Thorax and Lungs

Question 1

What are the components of examining the posterior chest?

Answer 1

Inspect Thoracic Cage

• shape/configuration of chest wall (elliptical, symmetrical, scapulae symmetrically placed and hemithorax)
• respiration
• anteriorposterior diameter < transverse diameter
• neck/trapezius muscles
• position patient takes to breath
• assess skin/lips/nails colour and conditions

Palpate Posterior Chest

• general palpation over entire chest and transverse area
• symmetrical expansion
• checking for tactile fremitus

Percuss Posterior Chest
-lung fields

Auscultate Posterior Chest

• breath sounds
• adventitiuous sounds

Question 2

What are the components of percussing the posterior chest?

Answer 2

Determine predominant note over the lungs fields

• there should be resonance and symmetry of sound(low-pitched, clear, hollow sound)
• 9 sites

Question 3

What are the components of auscultating the posterior chest?

Answer 3

evaluate presence of breath sounds

• sitting, lean slightly forward with arms across lap
• take deep breaths through the mouth
• test 9 sites on each side using diaphram noting veicular sounds over most of back except near trachea where sounds may be bronchovesicular
• note any adeventitious sounds, should be none

Question 4

what is inspected about the posterior thoracic cage?

Answer 4

• shape, configuration of chest wall
• respiration rate, rhythm, effortless, position to breathe
• confirm that the anteriorposterior diameter is less than the transverse (when equal, called barrel chested)
• trapezius and sternomastoid muscles
• skin/nail colour and condition

Question 5

palpatation of the thoracic cage or chest

Answer 5

• use finger to palpate entire chest wall/trachea
• note areas of tenderness, temperature, moisture, lumps or lesions
• symmetrical expansion (place thumbs near one another at level of t9, push thumbs together slightly and have patient take a deep breath)
• check tactile fremitus 5 sites on each side using ulnar edge of one hand as

Question 6

what should be inspected about the anterior thoracic cage?

Answer 6

-shape/configuration
-sloping ribs
-sternomastoid and trapezius muscles
costal angle (90)
-facial expression relaxed and benign
-level of consciousness is alert and cooperative
-respiration rate is normal, effortless, regular rate and rhythm
-bilateral symmetry
-skin colour and condition. Lips and nails

Question 7

what are the components of auscultating the anterior chest?

Answer 7

• have patient sit, leaning forward slightly
• arms across lap
• breathe deeply through mouth
• use diaphram and listen to one full respiration at each location, comparing bilaterally
• vesicular sounds over peripheral lung fields and bronchovesicular over major bronchi (btwn scapulae/at sternum)
• note any adventitious sounds, there should be none

Question 8

how is tactile fremitus tested?

Answer 8

• using ulnar edge of one hand
• 5 sites per side, total of 10 total are tested and compared bilaterally
• have patient say “blue moon” or “ninety-nine”

Question 9

how is symmetric expansion tested?

Answer 9

*symmetric expansion is part of palpation and is tested

by spreading hands across posterior or anterior part of thoracic cage at level of T9, pushing thumbs towards eachother to take up a small part in middle and then have patient take a deep breath

Question 10

what is the sound expected over a lung field?

Answer 10

resonance

Question 11

what are vesicular sounds?

Answer 11

they are auscultated breathing sounds heard over peripheral lung fields

the inspiration is longer than that expiration portion of the sound

Question 12

what are bronchovesicular sounds?

Answer 12

they are auscultated breathing sounds heard over the major bronchi (between scapulae in back or at strenum in front)

inspiration and expiration are roughly the same length