Anatomy and Physiology: Thoracic Landmarks
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Questions and Answers

What type of abnormal lung sound is characterized by high-pitched, musical tones mostly heard during expiration?

  • Fine Crackles
  • Wheeze (sibilant) (correct)
  • Course Crackles
  • Pleural Friction Rub

    • Which of the following describes the expected percussion technique on the posterior chest?

  • Avoid all intercostal spaces during percussion
  • Percuss over the scapulae and ribs
  • Begin at the bases and move upward
  • Percuss side-to-side over interspaces (correct)

    • What is the clinical term for rapid respirations exceeding 24 breaths per minute?

  • Hyperventilation
  • Hypoventilation
  • Bradypnea
  • Tachypnea (correct)

    • Which adventitious lung sound is characterized by low-pitched bubbling that can be cleared with a cough?

    <p>Course Crackles</p> Signup and view all the answers

    What indicates the presence of pleural surfaces rubbing together during respiration?

    <p>Pleural Friction Rub</p> Signup and view all the answers

    What is the purpose of using landmarks in respiratory assessment?

    <p>To provide exact locations for assessment findings</p> Signup and view all the answers

    Which structure is part of the visceral membrane?

    <p>Outer surface of each lung</p> Signup and view all the answers

    Which change in the respiratory system is commonly associated with aging?

    <p>Weakening of skeletal muscles</p> Signup and view all the answers

    What is the significance of the sternal angle during the respiratory assessment?

    <p>It is the bifurcation point of the trachea</p> Signup and view all the answers

    What should a patient's costal angle ideally be for normal respiratory assessment?

    <p>Slightly less than 90 degrees</p> Signup and view all the answers

    What condition can lead to increased retention of CO2 in the body?

    <p>Weakening of respiratory muscles</p> Signup and view all the answers

    What is a common consequence of posterior thoracic inspection?

    <p>Alignment of vertebrae</p> Signup and view all the answers

    In the context of respiratory illness history, which question is relevant?

    <p>Are you experiencing any respiratory problems?</p> Signup and view all the answers

    What does tactile fremitus assess during a respiratory examination?

    <p>Palpable vibrations through the chest wall</p> Signup and view all the answers

    Which respiratory sound is characterized by soft sounds and low pitch?

    <p>Vesicular</p> Signup and view all the answers

    What is the expected AP:T diameter ratio for a healthy thorax?

    <p>1:2</p> Signup and view all the answers

    What may increase the risk of respiratory disease in certain populations?

    <p>Living in urban areas</p> Signup and view all the answers

    Which might indicate an increased risk of pneumonia?

    <p>History of asthma</p> Signup and view all the answers

    What finding is indicated by the presence of fine crackles during auscultation?

    <p>Fluid-filled alveoli</p> Signup and view all the answers

    Which term describes the abnormal lung sound characterized by low-pitched grating during both inspiration and expiration?

    <p>Pleural friction rub</p> Signup and view all the answers

    When assessing respiratory expansion, which area is most appropriate to palpate explicitly?

    <p>At the ribs and intercostal spaces</p> Signup and view all the answers

    What is the primary characteristic of tachypnea?

    <p>Rapid breaths exceeding 24 per minute</p> Signup and view all the answers

    Which auscultation finding is specifically associated with air colliding with secretions?

    <p>Coarse crackles</p> Signup and view all the answers

    What is a typical characteristic of whispered pectoriloquy in a respiratory evaluation?

    <p>Increased volume with whispered sounds</p> Signup and view all the answers

    Which breathing pattern is defined as a slow, regular respiration?

    <p>Bradypnea</p> Signup and view all the answers

    What is the expected percussion note over interspaces during a respiratory assessment?

    <p>Resonance</p> Signup and view all the answers

    What common respiratory condition could lead to a barrel chest appearance?

    <p>Chronic Obstructive Pulmonary Disease (COPD)</p> Signup and view all the answers

    Which characteristic differentiates a wheeze from other adventitious sounds?

    <p>High-pitched and musical</p> Signup and view all the answers

    What change occurs in the thoracic cavity that can contribute to a barrel chest appearance?

    <p>Calcification of costal cartilage</p> Signup and view all the answers

    Which physical examination technique assesses bilateral chest expansion?

    <p>Palpation</p> Signup and view all the answers

    Which lifestyle factor is considered a major risk for respiratory disease in the United States?

    <p>Tobacco use</p> Signup and view all the answers

    Which of the following describes a characteristic of bronchial breath sounds?

    <p>Heard over major bronchi</p> Signup and view all the answers

    What is the primary purpose of utilizing landmarks during a respiratory assessment?

    <p>To provide precise references for anatomical features</p> Signup and view all the answers

    Which finding during an inspection may suggest respiratory difficulty in a patient?

    <p>Cyanosis of lips and nail beds</p> Signup and view all the answers

    What is indicated by a decreased diameter of the thoracic cavity?

    <p>Potential for respiratory illness</p> Signup and view all the answers

    What assessment technique is utilized to determine the density of lung tissue?

    <p>Percussion</p> Signup and view all the answers

    Which of the following describes a key factor in the increased incidence of respiratory diseases in certain cultural groups?

    <p>Environmental and occupational exposures</p> Signup and view all the answers

    What is the primary concern when assessing for tactile fremitus in patients?

