Ab Thorax Week 4

Which diameter is larger in normal adults?

Lateral

What is the normal Lateral:A-P ratio of the thorax?

2:1

What is the name of an altered ratio of lateral:A-P thorax dimensions (1:1)?

Barrel chest

What are the potential causes of barrel chest?

Infancy

Elderly

Emphysema

What is the term for depression of the lower portion of the chest?

Funnel chest

What is the AKA of funnel chest?

Pectus excavatum

What finding of the heart can be caused by pectus excavatum?

Murmurs

What is the term for term for anterior displacement of the chest?

Pigeon chest

What are the AKAs of pigeon chest?

Pectus carniatum

Keel chest

T or F: Both pectus excavatum and pectus carniatum require immediate referral due to the harmful symptoms they can cause

False (they are both clinically insignificant

What is the term for tender nodules at the costochondral junction?

Rachitic rosary

What condition causes rachitic rosary?

Rickets (vitamin D deficiency)

What is the term for a sharply angled kyphosis due to a collapsed vertebra?

Gibbus deformity

What lung disease can lead to a collapsed vertebra?

Tuberculosis

What is the term for abnormal thoracic curvature with vertebral rotation?

Kyphoscoliosis

What condition can distort underling lungs and make lung findings difficult?

Kyphoscoliosis

What is the term for paradoxical movements of the thorax during breathing?

Flail chest

What can cause flail chest?

Multiple rib fractures

What direction does the injured area move with flail chest on inhale/exhale?

Inward/Outward

Why does flail chest require immediate referral?

Rib fracture can lead to lung puncture

What do you initially palpate the thorax for?

Masses and tenderness

How should the patient hold their arms when palpating between the scapulae?

Crossed in front

How many areas are palpated on the posterior thorax?

8 (4 each side)

How many areas are palpated on the anterior thorax?

6 (3 on each side)

What are you palpating for in the different thorax areas?

Tactile Fremitus

What should the patient do while you palpate for tactile fremitus?

Say "99" in a slow, deep voice

What part of the hand do you use to palpate tactile fremitus

Ball or Ulnar edge

What does increased vibration of tactile fremitus indicate?

Increased density of lung tissue?

What can cause increased density of lung tissue?

Pneumonia

What does decreased vibration of tactile fremitus indicate?

Decreased density of lung tissue

Decreased transmission of air to the chest wall

What can cause decreased density of lung tissue?

Emphysema

What can cause decreased transmission of air to the chest wall?

Pneumothorax

Pleural effusion

What is the patient's arm position when testing respiratory expansion?

At their sides

What vertebral level is respiratory expansion performed at?

T10

What does the patient do when testing for respiratory expansion?

Inhale deeply

How many times should the patient breath when testing for respiratory expansion?

3

What can cause unilateral decreased expansion of the ribs?

Lung problem

Diaphragm problem

Pleural effusion or pneumothorax

Lobar pneumonia

What can cause bilateral decreased expansion of the ribs?

Emphysema

Ankylosing spondylitis

How many areas do you percuss on the posterior thorax?

14

What is the patient arm position during posterior thorax percussion?

Crossed in front

How many areas are percussed on the anterior thorax?

12

What is the patient arm position for anterior thorax percussion?

Down by sides

What is the direction of percussion of the thorax?

Ladder pattern right-left then left-right

What normally sounds flat?

Muscles

What does a flat sound on the lung indicate?

Massive pleural effusion

Pneumonectomy

Complete lung collapse

What normally sounds dull?

Liver

What does a dull sound on the lung indicate?

Tumor

pulmonary edema

atelectasis (lung collapse)

(lots of things)

What normally sounds resonant?

Lung

What pathology of the lung can a resonant sound accompany?

Chronic bronchitis

What normally sounds hyperresonant?

Nothing

What does a hyper resonant sound on the lung indicate?

Emphysema

small pneumothorax

Acute asthmatic attack

What normally sounds tympany?

Abdomen / gastric air bubble

What does tympany over the lung suggest?

Large pneumothorax

What condition would cause hyperresonance in the top of the lung and dull sound in the lower lung?

Hemopneumothorax

What type of tactile fremitus would be present in a hemopneumothorax?

Decreased in both the top and bottom

What is tactile fremitus over a pneumonectomy?

Decreased, almost none

What is the only posterior thorax examination where the patient has their arms by their sides?

Respiratory expansion

How many points are ausculated for posterior lung sounds?

14

How many points are auscultated for anterior lung sounds?

12

T or F: All the points of auscultation are exactly the same as the points for lung percussion

True

What is the term for an abnormal breath sound?

Adventitious sound

What test is performed when abnormalities are found on lung auscultation?

Spoken or whispered voice

What part of the stethoscope is used to auscultate the lung sounds?

Diaphragm (firm pressure)

What are the 4 breath sounds?

Vesicular

Bronchiovesicular

Brionchial

Tracheal

What are the breathing instructions for lung auscultation?

Breath slowly, deeply, and quietly through an open mouth

T or F: The patient should take one breath every time the doctor moves to the next auscultation point

False (they should breath at a normal rate)

What is the dominant normal breath sound?

Vesicular

What is the lowest pitched breath sound?

Vesicular

What is the inhale:exhale duration ratio in vesicular breath sounds?

3:1

What population are diminished vesicular breath sounds found in?

Elderly

Thick-walled people (Muscle or fat)

emphysema

What population are harsh vesicular breath sounds found in?

Children

Thin-walled individuals (skinny)

After exercise

What is the intensity of expiratory vesicular breath sounds?

soft

What is the pitch of expiratory vesciular breath sounds?

low

Where are vesicular breath sounds heard?

Periphery (majority) of the lung field

What is the inhale:exhale ratio of bronchovesicular breath sounds?

1:1

What is the intensity of the expiratory bronchovesciular breath sound?

Intermediate

What is the pitch of the intermediate bronchovesicular breath sound?

Intermediate

Where are bronchovesicular breath sounds normally heard?

Between scapulae and anterior 1st and 2nd interspaces

What is the inhale:exhale ratio for bronchial breath sounds?

2:3 (with a pause in between)

What is the intensity of expiratory bronchial sounds?

loud

What is the pitch of expiratory bronchial breath sounds

high

Where are bronchial breath sounds normally heard?

over the manubrium

What is the highest pitched breath sound?

tracheal

What is the inhale:exhale ratio of tracheal breath sounds?

1:1 (with a pause)

What is the intensity of the expiratory tracheal breath sound?

loud/harsh

What is the pitch of the expiratory tracheal breath sound?

highest

What are tracheal breath sounds normally heard?

Trachea (over the neck)

What conditions can cause a lack of ventilating lung tissue?

Complete airway obstruction

pneumonectomy

paralyzed diaphragm

Atelectasis with a bronchial plug

What pleural processes can prevent breath sound from reaching the stethoscope?

Pleural effusion

Pneumothorax

Hemothorax

What can produce an abnormal bronchiovesciular breath sound?

Partial atelectasis (with patent bronchus)

Early pneumonia

Small tumors

Pulmonary edema

What is the name of the process by which alveoli fill with fluid and cells?

Consolidation

What can cause abnormal bronchial breath sounds?

Atelectasis (with patent bronchus)

Lung tumor

Pneumonia

Pulmonary infarction

T or F: The pleura of the lung is insensitive to pain while the lung tissue itself is

False (the lung tissue is insensitive to pain, but the pleura of the lung can feel pain)