternal notch works in respiratory examination
- explain to the patient that the procedure may be uncomfortable
- palpate the trachea by your index and middle fingers at the supra-sternal notch in between the sternal heads of sternomastoid
- assess if trachea is centrally placed
outline 4 steps of assessment of chest expansion by palpation in respiratory surface anatomy
- explain what you will do to the patient
- place thumbs at level of T10 with fingers grasping and level with rib cage
- ask patient to take a deep breath in through their mouth
- assess movement of your hands - anteriorly or with a tape measure.
outline how you would examine chest expansion in palpation and what should it be from full expiration to full inspiration
step: ask patient to inspire maximally and then measure how much the chest expands outwardly and antero-posteriorly
- should be equal to or > 5cm expansion from full expiration to full inspiration
what 5 things can cause a reduction in chest expansion upon palpation of chest in respiratory surface anatomy?
- fibrosis
- collapse
- consolidation
- effusion
- pneumothorax
how do you examine vocal fremitus in a patient in palpation examination
- place palm/ulnar side of the hand on the chest wall
- ask patient to repeat word “ninety-nine”
- feel for vibrations in chest wall and compare left and right sides
- it is abnormal if the left and right vibrations are different
what does abnormal vocal fremitus suggest if the differences are increased vibration on one side vs decreased vibration?
increased vibration on one side:
- consolidation/ masses
decreased vibration:
- effusion of some kind
outline the steps to perform percussion examination
- place left 3rd digit (finger pad) in the intercostal spaces
- tap the left middle phalanx (phalanges) with the 3rd digit of the right hand
- withdraw the middle finger quickly after the tap wiht a brisk, relaxed, bouncy movement
- keep tapping and listen to the sound produced
if these sounds are produced in the lungs, what disorders does it denote:
- Resonant
- Hyper-Resonant
- Tympanic
- Dull
- Stony dull
resonant:
- normal lungs
hyper-resonant:
- pneumothorax
- tympanic:
over hollow viscera
Dull:
- consolidation/collapse
stony dull:
- effusion/mass
what 3 sounds do you look out for upon auscultation
- quality of breath sounds
- intensity of breath sounds
- additional/adventitious breath sounds
what are 3 vesicular breath sound features you will look out for upon ascultation?
- if inspiration is longer than expiration
- if there is no pause between inspiration and expiration
- if expiration is short
what are 2 bronchial breath sound features you will look for upon auscultation?
- if blowy sound is heard in peripheral lung when alveolar air is replaced by solid lung tissue
- equal length of expiration and inspiration but with a gap
what are 4 disorders where you can hear the bronchial breath sounds in other parts of the lung
- consolidated lung
- collapsed lung
- pleural effusion
- fibrotic lung
what are 4 adventitious sounds that could be heard upon auscultation?
- wheeze
- stridor
- rhonchi
- pleural rub
what is wheezing
adventitious sound with a high pitch and occurs during inspiration, expiration or both
what is stridor
wheeze that is heard ONLY in INSPIRATION
what does stridor indicate?
stridor indicates partial obstruction of the trachea or the larynx
what is rhonchi and what does it suggest?
rhonchi:
- low pitched sound with snoring quality
- rhonchi suggest secretions in the large airways
what is pleural rub and what does it suggest
pleural rub:
produced due to 2 inflamed pleural surfaces being rubbed together
- it suggests pneumonia or pulmonary embolism
why would inflammation in the diaphragmatic pleura cause shoulder pain
because it will stimulate the phrenic nerve, which would cause shoulder or neck pain