    <p>Determining the presence of consolidation</p> Signup and view all the answers

    Match the following thoracic landmarks with their descriptions:

    <p>Suprasternal notch = Between clavicles/top of sternum Manubrium = Upper part of the sternum Xyphoid process = Lower tip of the sternum Costal angle = Angle formed by the ribs at the xiphoid process</p> Signup and view all the answers

    Match the following respiratory assessment techniques with their purposes:

    <p>Auscultation = Listening to breath sounds Palpation = Feeling for chest expansion Inspection = Observing for signs of respiratory difficulty Percussion = Determining the density of lung tissue</p> Signup and view all the answers

    Match the following conditions with their potential effects on the respiratory system:

    <p>Aging = Decreased lung elasticity Kyphosis = Decreased lung inflation ability Obesity = Increased risk for shortness of breath COPD = Hyperresonance during percussion</p> Signup and view all the answers

    Match the following respiratory sounds with their characteristics:

    <p>Bronchial = Louder and higher-pitched Vesicular = Soft sound and low pitch Bronchovesicular = Moderate sound and pitch Wheezing = Musical respiratory sound</p> Signup and view all the answers

    Match the following respiratory conditions with their typical symptoms or concerns:

    <p>Asthma = Bronchoconstriction Pneumonia = Increased tactile fremitus Emphysema = Barrel chest appearance Tuberculosis = Increased incidence in poor populations</p> Signup and view all the answers

    Match the following aspects of the thoracic cavity with their significance:

    <p>AP:T diameter = Expected 1:2 ratio Costal cartilage calcification = Decreased depth of respirations Barrel chest = AP=T ratio equals 1:1 Sternal angle = Trachea bifurcation at T4</p> Signup and view all the answers

    Match the following types of cough with their descriptions:

    <p>Dry cough = Non-productive without mucous Productive cough = Accompanied by sputum Paroxysmal cough = Sudden, severe bouts Barking cough = Resembles a seal</p> Signup and view all the answers

    Match the following environmental concerns with their associated respiratory issues:

    <p>Asbestos = Asbestosis Secondhand smoke = Increased respiratory infections Molds = Allergic reactions Dust = Worsening of asthma symptoms</p> Signup and view all the answers

    Match the following subjective examination questions with their relevant topics:

    <p>Do you smoke? = Tobacco use history Are you having any problems? = General respiratory concerns How much mucous do you have? = Cough description What brings on dyspnea? = Shortness of breath triggers</p> Signup and view all the answers

    Match the following adventitious lung sounds with their descriptions:

    <p>Fine Crackles = High pitched short, crackling sounds, primarily on inspiration Coarse Crackles = Loud, low pitched bubbling, clears with cough Pleural Friction Rub = Low pitched grating during inspiration and expiration Wheeze = High-pitched musical sounds, mostly during expiration</p> Signup and view all the answers

    Match the following respiratory patterns with their definitions:

    <p>Tachypnea = Rapid respirations exceeding 24 breaths/min Bradypnea = Slow and regular respirations Apnea = Temporary cessation of breathing Hyperpnea = Increased depth and rate of breathing</p> Signup and view all the answers

    Match the following physical examination techniques with their purposes:

    <p>Palpation = Assess for tenderness and abnormalities Percussion = Determine lung density by sound Auscultation = Evaluate breath sounds Inspection = Visual assessment of respiratory effort</p> Signup and view all the answers

    Match the following abnormal respiratory findings with their causes:

    <p>Barrel Chest = Associated with COPD and normal aging Fremitus = Increased if fluid is present in the lungs Cyanosis = Indicates low oxygenation of blood Hypoxia = Deficiency in the amount of oxygen reaching tissues</p> Signup and view all the answers

    Match the following lung sounds with their expected clinical scenarios:

    <p>Fine Crackles = Collapsed or fluid-filled alveoli popping open Course Crackles = Air colliding with secretions Wheeze = Air passing through narrow passageways Pleural Friction Rub = Pleural surfaces rubbing together</p> Signup and view all the answers

    Match the following respiratory assessment techniques with their descriptions:

    <p>Tactile Fremitus = Assesses vibrations transmitted through the chest wall Respiratory Expansion = Evaluates the movement of the chest during breathing Auscultation of Breath Sounds = Listens to lung sounds using a stethoscope Percussion Over Interspaces = Identifies changes in lung density</p> Signup and view all the answers

    Match the following lung conditions with their associated physical findings:

    <p>COPD = Barrel chest appearance Pneumonia = Decreased breath sounds and crackles Pleural Effusion = Decreased fremitus and dullness on percussion Atelectasis = Decreased breath sounds and increased tactile fremitus</p> Signup and view all the answers

    Match the following signs with their interpretations in respiratory assessment:

    <p>Cyanosis = Poor oxygenation of tissues Clubbing = Chronic hypoxia or lung disease Bradypnea = Possible neurological issue or metabolic condition Tachypnea = Response to fever or respiratory distress</p> Signup and view all the answers

    Match the following auscultation findings with their characteristic descriptions:

    <p>Stridor = High-pitched sound indicating upper airway obstruction Rhonchi = Coarse rattling noise due to secretions Diminished Breath Sounds = Reduced airflow in some areas of the lung Normal Breath Sounds = Clear sounds heard in healthy lung fields</p> Signup and view all the answers

    What are the surface landmarks of the abdominal assessment?

