Thorax 3: Flashcards by Sydney Carrera-Brown

What are the atypical ribs of the thoracic cage?

1st rib (Flat rib)

11th rib (Floating)

12th rib (Floating)

How well did you know this?

Not at all

Perfectly

The head of the first rib articultes with? What does the costal cartillage of the first rib joint together with to form?

Costal cartillage joins with manubrium to form a primary cartilagenous joint

How well did you know this?

Not at all

Perfectly

What ribs are considered true, false and floating ribs?

True = 1-7 (connect directly to sternum)

False = 8-10 (do not directly connect to sternum)

Floating = 11-12 (No connection to sternum)

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

Which ribs show pump handle movement?

Which ribs show bucket handle moevement?

Upper ribs: Pump handle movement

Lower ribs: Bucket handle movement

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

The jugular notch is at which vertebral level

T2/T3

How well did you know this?

Not at all

Perfectly

The sternal angle (aka manubriosternal joint) is located at what vertebral levels?

T4/T5

How well did you know this?

Not at all

Perfectly

The xiphisternal joint is located at what vertebral level?

T8/T9

How well did you know this?

Not at all

Perfectly

Palpate the following spinous proccesses:

T12

N.B. You can tell if its C7 by telling patient to put head back. The first palpable process is c7

How well did you know this?

Not at all

Perfectly

Surface landmark the pleura of the right lung on the anterior chest wall

(A) Apex of the pleura (in the root of neck, above medial 1/3 of the clavicle)

(B) Just over the sternoclavicular joint

(D) Just right of AML at level of 4th CC

(E) Just right of AML at level of 6th CC (xiphoid process)

(F) MCL at the level of 8th rib (just above costal margin)

(G) MAL at the level of 10th rib (lowest point of costal margin)

How well did you know this?

Not at all

Perfectly

Surface landmark the pleura of the right lung on the posterior chest wall

(G) MAL at the level of 10th rib (lowest point of costal margin)

(H) Scapular line (medial border of scapula) crosses the 12th rib.

(I) Transverse process of L1 vertebra (subcostal pleura below 12th rib)

(J) Transverse process T1 vertebra (first palpate spine of T1)

How well did you know this?

Not at all

Perfectly

Surface landamrk the entirety of the right pleura of the lung

(A) Apex of the pleura (in the root of neck, above medial 1/3 of the clavicle)

(B) Just over the sternoclavicular joint

(D) Just right of AML at level of 4th CC

(E) Just right of AML at level of 6th CC (xiphoid process)

(F) MCL at the level of 8th rib (just above costal margin)

(G) MAL at the level of 10th rib (lowest point of costal margin)

(H) Scapular line (medial border of scapula) crosses the 12th rib.

(I) Transverse process of L1 vertebra (subcostal pleura below 12th rib)

(J) Transverse process T1 vertebra (first palpate spine of T1)

Connect all points (A) to (J).

How well did you know this?

Not at all

Perfectly

How does surface marking the left lung differ to the right?

Be wary of cardiac notch

Draw a notch between 4th costal cartiallage and 6th rib

How well did you know this?

Not at all

Perfectly

Surface landmark the left LUNG in its entirety

How well did you know this?

Not at all

Perfectly

Draw the oblique fissure of the right lung

Oblique fissure begins at junction between 6th rib and mid-clavicular line in anterior side

Runs along to the posterior region where it ends at the T3 level

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

List the step by step strcutured approach of a respiratory examination

1) Position (correct positioning of the patient and your position)
2) Inspection (observing with your eyes using visual sense)
3) Palpation (feeling with your hands using touch sense)
4) Percussion (tapping on the body parts to elicit sounds)
5) Auscultation (listening to sounds using a stethoscope using your hearing sense)
6) Assessment of function (putting into action)

For most of the respiratory system examination, it is important to have the patient lying in what matter?

Supine position with upper body elevated 35-45 degrees

In a respiratory examination, what 7 things must be inspected for from the end of the bed?

In a respiratory examination, what 6 things must be inspected for on the hands?

Look for peripheral cyanosis on hands

Look for tar staining on palms (smoking)

Finger clubbing

Temperature of arms

Assess for fine tremors (indicates B2 agonist/salbutamol use)

Assess for asterixis (CO2 retention)

Assess the respiratory rate and state the normal range

Tell patient that you would like to feel for their pulse

Pretending to feel for pulse, assess the respiratory rate by counting the amount of breaths per minute.

