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OSPE > Respiratory system > Flashcards

Respiratory system Flashcards

1
Q

which are the false ribs?

A

ribs 8-10

they attach indirectly to ternum through CC of rib 7

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2
Q

which are the floating ribs?

A

11 and 12

do not attach to sternum

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3
Q

what is the subcostal plane?

A

level of T3

plane passing through lowest margin of ribs

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4
Q

what are the surface markings of the upper lobe of the R lung?

A
  • 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
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5
Q

what are the surface markings of the middle lobe of the R lung?

A
  • 4th right CC
  • 6th right CC just lateral to AML
  • 6th rib at MCL
  • 4th rib at MAL
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6
Q

what are the surface markings of the lower lobe of the R lung?

A
  • 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
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7
Q

what are the surface markings of the upper lobe of the L lung?

A
  • 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
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8
Q

what are the surface markings of the lower lobe of the L lung?

A
  • 6th L rib at MCL
  • 8th rib at MAL
  • 10th rib at scapular line
  • 10th rib just lateral to PML
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9
Q

what happens at 4-6th rib anteriorly?

A

L lung deviates from midline, compared to R lung

due to hearts position in mediastinum

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10
Q

what does the oblique fissure of right lung do?

A

separates lower lobe of R lung from upper and middle lobes

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11
Q

what does the oblique fissure of left lung do?

A

separates inferior lobe of L lung from superior lobe

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12
Q

how do you surface mark the oblique fissure in both lungs?

A
  • 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
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13
Q

how do you surface mark the transverse fissure in R lung?

A
  • right 4th CC

- line extending along 4th rib to meet oblique fissure at MAL near axilla (above nipples in males)

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14
Q

what are the surface markings of the R parietal pleura?

A
  • 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
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15
Q

what are the surface markings of the L parietal pleura?

A
  • 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
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16
Q

what are the surface markings of the R visceral pleura?

A
  • 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
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17
Q

what are the surface markings of the L visceral pleura?

A
  • 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
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18
Q

how do you investigate symmetrical lung inflation?

A
  • place hands around lateral ribcage
  • ask pt to take a deep breath in
  • measure by eye how much thumbs move apart in each direction
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19
Q

what is normal lung inflation?

A

thumbs move apart at an equal distance of 2-3cm in each direction

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20
Q

what would decrease lung expansion?

A

lung disease

e.g. pneumonia, collapsed lung

21
Q

what would cause a unilateral decrease?

A

pleural effusion

22
Q

what would cause a bilateral decrease?

A

COPD

23
Q

how do you investigate breathing pattern and breathing rate?

A
  • 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?
24
Q

what does rapid shallow breathing suggest?

A

hyperventilation episodes, interstitial lung disease

25
Q

what does a prolonged expiratory phase suggest?

A

significant airway obstruction

e.g. asthma, COPD

26
Q

What is Kussmaul’s respiration?

A

rapid, deep, sighing breathing pattern
“air hungur”
caused by acidosis e.g. diabetic ketoacidosis

27
Q

where do you percuss the upper lobe on the anterior chest wall?

A
  1. medial 1/3 of clavicle directly onto bone

2. any point below clavicle and above 4th rib

28
Q

where do you percuss the upper lobe on the posterior chest wall?

A

at level of T1 and T3 b/ scapular line and vertebral column

29
Q

where do you percuss the middle lobe of R lung?

A

on anterior chest wall

  • 4th or 5th ICS (just under nipple for men)
  • just below axilla at MAL
30
Q

where do you percuss the lower lobe on the anterior chest wall?

A

6th ICS near MAL

just under base of breast in females

31
Q

where do you percuss the lower lobe on the posterior chest wall?

A

anywhere b/ scapula to T10

8th rib at scapular line

32
Q

when is a resonant sound heard?

A

lung is air filled

33
Q

when is a dull sound heard?

A

presence of fluid

when tissue density is increased

34
Q

when is a flat sound heard?

A

solid in pleural space

35
Q

when is a hyperresonant sound heard?

A

pneumothorax

36
Q

before auscultation, what do you need to do?

A
  1. consent
  2. stethoscope on the correct way
  3. ensure diaphragm is engaged by lightly tapping on it
37
Q

where do you auscultate the upper lobe on the anterior chest wall?

A
  1. lung apex - above medial 1/3 clavicle

2. any point on ant chest wall below clavicle and above 4th rib

38
Q

where do you auscultate the upper lobe on the posterior chest wall?

A

upper back near scapula spine (level T3)

39
Q

where do you auscultate the middle lobe of the R lung?

A

anterior chest wall

  1. 5th ICS at MCL (just under nipple for men)
  2. just below axilla at MAL
40
Q

where do you auscultate the lower lobe on the anterior chest wall?

A

6th or 7th ICS near MAL

just under base of breast

41
Q

where do you auscultate the lower lobe on the posterior chest wall?

A

anywhere b/ scapula to T10

e.g. 8th rib at scapular line

42
Q

before demonstrating the safety triangle, what do you need to ask the pt to do?

A

ask pt to move the hand to the back of their head on the side you are going to demonstrate it on

43
Q

what is the posterior border of the safety triangle?

A

anterior border of latissimus dorsi

44
Q

what is the anterior border of the safety triangle?

A

lateral border of pectoralis major

45
Q

what is the inferior border of the safety triangle?

A

5th ICS at MAL

46
Q

what is the superior border of safety triangle?

A

below apex of axilla

47
Q

why is this the “safety triangle”?

A

can insert a chest drain here without damaging any nearby nerves e.g. long thoracic nerve

48
Q

where does the triangle of safety overlie?

A

2nd to 5th ICS

OSPE (8 decks)

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