    <p>Between diaphragm and top of pelvis, vertebral column and paravertebral muscles, lower rib cage and abdominal muscles.</p> Signup and view all the answers

    What types of viscera are found in the abdomen?

    <p>Solid</p> Signup and view all the answers

    Where is the liver primarily located?

    <p>Mostly in the RUQ.</p> Signup and view all the answers

    What is the function of the abdominal wall muscles?

    <p>Protect and hold the organs in place.</p> Signup and view all the answers

    The aorta is located just to the right of the midline.

    <p>False</p> Signup and view all the answers

    What are the signs of ascites?

    <p>Everted umbilicus</p> Signup and view all the answers

    What is rebound tenderness a sign of?

    <p>Inflammation (peritoneal irritation).</p> Signup and view all the answers

    What techniques are used for abdominal examination?

    <p>Percussion</p> Signup and view all the answers

    Dullness over fluid during percussion is a normal finding.

    <p>False</p> Signup and view all the answers

    What does Murphy’s sign indicate?

    <p>Cholecystitis (gallbladder inflammation).</p> Signup and view all the answers

    Which of the following conditions can result in an enlarged spleen?

    <p>Cirrhosis</p> Signup and view all the answers

    What happens to bowel sounds as the time since eating increases?

    <p>Bowel sounds may decrease.</p> Signup and view all the answers

    What is the primary role of the four layers of large flat muscles in the abdominal wall?

    <p>Protect and hold the organs in place</p> Signup and view all the answers

    Which organ is primarily located in the right upper quadrant (RUQ) of the abdomen?

    <p>Liver</p> Signup and view all the answers

    What changes in gastrointestinal function are typically observed in aging adults?

    <p>Delayed esophageal emptying</p> Signup and view all the answers

    What is the first step in performing an abdominal assessment?

    <p>Inspection</p> Signup and view all the answers

    What is considered an objective data collection technique during an abdominal assessment?

    <p>Palpation of the abdomen</p> Signup and view all the answers

    Which abdominal structure is located just lateral to the right midclavicular line?

    <p>Gallbladder</p> Signup and view all the answers

    What effect does keeping the room warm have on abdominal assessment?

    <p>Enhances abdominal wall relaxation</p> Signup and view all the answers

    What is the recommended position for a patient during an abdominal assessment?

    <p>Supine with knees bent</p> Signup and view all the answers

    Which area of the abdomen is primarily responsible for containing the aorta?

    <p>Left of midline</p> Signup and view all the answers

    What common issue may arise in aging adults related to gallbladder function?

    <p>Formation of gallstones</p> Signup and view all the answers

    What is the typical range for normal bowel sounds per minute during auscultation?

    <p>5-30 sounds</p> Signup and view all the answers

    Which technique is used to palpate the liver correctly?

    <p>place left hand behind the patient and right hand on RUQ</p> Signup and view all the answers

    What characteristic of the spleen's enlargement usually occurs with mononucleosis?

    <p>enlarged and soft with rounded edge</p> Signup and view all the answers

    What does the presence of rebound tenderness indicate during an abdominal assessment?

    <p>peritoneal irritation or inflammation</p> Signup and view all the answers

    When assessing the costovertebral angle for tenderness, what is the patient required to do?

    <p>sit up straight</p> Signup and view all the answers

    In which condition might a patient's abdominal palpation reveal involuntary rigidity?

    <p>peritoneal inflammation</p> Signup and view all the answers

    What is observed in a patient with ascites during abdominal examination?

    <p>everted umbilicus and taut skin</p> Signup and view all the answers

    Which finding suggests the presence of an aortic aneurysm upon palpation?

    <p>pulsating mass greater than 5 cm</p> Signup and view all the answers

    Which physiological response occurs during voluntary guarding in abdominal palpation?

    <p>muscles relax with exhalation</p> Signup and view all the answers

    What type of bowel sound is characterized by very high-pitched and increased activity?

    <p>hyperactive</p> Signup and view all the answers

    Study Notes

    Anatomy and Physiology

    • Visceral membrane lines the outside of the lungs
    • Parietal membrane lines the thoracic wall and the upper surface of the diaphragm

    Landmarks

    • Landmarks assist with locating assessment findings and visualizing underlying structures
    • Bony structures include the sternum, vertebrae, clavicles, and ribs
    • Imaginary horizontal and vertical lines are used to locate specific landmarks

    Anterior Landmarks

    • Suprasternal notch is the area between the clavicles and the top of the sternum
    • Sternal angle, or angle of Louis, is the junction between the manubrium and the body of the sternum
    • The sternal angle corresponds to the second rib and the bifurcation of the trachea
    • The costal angle should be less than 90 degrees; an increased angle signifies overinflation

    Other Landmarks

    • Midsternal
    • Midclavicular
    • Anterior axillary
    • Midaxillary
    • Posterior axillary

    Posterior Thorax Landmarks

    • C7 and T1 are prominent with the neck flexed
    • The lower border of the scapula is usually aligned with the 7th or 8th rib
    • The 12th rib forms the bottom of the rib cage

    Trachea and Bronchi

    • The trachea bifurcates at the sternal angle, which corresponds to the level of T4

    Respiratory System with Age

    • The lungs lose elasticity, skeletal muscles weaken, and costal cartilage becomes calcified with age
    • These changes decrease respiratory depth and affect thoracic cavity dimensions, which creates a barrel chest appearance
    • Kyphosis, or curved thoracic spine, limits lung inflation
    • These changes result in decreased oxygen intake and increased carbon dioxide retention, and increase the risk of dyspnea, post-operative complications, and pneumonia.

