THORAX & LUNGS Flashcards
-extends from the base of
the neck to the diaphragm.
-a.k.a Lower respiratory
tract
Composed of the lungs,
distal trachea, bronchi,
thoracic cage, and thoracic
cavity.
Thorax
= shorter & more
vertical → more prone to aspiration
Right Bronchus
recognizes ↑CO2 in the blood (primary stimulus) or ↓ O2 in the blood (secondary stimulus)
MEDULLA & Pons
increases CO2 in the blood (primary stimulus)
hypercapnia/ hypercarbia
decreases O2 in the blood (secondary stimulus)
hypoxemia
signals diaphragm (to speed up or slow down)
Medulla
**respiration/perfusion occurs (exchange of gases thru DIFFUSION)
Alveoli & Capillaries
*Relaxes = goes up, passive process; leads to POSITIVE PRESSURE forcing air out
Exhalation
*Contracts = goes down causing vertical expansion; creates NEGATIVE PRESSURE
Inhalation
Trachea, bronchi, esophagus,
heart, great vessels
MEDIASTINUM
-Provides support and protection Composed of:
-sternum
-12 pairs of ribs
-12 thoracic vertebrae
-muscles
-cartilage
Thoracic Cage
Cone-shaped, elastic organs in the
thoracic cavity where gas exchange occurs
LUNGS
U-shaped indentation.
Suprasternal notch
- Marks 2nd pair of ribs.
- Reference point for counting ribs and ICS.
Sternal angle (angle of Louis)
= vertebral prominence
C7
= floating ribs
11th & 12th rib
*coastal angle:
(anterior)
<90°
Vertical Reference Lines (Anterior)
- RIGHT midclavicular line
- Midsternal line
- LEFT midclavicular line
*costochondral angle
(posterior)
idk
lung right lobes
upper right lobes
middle right lobes
lower right lobes
Vertical Reference Lines (Lateral)
-Anterior axillary line
- Midaxillary line
- Posterior axillary line
Vertical Reference Lines (Posterior)
- LEFT scapular line
- Vertebral line
- RIGHT scapular line
lung left lobes
upper left lobes
lower left lobes
Seen in labored breathing (especially in children); indicates hypoxia.
Nasal Flaring
Early Clubbing
(180° angle)
→ Hypoxia.
Observed in asthma, emphysema, CHF; helps slow expiration & keep alveoli open.
Pursed Lip Breathing
-a drawing in of the muscles between the ribs when a person
inhales.
-may be sternal, suprasternal,
clavicular, intercostal.
Retractions
inspiratory contraction of the sternocleidomastoid, trapezius, and scalene muscles (commonly associated with severe obstructive
Accessory muscle
use
implies decreased ventilation to one side
Asymmetrical chest movement
(swayback) common posture of pregnancy “Pride of Pregnancy”
Lordosis
: (Leaning forward, hands on knees)
→ Seen in COPD to increase breathing capacity.
Tripod Position
(>180° angle)
→ Chronic oxygen deprivation.
Late Clubbing
the diamond-shaped gap formed
when two opposing fingers
are placed back to back
Schamroth window
thoracic kyphosis, lumbar lordosis & internally rotated shoulders
Swimmer’s slouch
: excessive forward rounding of the upper back. Can be common in the elderly.
Kyphosis
is a lateral (sideways) curve of the spine.
Scoliosis
Sternum protrudes forward. Congenital. Increased AP diameter.
Pectus Carinatum
(Pigeon Chest)
depression in lower sternum and is seen with congenital conditions that can cause murmurs or compress the heart and vessels..
Pectus Excavatum (Funnel Chest)
Ribs appear horizontal
(>45° angle) common in COPD.
AP to transverse diameter = 1:1
Barrel chest
Lung consolidation (pneumonia, tumor).
↑fremitus
Air trapping (emphysema,
pneumothorax, pleural effusion, obstruction, asthma).
↓fremitus
Thumbs move 5–10 cm apart
symmetrically with deep breath.
Chest Expansion
Resonance over
healthy lung tissue; flat over the scapula
percussion tones
Indicates trapped
air (emphysema,
pneumothorax).
Hyperresonance:
Suggests fluid or
solid tissue
replacing air
(pneumonia,
pleural effusion,
tumor)
Dullness
is commonly used as
an indication of
pyelonephritis; may
also indicate
fractures in elderly.
Costovertebral
angle tenderness:
a.k.a “costochondral
junction tenderness”
3–5 cm; up to 7–8 cm in well conditioned individuals.
Percuss from resonance to dullness at:
exhalation
inhalation
Normal DIAPHRAGMATIC
excursion
- Very loud, high pitch
- Over trachea
Tracheal
Normal BREATH sounds
Tracheal
Bronchial
Bronchovesicular
Vesicular
- Loud, high pitch
- Over manubrium
Bronchial
-Medium loudness, intermediate pitch
- 1st & 2nd ICS, and between scapula
Bronchovesicular
- Soft, low pitch
- Most of the lung field
Vesicular
Trachea shifts ipsilaterally
(toward affected side), ↓ breath sounds.
Obstructive atelectasis
Trachea shifts contralaterally (away from affected
side), absent breath sounds.
Pneumothorax/ Pleural effusion/ Hemothorax
: Prolonged breath sounds, hyperresonance.
Emphysema
high-pitched; musical sounds during exhalation, then eventually also during inhalation ex. Asthma or chronic emphysema
Sibilant
low-pitched; snoring/moaning sounds mainly during exhalation; may clear with coughing; A.k.a RHONCHI.
ex. Bronchitis
Sonorous
harsh, honking wheeze with severe broncholaryngospasm or obstruction in larynx/trachea
ex. Croup, epiglottitis, foreign body in airway
STRIDOR
high-pitched; popping; rolling strands of hair between fingers near your ear; due to air suddenly
opening deflated alveoli coated with secretions
ex. Pneumonia, CHF, bronchitis, asthma, emphysema
FINE
low-pitched; bubbling, moist sounds; a.k.a “Velcro rales”; due to air coming into contact with secretion-lined narrowed trachea & bronchi
ex. *same as fine crackles, and pulmonary fibrosis
COARSE
Low-pitched, sandy, HARSH GRATING, LEATHERY SOUND
-friction of inflamed and roughened pleura
-heard on inspiration and expiration
-often mistaken for coarse crackles
Ex. pleuritis
PLEURAL FRICTION RUB
*due to increased distance between lung and chest wall
Common in:
▪ Asthma, emphysema
▪ Tumor, atelectasis, total obstruction
▪ Effusions, fibrosis
ABSENT or DIMINISHED
