Thorax and Lungs Flashcards
*****Suprastrenal Notch
Marks MIDPOINT OF TRACHEA
Optimal placement end of ET tube
Sternal angle Starts with Useful for counting to down Localized findings \_\_\_\_\_ ****What does the sternal angle Mark? where dos it lie? Corresponds to \_\_\_\_\_\_\_\_\_\_\_
Angle of Louis Starts with 2nd rib • Useful for counting to down 10th • Localize findings horizontally ***** Marks TRACHEA BIFURCATION • Lies@levelofT4–T5 • Corresponds to upper border atria
*****What is the normal costal angle?
Disease state with increase costal angle?
Costal Angle normally <90° • >90° in emphysema
*****Spinous Processes
T1 – T4 align w/ same numbered ribs • T5 on - processes angle downward aligning w/ rib below
**Scapula Inferior Border •
lower tip at ________
Lower tips @ rib 7 or 8
*****Lines of reference
Midsternal Line
• Midclavicular Line
• Anterior Axillary Line
**Right lung____lobes and left lung ____lobes
3 lobes; 2 lobes
*****Reference lines cont’d
Vertebral Line
• Aka “mid-spinal line”
Scapular Line
• Extends thru inferior angle of scapula when arms are at the sides
*****Anterior Axillary Line
Extends down from anterior axillary fold
*****Midaxillary Line
• Extends down from axillary apex
**Posterior Axillary Line
• Extends down from post. Axillary fold
- ***Lung Borders : Base
* ***Lung Borders :Apex
Rests on Diaphragm @ 6th rib midclavicular line
Extends 3-4 cm above inner 3rd clavicle
**Lobes Oblique fissures
- cross 5th rib midaxillary
* Terminate @ 6th rib midclavicular
**Horizontal fissurea
Extends from 5th rib midaxillary up to 4th rib
***Thoracic Cavity - Posterior C7 marks ___
marks apex of lungs
**Thoracic Cavity - Posterior T10 marks ____
marks Bases of lungs
** Deep inspiration expands down to
T12
*****Upper lobes
• The rest is all Lower lobes
T1 – T3/T4
**2 Skeletal deformities limit thoracicc age excursion
• Scoliosis, Kyphosis
**AP:Transverse=__ indicates
1:1 • Barrel chest/horizontal ribs=chronic
Emphysema
**Hypertrophic Neck muscles
=COPD
** Cyanosis/Pallor/SkinLesions
**Tripod Position
COPD
Posterior chest ****Check for \_\_\_\_\_\_ *****Place hands with \_\_\_\_\_\_@ what level ? ******Then do what? ****Unequal expansion indicates what? FMPP
Symmetrical Expansion
THUMBS @T9
PINCH SMALL FOLD OF SKIN between thumbs
Marked atelectasis
Pneumonia
Fx ribs
Pneumothorax
*****Pain w/ deep breathing indicative
Pleuritis
***Check for palpable vibrations known as
ask the patient to do
WHAT PART OF THE HAND DO YOU USE?
• Check for Tactile Fremitus (palpable vibrations)
USE BALL OF HAND or ULNAR EDGE
Ask pt. to repeat “ninety-nine”
Resonant phrase generates strong vibrations
**Decreased Fremitus = (POPE) (4)
Pleural effusion
Obstructed bronchus
Pneumothorax,
Emphysema
**Increased Fremitus =
consolidation – lobar pneumonia
**Rhonchal fremitus =
thick bronchial secretions
****Crepitus = Indicats 2
palpable crackling w/ air in Sub-Q space (SubQ Emphysema) or S/P open thoracic surgery
-
too much air
Emphysema
Pneumothorax
*****Dull note means 4 conditions (TAPP)
abnormally dense
• Pneumonia
• Pleural effusion
- Atelectasis
• Tumor
If theres no excursion means
pleural effusion or atelectasis of lower lobes
*****Normally 3 types of sounds: (breath)
- Bronchial (“Tracheal”) B (short ins than exP)
- Bronchovesicular BV (same)
- Vesicular V (Periphery) insp longer than ex
**Decreased breath sounds due to
FOMSE
DECREASED: Obstructed Bronchial tree • Fb • Mucous plug • Secretions Emphysema • Lungs already hyperinflated =decreases noise
**For DECREASED breath sounds OTHER obstruction to sound can be because of
Pleurisy/pleural thickening
• Air (pneumothorax)
• Fluid (pleural effusion)
**Adult avg chst excursion
3-5 cm
**INCREASED breath sounds include
CCP :
INCREASED: Consolidation
Pneumonia
Compression (fluid in intrapleural space)
**Adventitious Sounds Crackles “rales”
Fine–high pitched popping–not cleared by coughing.
• Stiimulate sound by rolling strand of hair b/t fingers near ear
• Or moisten thumb & index finger & separate them near your ear
• Course crackles – (opening a Velcro fastener)
**Pleural Friction Rub –
coarse & low pitched, 2 pieces of leather
• Rubbed together close to ear
**Wheeze (Rhonchi)
- High pitched, musical squeaking – air squeezes thru constricted airway • Asthma if ONE EXPIRATION , OBSTRUCTION if on INSPIRATION
- Low pitched – musical snoring, moaning • Obstruction
**Stridor –CEO
High pitched, inspiratory, crowing •
CROUP
EPIGLOTITS
OBSTRUCTION
Normal voice transmission through chest wall is
soft, muffled, indistinct
**Pathology causes normal voice transmission to be
• Makes words/sounds Louder, Clear and Distinct
***Hypertrophic abd. Muscles can indicate
chronic emphysema
*** Strained/Tired face
COPD
*****Drowsiness
Cerebral hypoxia
** Clubbing distal fingers can indicate
Chronic Resp. Ds.
***Cutaneous ANGIOMAS on chest can indicate
liver ds / portal HTN
**Unequal expansion can indicate
obstructed or collapsed lung
***Accessory being muscles used can indicate
acute airway obstruction / massive atelectasis
***During anterior exam ______lag indicates
Expansion lag indicates
• atelectasis, pneumonia
***marks apex of lungs
Posterior C7
***Marks bases of lungs
Posterior T10
***Lungs extend from_____down to ______
Axilla Apex down to 7th rib
**Avoid percussing
over bone
**Pleural friction fremitus indicates
pleural inflammation
**What should be the DEPTH OF PERCUSSION
5-7 cm
****LESION _________wide are ________
<2-3cm are NOT DETECTABLE BY PERCUSSION
**What do you do to DETERMINE diaphragm excursion
PERCUSSION
**You percuss to do What
Determine diaphragm excursion
**Anterior Chest
______Chest for _______
Use _______along _______
Palpate CHEST FOR symmetric expansion
THUMBS; Costal margins
***what is a normal Ex time?
4 seconds
***Force exp > ______= ___Disease, what do you do ?
6 seconds
-Obstructive
Refer for PFTs
**C7 is the
VERTEBRA PROMINENS