    Respiratory System: Cultural Considerations

    • Respiratory diseases are more prevalent in poor, rural, urban, and recent immigrant groups due to increased exposure to asthma and tuberculosis
    • Patients should be fully disrobed for physical examinations, but cultural prohibition of removing clothing should be respected; a same-sex examiner may be necessary.

    Environmental Concerns

    • Occupational exposure to asbestos can lead to asbestosis
    • Air conditioning and heating systems contribute to increased respiratory infections
    • Home-based exposure to secondhand smoke, pet dander, dust, and mold can trigger respiratory problems

    Subjective Examination: Health History Questions

    • "Are you having any problems with your respiratory system?"
    • Compare current respiratory function to prior function
    • Are there breathing difficulties with exercise or lying down? Orthopnea is difficulty breathing while lying down.
    • History of respiratory illness or infection and the type of treatment used

    Cough

    • Cough description
    • Amount, color, consistency, odor, and presence of blood in mucus

    Chest Pain

    • Chest pain description

    Shortness of Breath (Dyspnea)

    • Dyspnea compared to the patient's normal breathing
    • What triggers it?
    • Is it related to body position or time of day?

    Wheezing

    • Wheezing is a musical respiratory sound

    Weight loss

    • Unintended weight loss

    History of Respiratory Disorders

    • Infections: COVID, bronchitis, pneumonia, tuberculosis
    • Chronic Disorders: emphysema, asthma
    • Frequency of colds

    Environmental Exposure

    • Dust, workplace conditions, allergens, workplace

    Self Care Behaviors

    • Pneumococcal vaccine (recommended for individuals 65 years or older)
    • COVID and influenza vaccinations
    • Use of protective wear

    Tobacco Use

    • Smoking cigarettes or cigars
    • Number of packs per day and duration of smoking
    • Exposure to secondhand smoke

    Inspection

    • Inspect for signs of respiratory difficulty
    • Assess the patient's color, especially lips and nail beds
    • Observe facial expression and level of consciousness
    • Listen to the patient's breathing
    • Inspect the patient's neck

    Inspection of the Posterior Chest

    • Shape and configuration: AP:T diameter should be 1:2
    • Muscles: Observe muscle development and any signs of muscle wasting
    • Skin: Inspect skin color and look for any abnormalities

    Palpation of the Posterior Chest

    • Assess symmetrical chest expansion

    Inspection of the Anterior Chest

    • Shape and configuration: Observe the costal angle, ribs, symmetry, deformities, and chest movement during breathing
    • Observe rate, rhythm, depth, and effort of breathing

    Palpation of the Anterior Chest

    • Examine the sternum, ribs, and intercostal areas for tenderness, masses, and crepitus (air in subcutaneous tissues)

    Palpation for Chest Expansion

    • Assess symmetry of chest movement and identify the areas of decreased or asymmetric expansion.
    • Assess for potential causes such as pain, pneumothorax, or fibrotic changes.

    Tactile Fremitus

    • Tactile fremitus is the palpable vibration when the patient speaks; diminished vibrations indicate obstruction, while increased vibrations suggest increased density

    Percussion of the Anterior Chest

    • Begin percussion in the supraclavicular area and move across and down, percussing over interspaces.

    Percussion Sounds

    • Resonance is the normal percussion sound.
    • Hyperresonance suggests overinflated lungs, as with COPD.
    • Dullness indicates organs such as the heart or liver.
    • Tympany suggests air-filled spaces such as the stomach.
    • Flat indicates bones or muscles.

    Auscultation of the Anterior Chest

    • Listen over the lung apices to the 6th intercostal space using the diaphragm of a stethoscope.
    • Instruct the patient to breathe deeply with an open mouth.
    • Listen to at least one full breath in each location.
    • Listen to the trachea and 1st and 2nd intercostal spaces next to the sternum in addition to the percussion locations.

    Normal Breath Sounds

    • Bronchial (Tracheal): Louder and higher-pitched sound heard over the trachea and larynx; expiration is longer than inspiration.
    • Vesicular: Soft and low-pitched sound heard over smaller bronchioles and alveoli; inspiration is longer than expiration.
    • Bronchovesicular: Moderate sound and pitch heard over major bronchi; inspiration and expiration are equal in duration.

    Auscultation of the Posterior Chest

    • Use the diaphragm of the stethoscope to auscultate over the posterior chest.
    • Instruct the patient to breathe deeply with their mouth open.
    • Listen to at least one full breath in each location.

    Voice Sounds

    • Auscultate voice sounds in the same anterior and posterior areas as tactile fremitus.
    • Bronchophony: The patient says "99" and you listen for a clearer and louder than expected sound.
    • Egophony: The patient says "eeee" and you listen for an "ay" sound.
    • Whispered Pectoriloquy: The patient whispers “1,2,3” and you listen for a clearer, louder than expected sound.

