Respiratory system Flashcards
which are the false ribs?
ribs 8-10
they attach indirectly to ternum through CC of rib 7
which are the floating ribs?
11 and 12
do not attach to sternum
what is the subcostal plane?
level of T3
plane passing through lowest margin of ribs
what are the surface markings of the upper lobe of the R lung?
- apex is 2-3cm above medial 1/3 of R clavicle
- steroclavicular joint
- right 2nd CC
- 4th right CC
- T3 just lateral to PML
- T1 just lateral to PML
what are the surface markings of the middle lobe of the R lung?
- 4th right CC
- 6th right CC just lateral to AML
- 6th rib at MCL
- 4th rib at MAL
what are the surface markings of the lower lobe of the R lung?
- 6th right CC lateral to AML
- 6th rib at MCL
- 8th rib at MAL
- 10th rib at scapular line
- 10th rib just lateral to PML
what are the surface markings of the upper lobe of the L lung?
- apex 2cm above medial 1/3 of clavicle
- sternoclavicular joint
- left 2nd CC
- 4th CC
- 6th CC lateral to AML
- T3 just lateral to PML
- T1 just lateral to PML
what are the surface markings of the lower lobe of the L lung?
- 6th L rib at MCL
- 8th rib at MAL
- 10th rib at scapular line
- 10th rib just lateral to PML
what happens at 4-6th rib anteriorly?
L lung deviates from midline, compared to R lung
due to hearts position in mediastinum
what does the oblique fissure of right lung do?
separates lower lobe of R lung from upper and middle lobes
what does the oblique fissure of left lung do?
separates inferior lobe of L lung from superior lobe
how do you surface mark the oblique fissure in both lungs?
- ask patient to sit up
- palpate lung border at T3 posteriorly (level of spine of scapula)
- anterior chest wall, identify 6th CC
- connect 2 points around lateral thoracic wall
how do you surface mark the transverse fissure in R lung?
- right 4th CC
- line extending along 4th rib to meet oblique fissure at MAL near axilla (above nipples in males)
what are the surface markings of the R parietal pleura?
- apex 2-3cm above medial 1/3 of clavicle
- R sternoclavicular joint
- 2nd CC at sternal angle
- 4th CC at sternal border
- 6th CC at sternal border
- 8th rib at MCL
- 10th rib at MAL
- 12th vertebra at scapular line
- L1 vertebra transverse process at PML
what are the surface markings of the L parietal pleura?
- apex is 2-3cm
- L sternoclavicular joint
- 2nd CC at sternal angle
- defect sharply to L compared to R
- 8th rib at MCL
- 10th rib at MAL
- 12th vertebra at scapular line
- L1 transverse process at PML
what are the surface markings of the R visceral pleura?
- apex 2cm above medial 1/3 clavicle
- right sternoclavicular joint
- 2nd CC at sternal angle
- 4th CC at sternal border
- 6th CC at sternal border
- 6th rib a MCL
- 8th rib at MAL
- 10th vertebra at scapular line
what are the surface markings of the L visceral pleura?
- apex 2cm above medial 1/3 clavicle
- L sternoclavicular joint
- 2nd CC at sternal angle
- defect sharply to L
- 6th rib at MCL
- 8th rib at MAL
- 10th vertebra at scapular line
how do you investigate symmetrical lung inflation?
- place hands around lateral ribcage
- ask pt to take a deep breath in
- measure by eye how much thumbs move apart in each direction
what is normal lung inflation?
thumbs move apart at an equal distance of 2-3cm in each direction
what would decrease lung expansion?
lung disease
e.g. pneumonia, collapsed lung
what would cause a unilateral decrease?
pleural effusion
what would cause a bilateral decrease?
COPD
how do you investigate breathing pattern and breathing rate?
- I’m going to have a look at your breathing, is that okay with you?
- count number of breaths for 30 seconds, multiply by 2
- is breathing pattern regular/irregular?
what does rapid shallow breathing suggest?
hyperventilation episodes, interstitial lung disease
what does a prolonged expiratory phase suggest?
significant airway obstruction
e.g. asthma, COPD
What is Kussmaul’s respiration?
rapid, deep, sighing breathing pattern
“air hungur”
caused by acidosis e.g. diabetic ketoacidosis
where do you percuss the upper lobe on the anterior chest wall?
- medial 1/3 of clavicle directly onto bone
2. any point below clavicle and above 4th rib
where do you percuss the upper lobe on the posterior chest wall?
at level of T1 and T3 b/ scapular line and vertebral column
where do you percuss the middle lobe of R lung?
on anterior chest wall
- 4th or 5th ICS (just under nipple for men)
- just below axilla at MAL
where do you percuss the lower lobe on the anterior chest wall?
6th ICS near MAL
just under base of breast in females
where do you percuss the lower lobe on the posterior chest wall?
anywhere b/ scapula to T10
8th rib at scapular line
when is a resonant sound heard?
lung is air filled
when is a dull sound heard?
presence of fluid
when tissue density is increased
when is a flat sound heard?
solid in pleural space
when is a hyperresonant sound heard?
pneumothorax
before auscultation, what do you need to do?
- consent
- stethoscope on the correct way
- ensure diaphragm is engaged by lightly tapping on it
where do you auscultate the upper lobe on the anterior chest wall?
- lung apex - above medial 1/3 clavicle
2. any point on ant chest wall below clavicle and above 4th rib
where do you auscultate the upper lobe on the posterior chest wall?
upper back near scapula spine (level T3)
where do you auscultate the middle lobe of the R lung?
anterior chest wall
- 5th ICS at MCL (just under nipple for men)
- just below axilla at MAL
where do you auscultate the lower lobe on the anterior chest wall?
6th or 7th ICS near MAL
just under base of breast
where do you auscultate the lower lobe on the posterior chest wall?
anywhere b/ scapula to T10
e.g. 8th rib at scapular line
before demonstrating the safety triangle, what do you need to ask the pt to do?
ask pt to move the hand to the back of their head on the side you are going to demonstrate it on
what is the posterior border of the safety triangle?
anterior border of latissimus dorsi
what is the anterior border of the safety triangle?
lateral border of pectoralis major
what is the inferior border of the safety triangle?
5th ICS at MAL
what is the superior border of safety triangle?
below apex of axilla
why is this the “safety triangle”?
can insert a chest drain here without damaging any nearby nerves e.g. long thoracic nerve
where does the triangle of safety overlie?
2nd to 5th ICS
