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Physical Assessment > Thorax And Lungs > Flashcards

Thorax And Lungs Flashcards

1
Q

What is the anterior boundary of the thorax?

A

Sternum and ribs

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2
Q

What is the posterior boundary of the thorax?

A

Ribs and thoracic spine

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3
Q

What is the superior boundary of the thorax?

A

Clavicles and neck tissues

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4
Q

What is the inferior boundary of the thorax?

A

Diaphragm

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5
Q

How should you describe chest findings?

A

In two dimensions, along the vertical axis and around the circumference of the chest

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6
Q

What is the vertical axis technique?

A
  1. Count ribs and intercostal spaces
  2. Place finger in the hollow curve of the suprasternal notch move it down 5cm to the sternal angle
  3. Adjacent to the sternal angle is the 2nd rib
  4. Use two rings to walk down the interspaces
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7
Q

Why is the 2nd intercostal space a special landmark?

A

Used for needle insertion for decompression of a tension pneumothorax

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8
Q

Why is the intercostal space between the 4th and 5th ribs a special landmark?

A

Used for chest tube insertion

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9
Q

Where is the place that a endotracheal tube on a chest X-ray is inserted?

A

The level of the 4th rib for the lower margin

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10
Q

Where are neurovascular structures on the ribs?

A

They run along the inferior margin of each rib

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11
Q

Where should needles and tubes be placed into the ribs?

A

Along the superior rib margin

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12
Q

Which ribs articulate with the sternum?

A

The first 7 ribs

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13
Q

Which ribs articulate with the costal cartilages just above them?

A

8th, 9th, and 10th

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14
Q

Which ribs have no anterior attachments?

A

11th and 12th ribs “Floating ribs”

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15
Q

What can be used as a landmark on the posterior side for counting ribs?

A

The 12th rib

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16
Q

What is a landmark for thoracentesis?

A

The intercostal space between the 7th and 8th ribs
*immediately superior to the 8th rib

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17
Q

What are some other helpful landmarks

A

Inferior tip of the scapula
Spinous processes of the vertebrae

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18
Q

What is the chest circumference technique?

A

Visualizing a series of vertical lines across the chest?

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19
Q

What is the mid sternal line?

A

Drops vertically along the sternum

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20
Q

What is the mid clavicular line?

A

Drops vertically from the midpoint of the clavicle

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21
Q

What is the anterior axillary line?

A

Drops vertically from the anterior axillary fold

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22
Q

What is the mid axillary line?

A

Drops vertically from the apex of the axilla

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23
Q

What is the posterior axillary line?

A

Drops vertically from the posterior axillary fold

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24
Q

What is the scapular line?

A

Drops from the inferior angle of the scapula

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25
Q

What is the vertebral line?

A

Overlies the thoracic spinous processes

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26
Q

What is the triangle of safety?

A

Anatomical region in the mid axillary line formed by
*lateral border of the pectoralis major anteriorly
*Lateral border of the Latissimus Dorsi posteriorly
*The nipple line Inferiorly
*safety position for chest tube insertions

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27
Q

What does the apex of the lung rise to?

A

Above the clavicle
*Approximately 2cm to 4cm

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28
Q

What does the lower border of the lung cross?

A

The 6th rib at the mid clavicular line
8th rib at the mid axillary line

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29
Q

Where does the lower border of the lung cross posteriorly?

A

Lies at the T10 spinous process

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30
Q

What does the oblique fissure run from?

A

T3 spinous process obliquely down and around the chest to the 6th rib at the mid clavicular line

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31
Q

Where does the horizontal fissure run from?

A

Runs close to the 4th rib and meets the oblique fissure in the mid axillary line near the 6th rib

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32
Q

Where does the trachea bifurcate to?

A

*At the sternal angle anteriorly
*T4 spinous process posteriorly

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33
Q

Describe the right main bronchus

A

Wider
Shorter
More vertical

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34
Q

How does the left main bronchus come into the lung hilum?

A

Extends inferolaterally
*From below the aortic arch and anterior to the esophagus and thoracic aorta

35
Q

How does the main bronchus divides?

A

1.Lobar
2. Segmental bronchi
3. bronchioles
4. Alveoli (terminal)

36
Q

Where does gas exchange happen

A

Alveoli

37
Q

Which bronchus is aspiration pneumonia more common in?

A

The right middle and lower lobes
*BC the right main bronchus is more vertical

38
Q

If an endotracheal tube is advanced too far during intubation where will it enter?

A

The right main stem bronchus

39
Q

What is the visceral pleura?

A

Covers the outer surface of the lungs

40
Q

What is the parietal pleura?

A

Lines the pleural cavity along the inner rib cage

41
Q

What is between the visual and parietal pleura?

A

Pleural space
*Contain serous pleural fluid

42
Q

Which pleura has nerves?