    Palpation of the Posterior Chest:

    • Palpate for tenderness, masses, abnormalities, and ribs and intercostal spaces.
    • Assess for respiratory expansion and fremitus.

    Percussion of the Posterior Chest

    • Begin percussion at the apices and move side to side, percussing over interspaces.
    • Avoid the scapulae and ribs.

    Auscultation of the Posterior Chest

    • Auscultate the posterior chest using the stethoscope.
    • Instruct the patient to breathe deeply with their mouth open.
    • Listen to at least one full breath in each location.

    Abnormal Findings

    • Barrel chest: AP:T diameter is 1:1, horizontal ribs, and possible causes include aging or COPD.
    • Adventitious lung sounds:
      • Fine Crackles: High-pitched, short crackling, popping sounds heard mostly during inspiration; do not clear with a cough.
      • Course Crackles: Loud, moist, low-pitched bubbling sound heard during inspiration and/or expiration; clears with coughing or suctioning.
      • Pleural Friction Rub: Low-pitched grating sound heard during inspiration and expiration; indicates pleural surfaces rubbing together.
      • Wheeze (sibilant): High-pitched, musical sound heard mostly during expiration; indicates air passing through narrow passageways.

    Respiratory Patterns

    • Tachypnea: Rapid breathing rate (>24 breaths/min) with possible causes including fever, exercise, pleuritic pain, or pneumonia.
    • Bradypnea: Slow, regular breathing with possible causes including sleep, medication, drug overdose, or increased intracranial pressure.

    Thorax Anatomy

    • The Thorax is the chest cavity, containing lungs and heart.
    • The Mediastinum is the space between the lungs, housing the heart, trachea, esophagus, and major blood vessels.
    • The Apices of the lungs are the tops of the lungs, extending above the clavicles.
    • The Pleural membranes surround each lung:
      • Visceral Pleura lines the outside of each lung.
      • Parietal Pleura lines the chest wall and diaphragm.
    • The space between the visceral and parietal pleura is called the pleural space, containing a small amount of lubricating fluid.

    Landmarks for Chest Assessment

    • Landmarks help identify specific locations on the chest for examination.
    • Bony landmarks include the Sternum, vertebrae, clavicles, and ribs.
    • Imaginary lines help divide the chest for accurate examination.

    Anterior Chest Landmarks

    • Sternum:
      • Suprasternal Notch (Jugular Notch): indentation at the top of the sternum between the clavicles.
      • Manubrium: upper section of the sternum, with the sternal angle (Angle of Louis) at its junction with the body of the sternum, corresponding to the level of the second rib.
      • Body: the middle section of the sternum.
      • Xiphoid Process: the most inferior part of the sternum.
    • Costal Angle: The angle formed by the lower ribs, normally slightly less than 90 degrees. An increased angle suggests overinflation of the lungs.

    Other Chest Landmarks

    • Midsternal line: Vertical line down the middle of the sternum
    • Midclavicular line: Vertical line down the middle of each clavicle
    • Anterior Axillary line: Vertical line extending down from the anterior axillary fold
    • Midaxillary line: Vertical line extending down from the middle of the axilla
    • Posterior Axillary line: Vertical line extending down from the posterior axillary fold

    Posterior Chest Landmarks

    • Vertebrae and Scapulae: Used to identify locations on the posterior chest.
      • C7/T1 (vertebrae): Typically prominent with the neck flexed.
      • Lower border of the scapula: Usually at the 7th or 8th rib.
      • 12th rib: Forms the bottom of the rib cage.

    Trachea and Bronchi

    • The Trachea (windpipe) bifurcates (splits) at the level of the sternal angle (T4 vertebra) into the two main bronchi, which lead to the lungs.

    Respiratory System Changes with Age

    • Decreased lung elasticity, weaker respiratory muscles, and calcification of costal cartilage lead to:
      • Decreased depth of respirations.
      • Changes in thoracic cavity diameters, resulting in a barrel chest (AP = T).
    • Kyphosis: Curved thoracic spine, further reducing lung capacity.
    • These changes result in less oxygen delivered to the body and increased carbon dioxide retention.
    • Increased risk of dyspnea (shortness of breath), postoperative complications, and pneumonia.

    Cultural Considerations in Respiratory Assessment

    • Increased incidence of respiratory diseases (asthma, TB) in poor, rural, urban, and recent immigrant groups is observed.
    • Full disrobing for examination may be culturally sensitive; respecting patients' preferences and ensuring a same-sex examiner is crucial.

    Environmental Factors Affecting Respiratory Health

    • Occupational:
      • Asbestos exposure leading to asbestosis.
      • Air conditioning/heating systems increasing respiratory infections.
    • Home:
      • Secondhand smoke, pet dander, dust, and molds can contribute to respiratory problems.

    Subjective Examination: Health History Questions

    • General respiratory health and any changes over time.
    • Dyspnea (shortness of breath): Severity, triggers, and positional dependence (orthopnea).
    • Cough: Description, mucus characteristics (amount, color, consistency, presence of blood or odor).
    • Chest pain: Location, character, and triggers.
    • Wheezing: Musical respiratory sound.
    • Weight loss: Can be a sign of underlying respiratory disease.

