Respiratory System Flashcards
What position should the patient be in during a respiratory examination?
45 degree angle
What should be exposed during a respiratory examination?
anterior chest wall
What should you ask the patient to do when examining lymph nodes?
as the patient to sit across the couch with their legs dangling off the sides
Where does the trachea divide into the left and right main bronchi?
the level of the sternal angle - T4/T5
Where is the trachea?
- middle of the neck
- suprasternal notch of the manubrium
What should you tell the patient before assessing for tracheal deviation?
warn them that it may be uncomfortable
What does tracheal displacement towards the side of the lung lesion suggest?
- upper lobe collapse
- upper lobe fibrosis
- pneumectomy
What does tracheal displacement away from the side of the lung lesion suggest?
- extensive pleural effusion
- tension pneumothorax
- chest expansion
Where do you place your hands when assessing chest expansion (anterior)?
- below the 5th and 6th rib
- thumbs should align in the mid-sternal line
How much chest expansion would you expect to see in a normal healthy adult?
5 cm
Where do you place your hands when assessing chest expansion (posterior)?
- posterior midline
- level T10
What does the movement of the anterior chest wall indicate?
the expansion of the upper and middle lobes
What does the movement of the posterior chest wall indicate?
the expansion of the lobes of the lung
What can cause unilateral decreased expansion?
- pneumothorax
- pleural effusion
- collapsed lung
- consolidation
Where should you percuss/auscultate during a respiratory exam?
- apex
- 2nd intercostal space
- 5th intercostal space
- axilla
What is different when auscultating the apex of the lungs?
use the bell not diaphragm of the stethoscope
What does hyper-resonant percussion suggest?
- pneumothorax
- hollow bowels
- COPD
What does hypo-resonant percussion suggest?
- pleural effusion (stoney dull)
- lung tumour (flat/dull)
- consolidation (flat/dull)
- collapse (flat/dull)
What are the 2 types of sounds heard during auscultation of the lungs?
- vesicular sounds
- bronchial sounds
What are bronchial sounds?
high pitched notes heard over the trachea, suprasternal notch, manubrium, sternal angle and the sternoclavicular joints.
Where are bronchial sounds heard?
- anteriorly over the manubrium
- posteriorly between C7 and T3
- over areas of pathology
Why are bronchial sounds heard?
airways are not surrounded by alveolar tissue - therefore turbulence is heard without any filtering
What are the characteristics of bronchial sounds?
- hollow and high pitch
- expiratory phase > inspiratory phase
- distinct pause between the expiratory and inspiratory phase
In which pathologies are bronchial sounds heard?
- consolidation
- localised pulmonary fibrosis
- pleural effusion
- collapsed lung
What are vesicular sounds?
low notes present all over the rest of the chest where normal lung tissue is present?
What are the characteristics of vesicular sounds?
- inspiratory sound in lobar and segmental airways
- expiratory sound in the central airways
- inspiratory phase > expiratory phase (time and intensity)
- no pause between the 2 phases
What causes vesicular sounds?
lung tissue filters the sounds of air turbulence, low pitched sound
What does reduced intensity of vesicular sounds suggest?
- shallow breathing
- airway obstruction
- hyperinflation
- pneumothorax
- pleural effusion
- pleural thickening
- obesity
What happens to the expiratory phase (vesicular sound) in asthma and chronic bronchitis?
prolonged expiration phase
Where can you auscultate for the middle lobe of the right lung in females?
right axilla
Where can you auscultate for the lower lobe of the lungs in females?
6th rib
Where can you auscultate for the superior lobe of the lungs?
2nd intercostal space and infraclavicular
Where can you auscultate for the middle lobe of the lungs?
6th intercostal space
Where can you auscultate for the inferior lobe of the lungs?
axillae
Where is the lung hilum?
mid point of the scapular and posterior median line opposite the spines of T4-T6
Where should you auscultate on the anterior chest wall?
- supraclavicular (bell)
- infraclavicular
- 2nd intercostal space
- 6th intercostal space
- axillae
Where should you auscultate on the posterior chest wall?
- level of trapezius
- level of scapulae spine
- level of 10th rib
What is tactile vocal fremitus?
the vibration of the chest wall during vocal sound (from the larynx, down the bronchial tree and into the chest wall)
How do you assess tactile vocal fremitus?
- ask the patient to say 99
- palpate the chest wall
- vibrations should be equal
What does a decrease in tactile vocal fremitus suggest?
decrease in density (increased distance between chest wall and the lungs)
- pneumothorax
- COPD
- pleural effusion
What does a increase in tactile vocal fremitus suggest?
increase in density
- consolidation in pneumonia
- tumour tissue in cancer
Where do you asses for tactile vocal fremitus?
both the anterior and posterior chest wall
What lymphnodes should be palpated?
- submental
- submandibular
- preauricular/parotid
- postauricular
- occipital
- superior deep cervical nodes
- inferior deep cervical nodes
- supraclavicular nodes
Where are the submental nodes?
inferior to the chin
Where are the submandibular nodes?
inferior to the angle of the mandible
Where are the preauricular/parotid nodes?
anterior to the ear
Where are the postauricular nodes?
posterior to the ear
Where are the occipital nodes?
base of the occipital
Where are the superior deep cervical nodes?
superior aspect of the sternocleidomastoid
Where are the inferior deep cervical nodes?
inferior aspect of the sternocleidomastoid
Where are the supraclavicular nodes?
superior to the clavicle
What does cervical lymphadenopathy suggest?
- lung cancer metastasis
- tuberculosis
- sarcoidosis
- respiratory tract infection
What would be seen during an examination when there is community acquired pneumonia?
- sharp pain on deep inspiration
- dullness to percussion (in effected region of the lung)
- crackles and reduced air entry (in effected region)
How is consolidation seen on an x-ray?
consolidation is more dense than air, and therefore whiter - increased opacification
What can cause consolidation?
- pus
- pulmonary oedema
- haemorrhage
- cancer
What can be seen on air bronchograms?
consolidated airways with trapped air - darker and superimposed over the increased opacification
What is the silhouette sign?
loss of the normal border of a structure on a chest x-ray
What is the borders of the triangle of safety for chest drains?
superior: apex below the axilla
medial: anterior axillary fold of pectoralis major
lateral: posterior axillary fold of latissimus dorsi
inferior: 4th/5th intercostal space
Where can you place the needle for a chest drain?
2nd, 3rd, 4th and 5th intercostal space on the midaxillary line
Where is the anterior oblique fissure?
junction of 6th rib and midclavicular line
What are the top point of the pleura?
1 inch above the medial 3rd of the clavicle
What are the bottom point of the pleura?
8th rib, midclavicular line
What is the landmark of the lung hilum?
mid point of scapular and posterior median line opposite spines of T4-T6
Where is the scapular line?
medial border of scapula
Where is the posterior oblique fissure?
T3 level