Normal range is 12-20 breaths per minute

Assess the JVP (Jugular venous pressure). What does a raised JVP indicate?

Ask patient to turn their head to the left

The jugular vein should be located between the sternocleomastoid heads.

Raised JVP indicates Cor pulmonale (aka Right-sided heart failure)

Inspect the face and describe what you are looking for.

First ask patient to look straight ahead for you and check for central cyanosis (indicates hypoxia)

Ask to pull down on the lower eyelid and check for conjunctival pallor (pale conjunctiva indicates anaemia)

Inspect the mouth and descrieb what you are looking for

Ask patient to open mouth (look for angular stomatitis [redness at angle of lips] Ask patient to lift toungue towards roof of mouth (assess for central cynaosis)

Inspect the chest and describe what you are looking for.

Look for scars Chest wall deformities Then ask patient to lift their arm for you (do for both sides) and inspect for scars (lateral thoracotomy)

Assess the tracheal position

Put two fingers on opposite sides of sternal head of sternocleomastoid muscle and use middle finger. Place it on the trachea and dragn finger dowm trachea using the other two fingers as reference/ Alternative: Place middle finger in jugular notch. With the two fingers adjacent, place them on the opposite sides of the trachea moving downwards and assesing for deviation.

What are 2 causes for tracheal deviation away from the lesion? What are 2 causes for tracheal deviation towards the lesion?

Away: Tension pneumothorax, Large pleural eflusions Towards: lobar collapse, pneumonectomy

Assess for the cricosternal distance. What is a normal finding?

Put as many fingers as you can between the sternal notch and the cricoid cartillage Normal finding is 3-4 fingers (Less fingers can indicate COPD or other conditions which result in hyperinflation)

What is an abnormal finding when measuring cricosternal distance and what does this suggest?

Less than 3 fingers between jugular notch and the cricoid cartillage. Suggests **hyperinflation** caused by COPD or asthma for example

Palpate the apex beat

Beat can be felt at **mid-clavicular line** at the 5th intercostal space

List 3 causes for a misplaced apex beat

Right ventricular hypertrophy Large pleural effusion Tension pneumothorax

Assess chest wall expansion

Place your hands on the patient’s chest, inferior to the nipples. Wrap your fingers around either side of the chest. Bring your thumbs together in the midline, so that they touch. Ask the patient to take a deep breath in. Observe the movement of your thumbs (in healthy individuals they should move symmetrically upwards/outwards during inspiration and symmetrically downwards/inwards during expiration

What does symmetrical reduced chest expansion suggest?

Pulmonary fibrosis

Give 3 examples of causes of asymetrical reduced chest expansion.

pneumothorax pneumonia pleural effusion

Percuss the anterior chest wall

Suggested areas: Apex (supraclavicular) Infraclavicular 2nd intercostal space (nearish mid-clavicular line) 6th intercostal space [Inferior lobe] Axilla

What does consolidation, lobar collapse and a tumor sound like upon percussion?

Dull

A patient with a pneumothorax will have which type of sound upon percussion?

Hyperesonance

How would you assess tactile vocal fremitus?

Using the ulnar (pinky finger) side of the hand, ask patient to say 99 and assess major regions of the anterior and posterior chest wall and compare the vibration.

Increased vibration in a tactile vocal fremitus assesment can suggest?

Increased tissue density (e.g. consolidation, tumour, lobar collapse).

Reduced vibration in a tactile vocal fremitus assesment can suggest?

Decreased vibration over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).

Normal breathing sound is described as? Describe what normal breathing sounds like

Vesicular breathing Soft, low pitched, and rustling in quality Inspiratory phase lasts longer than the expiratory phase Intensity of inspiration is greater than that of expiration Inspiration is higher pitch than expiration No pause between inspiration and expiration

How does bronchial breathing differ from vesicular breathing? What does detection of bronchial breathing in non bronchial areas suggest?

Harsh-sounding (similar to auscultating over the trachea) inspiration and expiration are equal and there is a pause between. This type of breath sound is associated with consolidation.

Reduced breath sounds (quiet) suggests?

Reduced air entry (do not say its reduced air sounds in notes it is known as reduced breath sounds) e.g. pneumothorax, pleural effusion