    Subjective Examination: Respiratory History Questions

    • Specific respiratory disorders:
      • Infections: COVID, bronchitis, pneumonia, TB
      • Chronic disorders: Emphysema, asthma
      • Frequency of colds
    • Environmental exposure to dust, allergens, and workplace hazards.
    • Self-care behaviors: Pneumococcal vaccine (recommended for 65 and older), COVID-19, and influenza immunizations, use of protective wear.

    Subjective Examination: Smoking History

    • Tobacco use is a significant contributor to preventable death.
      • Ask about cigarette or cigar smoking, pack-years (packs per day multiplied by years smoked), and secondhand smoke exposure.

    Inspection (visual examination)

    • Observe for signs of respiratory difficulty:
      • Color: Assess lip and nail bed color for cyanosis (blue discoloration).
      • Breathing: Listen to the patient's breathing pattern.
      • Neck: Inspect for use of accessory muscles for breathing.
      • Facial expression: Look for signs of distress or pain.
      • Level of Consciousness: Assess alertness.

    Inspection: Posterior Chest

    • Shape and Configuration:
      • Assess the anteroposterior (AP) to transverse (T) diameter, which should be approximately 1:2.
      • Observe muscle development and symmetry.
      • Examine the skin for any abnormalities.

    Palpation (touching and feeling) of Posterior Chest

    • Symmetric Chest Expansion: Assess for equal expansion of both sides of the chest during breathing.

    Inspection: Anterior Chest

    • Shape and Configuration:
      • Observe the costal angle, rib symmetry, and any deformities.
      • Assess respiratory rate, rhythm, depth, and effort (how hard the patient is working to breathe).

    Palpation: Anterior Chest

    • Palpate:
      • Sternum, ribs, and intercostal spaces for tenderness, masses, and abnormalities.
      • Count ribs and intercostal spaces.
    • Tenderness: Inflammation or injury.
    • Masses: Abnormal growths.
    • Crepitus: Air trapped in subcutaneous tissue, felt as crackling or popping.
    • Chest Expansion: Assess symmetry and any limitations in chest expansion.

    Tactile Fremitus (Vibration Felt)

    • Palpable vibrations felt on the chest wall when the patient speaks.
    • Diminished vibrations suggest an obstruction in the airway.
    • Increased vibrations suggest increased density (e.g., pneumonia).
    • Use the phrase "99" to assess tactile fremitus effectively.

    Percussion (tapping) of Anterior Chest

    • Technique: Begin at the supraclavicular area and percuss across and down, focusing on interspaces.
    • Expected Sounds:
      • Resonance: Healthy lung tissue.
      • Hyperresonance: Overinflated lungs, such as in COPD.
      • Dullness: Dense areas like organs (heart, liver), increased tissue density (e.g., pneumonia).
      • Tympany: Air-filled spaces like the stomach.
      • Flatness: Solid areas like bones and muscles.

    Auscultation (listening) of Anterior Chest

    • Technique: Use the diaphragm of a stethoscope. Ask the patient to breathe deeply with their mouth open. Listen to at least one full breath in each location. Include the trachea and the 1st and 2nd intercostal spaces next to the sternum.
    • Normal Breath Sounds:
      • Bronchial (Tracheal): Loud, high-pitched, heard over the trachea and larynx, inspiration shorter than expiration.
      • Vesicular: Soft, low-pitched, heard over the bronchioles and alveoli (peripheral lung fields), inspiration longer than expiration.
      • Bronchovesicular: Moderate sound and pitch, heard over the major bronchi (adjacent to the manubrium and between the scapulae), inspiration equal to expiration.

    Auscultation: Voice Sounds (Anterior and Posterior)

    • Technique: Auscultate in the same locations as tactile fremitus.
    • Expected Sounds:
      • Bronchophony: "99" sounds clearer and louder than normal.
      • Egophony: "eeeee" sounds like "aaaa."
      • Whispered Pectoriloquy: Whispered sounds are louder and clearer than normal.

    Palpation: Posterior Chest

    • Palpate for:
      • Tenderness
      • Masses
      • Abnormalities
      • Assess ribs and intercostal spaces.
      • Respiratory Expansion (symmetrical chest movement)
      • Tactile Fremitus

    Percussion: Posterior Chest

    • Technique: Percuss from the apices of the lungs (tops) across and down, focusing on interspaces, avoiding scapulae and ribs.

    Percussion: Expected Sounds (Posterior)

    • Same as for anterior chest.

    Auscultation: Posterior Chest

    • Technique: Auscultate the posterior chest in the same locations as for the anterior chest.

    Auscultation: Normal Breath Sounds (Posterior)

    • Same as for anterior chest.

    Abnormal Findings

    • Barrel Chest: AP diameter is equal to or greater than the T diameter (normally 1:2). This can occur with COPD or aging.

