Thorax and Lungs

Question 1

Thoracic cage

Answer 1

Bony structure with a conical shape, narrower at the top.
- defined by the sternum
- 12 pairs of ribs
- 12 thoracic vertebrae
- “floor” is the diaphragm

Question 2

Diaphragm

Answer 2

musculotendinous septum that separates the thoracic cavity from the abdomen.

Question 3

Floating ribs

Answer 3

the first seven ribs attach directly to the sternum via costal cartilages.
- RIbs 8, 9,10 attach to costal cartilage above
- Ribs 11, 12 are floating with free palpable tips

Question 4

Costochondral Junctions

Answer 4

points at which the ribs join their cartilages. NOT palpate

Question 5

Anterior Surface Landmarks

Answer 5

landmarks on the thorax are signposts for underlying respiratory structures. Knowing landmarks helps localize a findings and facilitates communication of findings

Question 6

Suprasternal notch

Answer 6

Hollow U-Shaped depression just above sternum, between clavicles.
(Anterior)

Question 7

Sternum

Answer 7

the “Breastbone” has three parts
- Manubrium
- The body
- Xiphoid process
- if you walk your fingers down the manubrium a few centimeters you will find a distinct bony ridge, the sternal angle.
(Anterior)

Question 8

Sternal Angle

Answer 8

• often called the angle of Louis, the articulation of the manubrium and body of the sternum, is continuous with the 2nd rib
  (Anterior)

Question 9

What is a useful place to start counting the ribs?

Answer 9

The Angle of louis (Anterior)
- identify the angle of louis and palpate lightly to the 2nd rib and slid down to 2nd intercostal space

Question 10

Costal Angle

Answer 10

right and left costal margins from an angle where they meet at the Xiphoid process
- 90 degrees or less
- this angle increases when rib cage is chronically overinflated, like in emphysema.

Question 10

How are the intercostal spaces numbered?

Answer 10

they are numbered by the rib above the space

Question 11

site of tracheal bifurcation into the right and left main bronchi

Answer 11

Angle of Louis.
- also corresponds with the upper border of the atria of heart, lies above the 4th thoracic vertebrae on the back.

Question 12

Posterior Thoracic Landmarks

Answer 12

counting ribs and intercostal spaces on the back is a bit harder because of the muscles and soft tissue surrounding the ribs and spinal column

Question 13

Vertebra Prominens

Answer 13

flex head feel for most prominent bony spur protruding at base of the neck. this is spinous process of C7
(posterior)

Question 14

Spinous Processes

Answer 14

stack together to form the spinal column.
- NOTE: spinous processes align with their same numbered ribs T4
- After T4 the spinous processes angle downward from their vertebral body and overlie the vertebral body and rib below

Question 15

Inferior border of the scapula

Answer 15

scapulae are located symmetrically in each hemithorax. the lower tip is usually at the 7th or 8th rib

Question 16

Reference lines

Answer 16

use these to pinpoint a findings vertically on the chest