PD Exam 2- Lung and Thorax

Which intercostal space is used for needle decompression for tension pneumothorax?

2nd intercostal space

Which intercostal space is used for chest tube insertion?

4th intercostal space

What is used for the lower margin of an endotracheal tube on a chest x-ray?

T4

Where should needles and tubes be placed due to neurovascular structures that run along the inferior margin?

Superior rib margins

The sternal angle (angle of louis) corresponds to which landmark?

2nd rib

Ribs 1-7 articulate with what?

Sternum

Ribs 8-10 articulate with what?

Costal cartilages above

Ribs 11-12 articulate with what?

No attachments, floating

The inferior tip of the scapula corresponds with which vertical landmark?

Level of 7th rib or interspace

What does the oblique fissure divide?

Divides each lung in half (upper and lower)

What does the horizontal fissure divide?

Divides right lung into RUL and RML

Where does the trachea bifurcate posteriorly?

T4 spinous process

What is the area for foreign body aspirations due to its angulation?

Right main bronchus

Which bronchus crosses anterior to the esophagus?

Left main bronchus

What is breathing controlled by?

Brainstem

What divides the thorax from the abdomen?

Diaphragm

What occurs when the diaphragm descends and enlarges the thoracic cavity?

Contraction

What kind of movement is seen during sitting?

More thorax movement

What kind of movement is seen during supine?

More abdominal movement

What is the number one indicator for respiratory effort evaluation?

Signs on central cyanosis

What is the order for lung and thorax examination?

Inspection, Palpation, Percussion, Auscultation

Should the chest be wider than it is deep or deeper than it is wide?

Wider than it is deep

During inspection of the chest wall, what is another name for hunchback?

Kyphosis

During inspection of the chest wall, what is having a deeper chest compared to wide?

Barrel chest

What is another word for funnel chest?

Pectus Excavatum

What is another word for pigeon chest with the sternum protruding out?

Pectus Carinatum

Which part of the exam includes testing chest expansion, feel for tactile fremitus, palpate and compare symmetric areas?

Palpation

Where do you place your thumbs when testing chest expansion?

10th rib

What part of palpation includes palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks and is a rough assessment tool?

Tactile Fremitus

Midsternal line

Midclavicular line

Anterior axillary line

Anterior axillary line

Midaxillary line

Posterior axillary line

Scapular line

Vertebral line

What surface of the hand do you use during tactile fremitus?

Ulnar

During tactile fremitus, decreased or absent means that the vibrations may be impreded. What could this mean?

COPD/EMPH- too much air

During tactile fremitus, increased means possible consolidation. What could this mean?

Tumor, pneumonia

During percussion, what part of the finger do you strike with?

Tip

What is the percussion norm for flatness?

Over thigh

What is the percussion norm for dullness?

Over liver

What is the percussion norm for resonance?

Normal lung

What is the percussion norm for hyperresonance?

NONE normally

What is the percussion norm for tympany?

gastric bubble, puffed cheeks

What is diaphragmatic excursion normally?

3-5.5 cm

During auscultation of the lungs, where do you use the diaphragm?

Intercostal spaces

What is the most important technique for assessing airflow through tracheobronchial tree?

Auscultation

What tests do you perform if abnormalities are noted during auscultation of lungs?

Pulmonary special tests-Bronchophony, Egophony, Whispered pectoriloquy

What are you listening for during auscultation of lungs?

Sounds of breathing, Adventitious sounds

What breath sound is soft and low-pitched, heard through inspiration and heard over most of both lungs?

Vesicular

What breath sound is with inspiratory and expiratory sounds about equal in length sometimes separated by silent interval, heard often in 1st and 2nd interspaces anteriorly and between scapulae?

Bronchovesicualr

How many spots on the posterior do you palpate?

4 pairs- 8 total

How many spots on the posterior do you percuss and auscultate?

7 pairs- 14 total

What breath sounds in louder and higher in pitch between with a silence between inspiratory and expiratory sounds, if heard at all is heard over the manubrium?

Bronchial

What breath sound has inspiratory and expiratory sounds that are about equal with loud intensity and relatively high pitched, heard over the trachea?

Tracheal

What type of pattern do you use for auscultation?

Ladder pattern

What is heard during the adventitious sound of FINE crackle?

soft, high pitched, very brief.

What is a FINE crackle sounds associated with?

Pulmonary fibrosis, interstitial fibrosis, interstitial pneumonitis

What is heard during the adventitious sounds of COARSE crackle?

somewhat louder, lower in pitch, not so brief

What is a COARSE crackle associated with?

COPD, asthma, bronchiectasis, pneumonia, heart failure

Which adventitious sound has a relatively high pitched hissing or shrill quality? May be referred to as musical

Wheezes

What is the adventitious sound of wheezing associated with?

asthma, airway diseases or conditions

Which adventitious sound has relatively low pitch, snoring quality?

Rhonchi

The adventitious sound rhonchi can often clear with what?

Coughing

What is heard in the adventitious sound stridor?

A continuous high frequency, high pitched musical produced as air moves through a narrowing in IN UPPER RESPIRATORY TRACT. Best heard over neck on inspiration

What is the adventitious sound stridor associated with?

Epiglottis, anaphylaxis, FB, airway edema

Which adventitious sound has a discontinuous low frequency, arises from inflammation of visceral pleura as it slides against the parietal pleura?

Pleural rub

Which adventitious sound sounds like walking on fresh snow?

Pleural rub

What does the adventitious sound Mediastinal crunch (hammans crunch) sound like?

precordial crackles synchronous with heartbeat.

What is associated with the adventitious sound mediastinal crunch?

Tracheobronchial injury, blunt trauma, pulmonary disease

What is the normal and positive finding for Bronchophony? (ninety-nine)

Normal- muffled and indistinct

Positive- louder, clearer voice sounds

What is the normal and positive finding for Egophony? (eee)

Normal- muffled long “E” sound

Positive- “E” is heard as ayyy

What is the normal and positive finding for whispered pectoriloquy? (whispered ninety nine)

Normal- faintly and indistinctly if at all

Positive- louder, clearer whispered

How should the anterior chest examine be performed?

Supine

How many spots on the anterior should be palpated?

3 pairs- 6 spots

Where does the heart normally produce a dullness?

Left 3rd-5th interspace

What will mark the lower border of the right lung?

Liver

How many spots should be auscultated on the anterior chest?

6 pairs- 12 spots

How do you check for the anterior axillary lymph node?

Grasp the anterior axillary fold between your thumb and fingers and palpate inside the border of the pectoral muscel

How do you check for the lateral axillary lymph node?

From high in the axilla, feel along the upper humerus

How do you check for the posterior axillary lymph node?

Step behind the patient and with your hand feel inside the muscle of the posterior axillary fold

How do you check for the central axillary lymph node?

Deep within the central axilla