    • Adventitious Lung Sounds:

      • Fine Crackles: High-pitched popping or crackling sounds (often heard during inspiration), usually do not clear with coughing, suggest collapsed or fluid-filled alveoli.
      • Course Crackles: Loud, moist, bubbling sounds, usually heard during inspiration or expiration, often clear with coughing or suctioning, suggest air colliding with secretions in larger airways.
      • Pleural Friction Rub: Low-pitched, grating sound, heard during inspiration and expiration, suggests inflammation or irritation of the pleura (lining of the lungs).
      • Wheezing (Sibilant): High-pitched whistling or musical sound, often heard during expiration, suggests narrowing of the airways.

    • Respiratory Patterns:

      • Tachypnea: Rapid, shallow breaths (>24 breaths per minute).
      • Bradypnea: Slow, regular breaths.

    • It is important to remember that these are just a few examples of abnormal findings. A thorough examination should take into account the patient's history, symptoms, and other clinical findings.

    Thoracic Landmarks

    • Sternum: The sternum (breastbone) is divided into three parts: the manubrium, body, and xiphoid process.
    • Sternal Angle: The sternal angle (angle of Louis) is located at the junction of the manubrium and body. It is a significant landmark that corresponds to the level of the second rib and the bifurcation of the trachea.
    • Costal Angle: The costal angle is the angle formed by the right and left costal margins. It should be less than 90 degrees.
    • Vertebrae: The thoracic vertebrae are numbered T1 through T12, with T1 being the first thoracic vertebra located at the level of the sternal angle.
    • Clavicles: The clavicles (collarbones) attach laterally to the sternum.
    • Ribs: There are 12 pairs of ribs, and the lower border of the scapula usually corresponds to the 7th or 8th rib.
    • Imaginary Lines: Midsternal, Midclavicular, Anterior axillary, Midaxillary, Posterior axillary lines are useful for documenting findings on the chest.

    Respiratory System Changes with Age

    • Decreased Lung Elasticity: Lungs become less elastic with age, reducing their ability to expand fully.
    • Skeletal Muscle Weakening: Muscles involved in breathing weaken, leading to diminished respiratory capacity.
    • Calcified Costal Cartilage: Costal cartilage, which connects ribs to the sternum, becomes stiff, limiting chest expansion.
    • Increased Risk for Respiratory Issues: These age-related changes increase susceptibility to dyspnea (shortness of breath), postoperative respiratory complications, and pneumonia.

    Subjective Examination - Health History

    • Respiratory Problems: Inquire about any respiratory problems, including those experienced during exertion, lying down (orthopnea), or compared to the patient's baseline.
    • Respiratory Illness History: Obtain detailed information about past respiratory illnesses or infections, including treatment received.
    • Cough: Assess the characteristics of the cough (type, frequency, duration, etc.) and any accompanied mucus.
    • Mucus: Note the amount, color, consistency, presence of blood, and odor of any mucus.
    • Chest Pain: Investigate any chest pain associated with breathing.
    • Dyspnea (Shortness of Breath): Assess the severity, triggers, and time of day when the patient experiences dyspnea.
    • Wheezing: Investigate the presence of wheezing, which is a musical respiratory sound often associated with airway narrowing.
    • Weight Loss: Significant unintentional weight loss can be a sign of underlying respiratory issues.
    • Respiratory Disorders History: Gather a complete history of respiratory disorders, including infections, chronic conditions, and frequency of colds.
    • Environmental Exposure: Assess exposure to allergens, dust, and workplace hazards.
    • Self-Care Behaviors: Inquire about vaccination status (pneumococcal and influenza) and use of protective wear.
    • Tobacco Use: Assess current and past tobacco usage, including cigarettes, cigars, and exposure to secondhand smoke.

    Inspection

    • Respiratory Difficulty: Inspect the patient for signs of respiratory distress, such as color changes (lips, nail beds), breathing patterns, facial expressions, and level of consciousness.
    • Posterior Chest: Inspect the posterior chest for symmetry, shape, configuration, muscle development, and skin condition.
    • Anterior Chest: Inspect the anterior chest for shape, configuration (including the costal angle), symmetry, and observe the rate, rhythm, depth, and effort of breathing.

    Palpation

    • Posterior Chest: Palpate the posterior chest for symmetry of chest expansion, tenderness, masses, and abnormalities, and assess tactile fremitus.
    • Anterior Chest: Palpate the anterior chest for tenderness, superficial masses, crepitus (air in the subcutaneous tissues), and assess chest expansion and tactile fremitus.

    Percussion

    • Percussion Technique: Percuss the anterior and posterior chest over intercostal spaces, starting at the apices and moving downwards.
    • Percussion Sounds:
      • Resonance: Normal sound over lung tissue.
      • Hyperresonance: Indicates overinflation (e.g., COPD).
      • Dullness: Signals a solid or fluid-filled area like organs (heart, liver).
      • Tympany: Heard over the stomach.
      • Flatness: Heard over bones and muscles.

    Auscultation

    • Technique: Auscultate the anterior and posterior chest using the diaphragm of a stethoscope, listening for at least one full breath in each location.
    • Areas of Auscultation: Include the apices, lower lung fields, intercostal spaces, and areas next to the sternum.
    • Normal Breath Sounds:
      • Bronchial (tracheal): High-pitched and louder over the trachea and larynx (inspiration < expiration).
      • Vesicular: Soft, low-pitched sound over smaller bronchioles and alveoli (peripheral lung fields) (inspiration > expiration).
      • Bronchovesicular: Moderate in pitch and intensity, heard over major bronchi (inspiration = expiration).

