Respiratory system Flashcards
Demonstrate how you would investigate symmetrical inflation of the lung and describe the anatomical basis
Chest expands symmetrically on both sides during inspiration Ask subject to sit over edge of the couch
Look for asymmetry in movements of the chest wall
Stand in front of subject, place hands firmly on anterior chest wall (below 5th or 6th ribs/ beneath breast) with fingers extended around the sides of the chest
Thumbs meeting in the anterior midline, resting lightly on the chest wall, to allow its movement during respiration
Patient to take a deep breath in + observe how far thumb tips move apart ~5cm
Repeat on the posterior chest wall, with thumbs meeting in the posterior midline T10
Observe and describe the breathing pattern and breathing rate
Pretend to take radial pulse whilst observing chest movements as they breathe
Count breaths per minute
Rate 12-20/ minute = normal
Hyperpnoea/ hypopnoea
Depth
Rhythm
How would you demonstrate percussion of upper/middle/lower lobe(s) of right/left lungs?
Symmetrically + systematically on anterior + posterior
Anterior:
Areas 1 + 2 for lung apex
Areas 3, 4, 6 + 10 for upper lobes
Areas 5 or 9 are for middle lobe
Areas 7 + 8 for lower lobes
Areas 9 + 10= just below the axilla on the anterior chest wall
Posterior:
Areas 1 + 2 for apex
Areas 3, 4, 5 + 6 for lower lobes
Describe and demonstrate where you would auscultate upper/middle/lower lobe(s) of right/left lungs
Deep breaths through open mouth
Apex = 1 + 2 (use bell)
Superior lobe = 3 + 4
Middle lobe= 5 + 9
Lower lobe= 7,8,9,10
In females lower lobes anteriorly are below base of breast (6th rib)
Describe and demonstrate the surface markings of the oblique fissure of the right/left lung
Oblique fissure closely follows medial scapula border when arm is raised above head this line anteriorly to meet the lower border of the lung.
Posteriorly: level of spine of T3
Anteriorly: lower border of lung at 6th CC
Smooth curved line around lateral wall = oblique fissure.
Describe and demonstrate the surface markings of the horizontal fissure of the right lung
Palpate 4th CC on right + go across 4th rib back to meet oblique fissure in the MAL
Passes above nipple in males.
Describe and demonstrate the surface marking of the inferior margin of parietal pleura of right lung
APEX: 2 cm above medial 1/3 of clavicle
Down over sternoclavicular joint
Continues down just right of the AML until 6th CC (xiphoid)
MCL at 8th rib
MAL at 10th rib (lowest point of costal margin)
Scapular line crossing the 12th rib
Transverse process of L1 vertebra
Transverse process of T1 vertebra
Describe the right and left lung in terms of fissures and lobes
Right lung: 3 lobes. Oblique fissure divides upper + middle lobe from lower lobe. Horizontal fissure divides upper from middle lobe.
Left lung: 2 lobes divided by an oblique fissure.
Describe and demonstrate the inferior margin of the visceral pleura of the right/left lung
Visceral pleura is continuous with parietal pleura at the hilum
Visceral pleura is firmly attached to surface of lung, including the fissures that divide the lungs into lobes.
Inferior margin = MCL at 6th rib (anteriorly), MAL at 8th rib (laterally), + scapular line at 10th rib (posteriorly).
Where is the triangle of safety for insertion of a chest drain? Which nerve are you avoiding?
Anterior border of latissimus dorsi
Lateralborder ofpectoralis major
Horizontalline at5th ICS MAL
Apex below axilla
Overlies 2nd-5th ICS
Avoiding long thoracic nerve lying behind, in the ‘safe triangle’.
Describe and demonstrate the surface marking of mediastinal pleura of right and left lung on anterior surface of chest wall
Mediastinal pleura = portion of parietal pleural membrane lining mediastinum.
Bounded by + continuous with anterior + posterior margins of costal pleura, cervical pleura superiorly + diaphragmatic pleura inferiorly.
What are the common causes of uni- and bilateral decrease in expansion of the chest?
Unilateral: pneumothorax, pleural effusion, collapsed lung
Bilateral: asthma, COPD
What should you hear on percussion of the lungs?
What deviations may you hear and when?
Resonant sounds (low pitch, hollow)
Dullness= Increased tissue density e.g. fluid
Stoney dullness= Pleural effusion
Hyper-resonance= Pneumothorax
Describe and demonstrate where you would auscultate upper/middle/lower lobe(s) of right/left lungs on the posterior chest wall
What should you hear in a healthy patient?
Patient sits on edge of couch.
Apex 1 + 2
Upper lobe 3 + 4
Lower lobe 5 + 6
Vesicular breathing (low pitch)
What are the 2 lung sounds? Where are they heard?
Bronchial: High pitched. Over trachea, suprasternal notch, manubrium, sternal angle, sternoclavicular joints. Airways not surrounded by alveolar tissue so air turbulence is heard with no filtering
Vesicular: Low pitched. Over rest of chest where normal lung tissue is present + filters sounds of air turbulence
