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Clinical Skills > Thorax & Lung Examination > Flashcards

Thorax & Lung Examination Flashcards

1
Q

Thorax is bound anteriorly by what?

A

Sternum and ribs

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2
Q

Thorax is bound laterally by what?

A

The ribs

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3
Q

The thorax is bound posteirorly by what?

A

Ribs and thoracic spine

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4
Q

The thorax is bound by what superiorly?

A

Clavicles and neck tissues

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5
Q

The thorax is bound by what inferiorly?

A

Diaphragm

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6
Q

The lungs end about as far down as what landmark?

A

Xiphoid process

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7
Q

What direction do the anterior ribs go?

A

Down and medially

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8
Q

What direction do the posterior ribs go?

A

Down and laterally

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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

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10
Q

Which vertebrae do the ribs start?

A

T1

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11
Q

How many ribs are there?

A

12

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12
Q

Which ribs are not found anteriorly?

A

Ribs 11-12

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13
Q

Where can you best appreciate ribs 11?

A

Laterally

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14
Q

Where can you best appreciate ribs 12?

A

Posteriorly

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15
Q

Which ribs are landmarks for the inferior angle of the scapula?

A

Ribs 7

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16
Q

The costal cartilages of which ribs articulate with the sternum?

A

Ribs 1-7

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17
Q

The costal cartilages of ribs 8-10 articulate with what?

A

The costal cartilages of rib 7

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18
Q

Which are the “floating” ribs?

A

Ribs 11-12

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19
Q

How do you know which interspace is which?

A

They are numbered by the rib above it

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20
Q

Where do neurovasculature structures run in relation to the ribs?

A

Just underneath them

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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

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22
Q

Where do you insert a needle for treating tension pneumothorax?

A

2nd interspace

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23
Q

Where do you insert a chest tube?

A

4th or 5th interspace (though the tube is generally placed where it is needed)

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24
Q

Where is the landmark for thoracentesis?

A

T7-8 (posteriorly)

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25
Q

When you insert a chest tube, or anything similar, what do you do to make sure you don’t leak out the air?

A

You put it in at an angle, so the layers can block it off as it heals

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26
Q

Difference between interscapular and infrascapular?

A

Interscapular - between the scapulae

Infrascapular - below the scapulae

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27
Q

Definition of the lung apices?

A

The uppermost portions of the lungs

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28
Q

Which lung has 3 fissures?

A

R lung

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29
Q

What are the names of the lobes of the R lung?

A

Upper, middle, and lower lobes

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30
Q

What is the name of the extra fissure in the R lung?

A

Horizontal (minor) fissure

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31
Q

What are the names of the L lung lobes?

A

Upper and lower

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32
Q

On a lateral CXR, what is the fissure called that divies the upper and lower lobes of the lungs?

A

L or R oblique fissures

33
Q

The horizontal fissure divides what in the R lung?

A

Divides the R upper lobe into two parts, the upper and middle

34
Q

T or F: The middle lobe of the R lung is supplied by the same bronchial trunk as the upper lobe?

A

False, they are supplied by different trunks

35
Q

If something is inhaled, which lung does it generally go to and why?

A

R lung, becuase the bronchial trunk is more of “straight shot” than it is to the L lung

36
Q

On a woman, where is the general area you should be listening at to hear the lungs?

A

along the lower bra line

37
Q

The two names of the lymph nodes for the lungs? - and where are they found?

A

Tracheobronchial (at the base of the trachae, before it branches into bronchii)
Bronchopulmonary (where the bronchii meet the lungs)

38
Q

On a CXR, which ribs (posterior or anterior) appear more prominent?

A

Posterior - watch the direction of the ribs as you’re looking at them!

39
Q

What do you call enlarged/inflammed lymph nodes around the bronchi?

A

hilar lymphadenopathy

40
Q

What is a hilum?

A

Depression or slit-like opening in an organ where the nerves and vessels enter and leave

41
Q

T or F: the visceral pleura covers the outer surface of the lung

A

True

42
Q

What side of the pleura lines the lung cavity (i.e. the rib cage and the diaphragm)?

A

Parietal

43
Q

What lubricates the pleura so that the lungs can move?

