Thorax and Lungs assessment Flashcards
The Thoracic Cage
- How many ribs
- Where do they attach
- What are Costochondral junctions and intercostal spaces
- What kind of cavity is the thorax
- What does it surround and what are the components
Ribs- 12 pairs:
- 1-7 attach directly to sternum via cartilage
- 8-10 attach indirectly to sternum via cartilage
- 11-12 do NOT attach to the sternum (floating ribs)
- Costochondral junctions– where ribs & costal cartilage join
- Intercostal spaces- spaces between the ribs (each intercostal space is numbered by the rib below it)
The thorax is a closed cavity
The thoracic ‘cage’ surrounds this cavity Important components include: -Sternum -Ribs -Vertebrae -Diaphragm
Vertebrae
- How many are there
- what does it support
- 12 thoracic vertebrae
- Lumbar supports the stress on lower back
Diaphragm
- What is it
- What kind of muscle and what does it separate
- Floor of thoracic cavity
- Dome-shaped muscle that separates the thoracic & abdominal cavities
Anterior thoracic bony landmarks
-What are the 4 significant landmarks
- Suprasternal notch
- Sternum
- Sternal Angle
- Costal Angle
Suprasternal notch
-describe it
U-shaped depression above the sternum
Sternum (breastbone) 3 parts:
Manubrium (below notch)
Body
Xiphoid Process
Sternal Angle (a.k.a. Angle of Louis):
- Where does it articulate
- Where it is located
- what are the two spots it marks
Articulation of manubrium + sternal body
Between 2nd ribs
Marks:
- Site of tracheal bifurcation into right & left main bronchi
- Upper border of atria of heart
Costal Angle:
- Where does it angle
- What is the usual degree and when is it abnormal (what is it called)
1.Angle where right & left costal margins meet at xiyphoid process
- Usually 90° or less
- Increases when rib cage is chronically overinflated (i.e. emphysema)
Posterior thoracic landmarks
- What is the difficulty to palpate compared to the anterior
- what are the four landmarks
Can be more difficult to palpate due to muscles & soft tissues surrounding landmarks
Significant landmarks include:
- Vertebra Prominens
- Spinous Processes
- Inferior border of scapula
- Twelfth rib
Vertebra Prominens
- Spinous process of
- Where is it best felt
- If you feel two what could it be
At base of neck, head flexed, most prominent bony protrusion
If you feel 2 equally prominent bumps: upper= C7, lower= T1
Spinous Processes
- How does it project
- What do you count
- What is it aligned to
Count down each spinous process
Align with the same numbered ribs only down to T4
-After that they angle downward & overlie the vertebral body & rib below
Inferior Border of the Scapula:
- Located how
- Where is the lower tip
- What is it important for
Located symmetrically
Lower tip is usually at the level of the 7th-8th rib
Important to know when auscultating
12th Rib
-How do you palpate it
Palpate midway between the spine & the pt’s side to find the free tip
References Lines ANT chest
- What are the lines for
- name the 3 lines
Use reference lines to pinpoint findings vertically on the chest
Midsternal- runs down the center of the sternum
Midclavicular- runs down the centre of the clavicle (typically close to the nipple)
Anterior Axillary- extends down from the anterior axillary fold
Reference Lines: POSTERIOR Chest
-Name the two
Vertebral- runs down the center of the vertebral column
Scapular- extends through the inferior angle of the scapula when arms are at the sides of the body
Reference Lines: LATERAL Chest 3
Anterior Axillary- extends down from the anterior axillary fold
Posterior Axillary – extends down from the posterior axilla fold
Midaxillary- runs down from the apex of the axilla & lies between & parallel to the other 2 lines
Sections of the Thoracic Cavity: 3
1) Mediastinum– contains the esophagus, trachea, heart, and great vessels
2) Right Pleural Cavity– contains right lung
3) Left Pleural Cavity– contains left lung
- Separate, so if one lung gets blocked other lung would still work
Lung Borders:
Name the 2 and their 3 components where they’re located
2) Apex:
1) Anterior chest: 3-4 cm above clavicles
2) Posterior chest: C7
3) Laterally: Apex of
Axilla
3) Base:
1) Anterior chest: 6th rib midclavicular line
2) Posterior chest: T10-T12
3) Laterally: 7-8th rib
The Lungs: ANTERIOR
- What lobes are mostly there
- What are the lobes the lungs are divided into
- Lengths?
- What should be noted
Anterior is mostly UPPER and MIDDLE lobes
Left lung- 2 Lobes:
- LUL= Left Upper Lobe
- LLL= Left Lower Lobe
- Narrower than the right d/t the heart
Right lung- 3 lobes:
- RUL= Right Upper Lobe
- RML= Right Middle Lobe
- RLL= Right Lower Lobe
- Shorter than the left d/t the liver
Note locations of fissures
The Lungs: POSTERIOR
- Posterior is mostly?
- What can you auscultate 2 and where are they located
Posterior is mostly LOWER lobes
UPPER Lobes: T1-T3
LOWER Lobes: T3-T10(exp.) or T12 (insp.)
-Middle lobe does NOT project onto the posterior chest at all
The Lungs: POSTERIOR
- Mostly what lobes 2
- What can you auscultate and where are they located
- What lobe does not project into the post. Chest
Posterior is mostly LOWER lobes
UPPER Lobes: T1-T3
LOWER Lobes: T3-T10(exp.) or T12 (insp.)
Middle lobe does NOT project onto the posterior chest at all
The Lungs: LATERAL Right
-What lobes and where is it located 3
Right UPPER lobe- Apex down to the horizontal fissure at the 5th rib (midaxilla)
Right MIDDLE lobe- Horizontal fissure (down and anteriorly) towards the 6th rib (midclavicular)
Right LOWER lobe- 5th-8th rib (midaxilla)
The Lungs: LATERAL Left
-What lobes and where are they located
Left UPPER lobe- Apex to 5th rib (midclavicular)
Left LOWER lobe- Extends to 8th (lateral) – or 7th
The lungs
-What are the three important points
The left lung has NO middle lobe
The anterior chest contains mostly middle & upper lobes (with very little lower lobe)
The posterior chest contains almost all lower lobe
