Thorax, Lungs & Breast Assessment – Lecture Review

These Question-and-Answer flashcards review key landmarks, techniques, normal findings, and abnormalities for thorax, lung, and breast assessment discussed in the lecture.

Why do clinicians use the pads rather than the tips of their fingers for palpation?

Pads contain more nerve endings, so they detect surface detail better.

What anatomical landmark is the small U-shaped notch at the top of the sternum?

The suprasternal (jugular) notch.

Name the three parts of the sternum.

Manubrium, body, xiphoid process.

At which intercostal space is the sternal angle (Angle of Louis) located?

At the 2nd intercostal space.

What is the normal degree of the costal angle in an adult?

About 90° or less.

Which lung lobes are auscultated on the right anterior chest?

Right upper, right middle, and right lower lobes.

Why is the left lung narrower than the right?

The heart indents the left lung creating the cardiac notch.

State the four main functions of the respiratory system.

Supply O₂, remove CO₂, maintain acid–base balance, and assist with heat exchange.

What is the primary chemical stimulus for normal breathing?

Elevated blood CO₂ (hypercapnia).

Define hypercapnia.

Excess carbon dioxide in the blood.

Define hypoxemia.

Low oxygen level in the blood.

Name two major accessory muscles used in forced inspiration.

Sternocleidomastoid and scalene muscles (pectoralis may also assist).

How long does an acute cough last?

2–3 weeks.

A cough that persists longer than two months is classified as what?

A chronic cough.

What is the normal anterior–posterior (AP) to transverse chest diameter ratio?

1 : 2.

Which chest shape is characteristic of long-standing COPD?

Barrel chest (AP ≈ transverse, 1 : 1).

Where do you place your hands to assess posterior chest expansion?

Thumbs at T9–T10, pinching a skin fold.

What phrase is repeated when assessing tactile fremitus?

“99.”

How does tactile fremitus change with pneumonia?

It is increased.

How does tactile fremitus change with pleural effusion, pneumothorax, or COPD?

It is decreased.

Why should you avoid placing a stethoscope directly over bone?

Bone transmits breath sounds poorly.

Which side of the stethoscope is used for lung auscultation?

The diaphragm.

Essential instruction before lung auscultation:

“Each time the stethoscope touches your skin, take a deep breath through your mouth.”

List the three normal breath sounds and their typical locations.

Bronchial (trachea), bronchovesicular (sternal borders & between scapulae), vesicular (peripheral lung fields).

What is the normal nail-base angle of the finger?

Approximately 160 degrees.

Which nail change (>180°) suggests chronic hypoxia?

Clubbing.

What patient posture often indicates COPD distress?

Tripod position—leaning forward with arms braced.

Describe pursed-lip breathing and its purpose.

Exhaling through narrowly pursed lips; prolongs expiration and releases trapped air.

What is crepitus (subcutaneous emphysema)?

A crackling sensation felt when air escapes into subcutaneous tissue.

Define tachypnea.

Respiratory rate >24 breaths per minute.

Define bradypnea.

Respiratory rate <10 breaths per minute.

Which adventitious breath sound is a high-pitched inspiratory crow and signals airway obstruction?

Stridor.

Which adventitious sound is a low-pitched grating heard with pleural inflammation?

Pleural friction rub.

Fine and coarse crackles are commonly associated with which conditions?

Pulmonary edema, pneumonia, heart failure, COPD, atelectasis.

What is atelectasis?

Collapsed or non-inflated alveoli.

Define pneumothorax.

Free air in the pleural space causing lung collapse.

In which breast quadrant do most cancers occur?

Upper outer quadrant including the Tail of Spence.

Give two visual signs of possible breast cancer.

Dimpling/puckering of skin or nipple retraction/asymmetry.

Which inspection positions enhance detection of breast abnormalities?

Arms overhead, hands on hips pressing, palms together, leaning forward.

During breast palpation, which part of the fingers is used and what pattern is followed?

Pads of three fingers in an up-and-down vertical strip pattern including the Tail of Spence.

What must always be done when palpating the nipple?

Gently compress the nipple to check for discharge.

List the key characteristics you document for a breast lump.

Location, size, shape, mobility, consistency (soft/firm).

Define gynecomastia.

Benign enlargement of male breast tissue due to estrogen–testosterone imbalance or other causes.

How does declining estrogen after menopause affect breast tissue?

Glandular tissue atrophies causing smaller, more pendulous breasts with easier-to-feel lumps.

Which assessment step always comes first in a respiratory exam?

Inspection.