A

Pleural fluid

44
Q

What is a pleural effusion?

A

Fills the potential pleural space with fluid

45
Q

What is a transudate?

A

Any fluid that has discharged through a normal membranes due to imbalanced hydrostatis and osmotic forces (i.e. imbalance of solids and liquids)

46
Q

What can be causes of transudates?

A

Atelectasis, heart failure, nephrotic syndrome

47
Q

What is an exudate?

A

Any fluid that has exuded out of a tissue or its capillaries, specifically because of injury or inflammation (i.e. leaky vessels)

48
Q

What can cause exudates?

A

Pneumonia, TB, pulmonary embolus, pancreatitis, malignancy

49
Q

How do you find the cause of a pleural effusion?

A

Stick a needle between T7-8 and send the fluid to the lab to look at cell count, LDH, protein

50
Q

What lab results would you find with a transudative pleural effusion?

A

Low protein, low LDH

51
Q

What lab results would you find with exudative pleural effusion?

A

high protein, high LDH

52
Q

What does it mean when the costal angle is “blunted?”

A

That “v” shaped angle that starts at the tip of the xiphoid process is not seen

53
Q

In a pleural effusion, the lung itself will sound like what?

A

Solid, because it’s being crushed by the excess fluid, so there’s less air in the lung itself

54
Q

What is a pneumothorax?

A

Air gets trapped in the pleural space

55
Q

What is the typical patient for spontaneous pneumothorax?

A

Tall, thin males ages 15-30 (although females of this description can get it, too)

56
Q

What do you want to look out for on a CXR when looking for a pneumothorax?

A

No lung markings (which are spiderweb-looking)

57
Q

What is the best rule of thumb when listening to the lungs?

A

Don’t listen over the clothes

58
Q

How can you listen to someone’s lungs posteriorly if they are unable to sit up?

A

Roll them from side to side to listen

59
Q

What is a “normal” documentation for lung examination?

A

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
Q

Healthy adult respiratory rate

A

~ 14-20 per min

61
Q

What are you looking for when you’re examining the thorax?

A

shape and condition of the chest and its movements

looking for any bony deformities, splinting, asymmetry

62
Q

What is splinting?

A

Breathing while guarding one side due to pain

63
Q

Normally, what is the thorax supposed to look like?

A

wider than deep

64
Q

What is a barrel chest and in what case do you often see this?

A

Increased AP diameter; COPD

65
Q

What is pectus excavatum (funnel chest)? And what problems can this cause?

A

Depression of the lower part of the sternum; compression of the heart and great vessels can cause murmurs

66
Q

What is pectus carinatum (pigeon chest)?

A

Sternum is displaced anteriorly, increaseing the AP diameter, the costal carilages adjacent to the protruding sternum are depressed

67
Q

What can be the result of a traumatic flail chest?

A

Paradoxical movement of the thorax - on inspiration, the injured area caves inward, while on expiration, the area moves outward

68
Q

What causes flail chest?

A

Multiple rib fractures due to trauma

69
Q

What is thoracic kyphoscoliosis?

A

Abnormal spinal curvatures and vertebral rotation deform the chest

70
Q

What is tactile fremitus?

A

Vibrations transmitted through the lung tissue when we talk

71
Q

How do you palpate tactile fremitus?

A

Felt with the ulnar aspects of the hand with patient saying “nintey-nine” or “one-one-one”

72
Q

When would tactile fremitus be absent?

A

If there is no lung tissue under your hand

73
Q

Why do we percuss the chest?

A

To establish whether the tissue underneath is air, fluid, or solid-filled

74
Q

What do you call the finger you put on the patient when percussing? (or the instrument?)

A

Pleximeter; middle finger

75
Q

What do you call the striking finger when percussing? And where do you strike on the pleximeter?

A

Plexor finger, you strike on the middle phalanx

76
Q

When is diaphramatic excursion absent in a patient?

A

phrenic nerve palsy

77
Q

When is diaphragmatic excursion reduced in patients?

A

emphysema

78
Q

With a normal diaphragmatic excursion, how far should the diaphragm move?

A

2 - 3 cm with normal respiration

3 - 5.5 cm with a full breath

Clinical Skills (5 decks)

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