Thorax & Lung Examination Flashcards
1
Q
Thorax is bound anteriorly by what?
A
Sternum and ribs
2
Q
Thorax is bound laterally by what?
A
The ribs
3
Q
The thorax is bound posteirorly by what?
A
Ribs and thoracic spine
4
Q
The thorax is bound by what superiorly?
A
Clavicles and neck tissues
5
Q
The thorax is bound by what inferiorly?
A
Diaphragm
6
Q
The lungs end about as far down as what landmark?
A
Xiphoid process
7
Q
What direction do the anterior ribs go?
A
Down and medially
8
Q
What direction do the posterior ribs go?
A
Down and laterally
9
Q
What is the costal angle?
A
The angle produced from the tip of the xiphoid process with the cartilagenous portions of the ribs
10
Q
Which vertebrae do the ribs start?
A
T1
11
Q
How many ribs are there?
A
12
12
Q
Which ribs are not found anteriorly?
A
Ribs 11-12
13
Q
Where can you best appreciate ribs 11?
A
Laterally
14
Q
Where can you best appreciate ribs 12?
A
Posteriorly
15
Q
Which ribs are landmarks for the inferior angle of the scapula?
A
Ribs 7
16
Q
The costal cartilages of which ribs articulate with the sternum?
A
Ribs 1-7
17
Q
The costal cartilages of ribs 8-10 articulate with what?
A
The costal cartilages of rib 7
18
Q
Which are the “floating” ribs?
A
Ribs 11-12
19
Q
How do you know which interspace is which?
A
They are numbered by the rib above it
20
Q
Where do neurovasculature structures run in relation to the ribs?
A
Just underneath them
21
Q
If you ever put in a chest tube, etc., where do you make sure to put it to avoid the neurovascular structures?
A
Just on top of the ribs
22
Q
Where do you insert a needle for treating tension pneumothorax?
A
2nd interspace
23
Q
Where do you insert a chest tube?
A
4th or 5th interspace (though the tube is generally placed where it is needed)
24
Q
Where is the landmark for thoracentesis?
A
T7-8 (posteriorly)
25
When you insert a chest tube, or anything similar, what do you do to make sure you don't leak out the air?
You put it in at an angle, so the layers can block it off as it heals
26
Difference between interscapular and infrascapular?
Interscapular - between the scapulae
| Infrascapular - below the scapulae
27
Definition of the lung apices?
The uppermost portions of the lungs
28
Which lung has 3 fissures?
R lung
29
What are the names of the lobes of the R lung?
Upper, middle, and lower lobes
30
What is the name of the extra fissure in the R lung?
Horizontal (minor) fissure
31
What are the names of the L lung lobes?
Upper and lower
32
On a lateral CXR, what is the fissure called that divies the upper and lower lobes of the lungs?
L or R oblique fissures
33
The horizontal fissure divides what in the R lung?
Divides the R upper lobe into two parts, the upper and middle
34
T or F: The middle lobe of the R lung is supplied by the same bronchial trunk as the upper lobe?
False, they are supplied by different trunks
35
If something is inhaled, which lung does it generally go to and why?
R lung, becuase the bronchial trunk is more of "straight shot" than it is to the L lung
36
On a woman, where is the general area you should be listening at to hear the lungs?
along the lower bra line
37
The two names of the lymph nodes for the lungs? - and where are they found?
Tracheobronchial (at the base of the trachae, before it branches into bronchii)
Bronchopulmonary (where the bronchii meet the lungs)
38
On a CXR, which ribs (posterior or anterior) appear more prominent?
Posterior - watch the direction of the ribs as you're looking at them!
39
What do you call enlarged/inflammed lymph nodes around the bronchi?
hilar lymphadenopathy
40
What is a hilum?
Depression or slit-like opening in an organ where the nerves and vessels enter and leave
41
T or F: the visceral pleura covers the outer surface of the lung
True
42
What side of the pleura lines the lung cavity (i.e. the rib cage and the diaphragm)?