A

The parietal pleura
*Innervated by intercostal and phrenic nerves

43
Q

What is the primary muscle of inspiration?

A

The diaphragm

44
Q

What happens to the diaphragm during inspiration?

A

Diaphragm contracts
*descends in the chest
*expands thoracic cavity

45
Q

During exercise what muscles are recruited for the extra work required to breathe?

A

The sternocleidomastoid muscles and scalenes

46
Q

What is dyspnea?

A

Painless but uncomfortable awareness of breathing that is inappropriate for the levels of exertion

47
Q

What are wheezes?

A

Occurs in a partial or airway obstruction from secretions and tissue inflammation in asthma or from a foreign body

48
Q

What is a cough?

A

A reflex response to stimuli that irritates receptors in the larynx, trachea, or large bronchi

49
Q

What can a cough signal?

A

Left-sided heart failure

50
Q

What is the most common cause of an acute cough?

A

Viral upper respiratory infection

51
Q

What is a cause of a chronic cough?

A

Post nasal drip
Asthma
Chronic bronchitis

52
Q

What is the mucus from a cough look like during a viral or bacterial infection?

A

Viral: white, gray
Bacterial: green

53
Q

What is hemoptysis?

A

blood coughed up from the lower respiratory tract

54
Q

What is a Levine sign?

A

Clenched fist over the sternum
*Angina pectoris

55
Q

Does lung tissue have pain fibers?

A

NO

56
Q

What are the six P’s of Dyspnea?

A
  1. Possible foreign body
  2. Pulmonary embolus
  3. Pneumonia
  4. Pump failure
  5. Pneumo-thorax
  6. Pulmonary brachial constriction
57
Q

What is the patient positioning for the posterior thorax?

A

Patient sitting
*Arms folded
*hands on opposite shoulders

58
Q

What is the patient position for the anterior thorax?

A

Patient is supine

59
Q

What is Cheyenne-stokes breathes?

A

Irregular
Deep breaths
*Drugs, heart failure, brain damage

60
Q

What is possible reason for prolonged expiration?

A

COPD
Obstruction breathing

61
Q

What is a barrel chest?

A

Increased AP diameter

62
Q

What is a funnel chest (Pectus Excavatum)

A

Depression in the lower portion of the sternum

63
Q

What is pigeon chest (Pectus carinatum)

A

Sternum is displaced anteriorly, increasing AP diameter

64
Q

What is lung excursion?

A

As the lungs move during inspiration
*placed hands on 10th ribs

65
Q

What is Fremitus/

A

Palpable vibrations that are transmitted through the bronchopulomary tree to the chest wall

66
Q

When can tactile fremitus be decreased?

A

COPD
Fibrosis
Thick chest wall

67
Q

What does percussion help with?

A

Establish whether the underlying tissues are air-filled, fluid filled or consolidated

68
Q

What is the pleximeter?

A

Finger that is getting hit

69
Q

What is the plexor finger?

A

Finger that is doing the hitting

70
Q

When does dullness replace resonance?

A

When fluid or solid tissue replaces air-containing lung

71
Q

Describe the steps of diaphragmatic excursion

A
  1. Determine the level of diaphragmatic dullness during quiet respiration
  2. Percussion downward until dullness replaces resonance
  3. Have the patient hold their breathe and percussion when until dullness replaces resonance
  4. Have the patient take a deep breath out and hold it. Percuss until resonance replaces dullness
72
Q

What is the duration, intensity, pitch and location of a vascular sound?

A

Duration: Inspiratory sound last longer than expiratory
Intensity: Soft
Pitch: Relatively low
Location: Over lungs

73
Q

What are you listening for during auscultation?

A

Adventitious breath sounds

74
Q

Where are tracheal breath sounds located?

A

Over the trachea

75
Q

Where are bronchial breath sounds located?

A

Over manubrium, between clavicles

76
Q

Where are bronchovesicular breath sounds located?

A

Over large airways near sternum

77
Q

Where are vesicular lungs sounds located?

A

Over peripheral lung tissue

78
Q

What are the adventitious breath sounds?

A

Crackles
Wheezes
Rhonchi

79
Q

What can severe asthma indicate?

A

A silent chest
*No airflow
*No gas exchange

80
Q

When are transmitted voice sound technique used?

A

If there are abnormally located bronchiovesicular or bronchial breath sounds auscultated during exam
*Testing for consolidation

81
Q

What does a bronchophony sounds like?

A

Speaking 99
*Heard clearly

82
Q

What does a egophony sound like?

A

Speak a long E
*Sounds like a long A

83
Q

What does a whispered pectoriloquy sound like?

A

Whisper 99
*heard very clearly

84
Q

What is the position of the anterior chest exam?

A

Supine position

Physical Assessment (12 decks)

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