Parietal
43
What lubricates the pleura so that the lungs can move?
Pleural fluid
44
What is a pleural effusion?
Fills the potential pleural space with fluid
45
What is a transudate?
Any fluid that has discharged through a normal membranes due to imbalanced hydrostatis and osmotic forces (i.e. imbalance of solids and liquids)
46
What can be causes of transudates?
Atelectasis, heart failure, nephrotic syndrome
47
What is an exudate?
Any fluid that has exuded out of a tissue or its capillaries, specifically because of injury or inflammation (i.e. leaky vessels)
48
What can cause exudates?
Pneumonia, TB, pulmonary embolus, pancreatitis, malignancy
49
How do you find the cause of a pleural effusion?
Stick a needle between T7-8 and send the fluid to the lab to look at cell count, LDH, protein
50
What lab results would you find with a transudative pleural effusion?
Low protein, low LDH
51
What lab results would you find with exudative pleural effusion?
high protein, high LDH
52
What does it mean when the costal angle is "blunted?"
That "v" shaped angle that starts at the tip of the xiphoid process is not seen
53
In a pleural effusion, the lung itself will sound like what?
Solid, because it's being crushed by the excess fluid, so there's less air in the lung itself
54
What is a pneumothorax?
Air gets trapped in the pleural space
55
What is the typical patient for spontaneous pneumothorax?
Tall, thin males ages 15-30 (although females of this description can get it, too)
56
What do you want to look out for on a CXR when looking for a pneumothorax?
No lung markings (which are spiderweb-looking)
57
What is the best rule of thumb when listening to the lungs?
Don't listen over the clothes
58
How can you listen to someone's lungs posteriorly if they are unable to sit up?
Roll them from side to side to listen
59
What is a "normal" documentation for lung examination?
Rate of 18, even rhythm, normal depth and effort
| No evidence of respiratory difficulty or asymmetry, no deformities, A/P and lateral diameters WNL
60
Healthy adult respiratory rate
~ 14-20 per min
61
What are you looking for when you're examining the thorax?
shape and condition of the chest and its movements
| looking for any bony deformities, splinting, asymmetry
62
What is splinting?
Breathing while guarding one side due to pain
63
Normally, what is the thorax supposed to look like?
wider than deep
64
What is a barrel chest and in what case do you often see this?
Increased AP diameter; COPD
65
What is pectus excavatum (funnel chest)? And what problems can this cause?
Depression of the lower part of the sternum; compression of the heart and great vessels can cause murmurs
66
What is pectus carinatum (pigeon chest)?
Sternum is displaced anteriorly, increaseing the AP diameter, the costal carilages adjacent to the protruding sternum are depressed
67
What can be the result of a traumatic flail chest?
Paradoxical movement of the thorax - on inspiration, the injured area caves inward, while on expiration, the area moves outward
68
What causes flail chest?
Multiple rib fractures due to trauma
69
What is thoracic kyphoscoliosis?
Abnormal spinal curvatures and vertebral rotation deform the chest
70
What is tactile fremitus?
Vibrations transmitted through the lung tissue when we talk
71
How do you palpate tactile fremitus?
Felt with the ulnar aspects of the hand with patient saying "nintey-nine" or "one-one-one"
72
When would tactile fremitus be absent?
If there is no lung tissue under your hand
73
Why do we percuss the chest?
To establish whether the tissue underneath is air, fluid, or solid-filled
74
What do you call the finger you put on the patient when percussing? (or the instrument?)
Pleximeter; middle finger
75
What do you call the striking finger when percussing? And where do you strike on the pleximeter?
Plexor finger, you strike on the middle phalanx
76
When is diaphramatic excursion absent in a patient?
phrenic nerve palsy
77
When is diaphragmatic excursion reduced in patients?
emphysema
78
With a normal diaphragmatic excursion, how far should the diaphragm move?
2 - 3 cm with normal respiration
| 3 - 5.5 cm with a full breath