    Voice Sounds

    • Auscultation Technique: Auscultate voice sounds over anterior and posterior chest in the same areas as tactile fremitus.
    • Bronchophony: Intensified transmission of spoken sounds ("99").
    • Egophony: Transmission of sounds as "e" instead of "eeeee".
    • Whispered Pectoriloquy: Clear transmission of whispered words ("1,2,3").

    Abnormal Findings

    • Barrel Chest: AP diameter = transverse diameter, horizontal ribs, common in COPD.
    • Adventitious Sounds: Abnormal lung sounds.
      • Fine Crackles: High-pitched, popping sounds, often heard during inspiration, clearing with coughing; caused by collapsed or fluid-filled alveoli opening.
      • Course Crackles: Loud, bubbly sounds, heard during inspiration and/or expiration, clearing with coughing or suctioning; air collides with secretions in larger airways.
      • Pleural Friction Rub: Low-pitched, grating sound heard with inspiration and expiration; caused by pleural surfaces rubbing together.
      • Wheezing (sibilant): High-pitched, musical sounds, heard during expiration, often associated with narrowed airways; caused by air passing through constricted airways.
    • Respiratory Patterns:
      • Tachypnea: Rapid, >24 breaths/minute, seen in fever, exertion, pleuritic pain, pneumonia.
      • Bradypnea: Slow, regular breathing.

    Abdominal Assessment - Surface Landmarks

    • The abdomen is located between the diaphragm and the top of the pelvis.
    • The abdominal wall is formed by four layers of large flat muscles that protect and hold the organs in place.
    • The abdominal wall includes:
      • Vertebral column and paravertebral muscles (back)
      • Lower rib cage and abdominal muscles (side and front)

    Abdominal Assessment - Structure & Function

    • Solid viscera maintain their shape.
      • Examples include: liver, pancreas, spleen, adrenal glands, kidneys, and ovaries
    • Hollow viscera change shape depending on their contents.
      • Examples include: stomach, gallbladder, small intestine, colon, and bladder.

    Abdominal Assessment - Structures

    • Liver: Primarily located in the Right Upper Quadrant (RUQ).
    • Stomach: Between the liver and spleen, just below the diaphragm.
    • Gallbladder: Below the liver, just lateral to the Right Midclavicular Line.
    • Small Intestine: Found in all four quadrants.
    • Spleen: Lateral to the Left Midaxillary Line, between the 9th-11th rib.
    • Aorta: Just left of midline, bifurcates 2 cm below the umbilicus.
    • Pancreas: Behind the stomach, in the RUQ.
    • Kidneys: Located at the costovertebral angle.

    Abdominal Assessment - Midline Structures

    • Aorta
    • Renal Artery
    • Uterus (if enlarged)
    • Bladder (if distended)

    Abdominal Assessment - Aging Adult

    • Increased fat deposits.
    • Decreased salivation.
    • Dry mouth.
    • Decreased sense of taste.
    • Delayed esophageal emptying.
    • Decreased gastric acid secretion.
    • Increased risk of gallstone formation.
    • Decreased blood flow to the liver.
    • Constipation.

    Abdominal Assessment - Subjective Data

    • Adult*
    • Appetite.
    • Dysphagia.
    • Food intolerance.
    • Pain.
    • Nausea/vomiting.
    • Bowel habits.
    • GI history.
    • Medications.
    • Nutrition.
    • Older Adult*
    • Grocery shopping and meal preparation.
    • Eating alone.
    • Food diary.
    • Bowel movements.

    Abdominal Assessment - Objective Data

    • Inspection, Auscultation, Percussion, Palpation

    Abdominal Assessment - Preparation

    • Drape the patient appropriately.
    • Empty the patient's bladder.
    • Keep the room warm to enhance relaxation.
    • Position the patient supine with head on a pillow, knees bent or on a pillow, and arms at their side.
    • Warm the stethoscope and hands.
    • Assess painful areas last.

    Abdominal Assessment - Inspection

    • Contour: Observe the overall shape of the abdomen.
    • Symmetry: Shine a light across the abdomen toward you, lengthwise. Ask the patient to take a deep breath and assess again.
    • Umbilicus: Note the location and any signs of protrusion or inversion.
    • Skin: Assess for:
      • Striae (lineae albicantes)
      • Nevi
      • Scars
      • Rashes or lesions
    • Peristalsis: Observe for any visible movement of the intestines.
    • Pulsations: Note any pulsations, especially in the epigastric area.

    Abdominal Assessment - Auscultation

    • Always begin auscultation in the Right Lower Quadrant (RLQ) as this is where the ileocecal valve is located.
    • Bowel Sounds:*
    • Note the frequency and character of bowel sounds.
    • Sound frequency can be affected by the time elapsed since the patient last ate.
    • Normoactive Bowel Sounds: 5-30 sounds per minute.
    • Hypoactive Bowel Sounds: Less than 5 sounds per minute.
    • Hyperactive Bowel Sounds: More than 30 sounds per minute.
    • Borborygmi: Loud, gurgling sounds that may indicate hunger or increased bowel motility.
    • Absent Bowel Sounds: No sounds heard after listening for 5 minutes in each of the four quadrants.

    Abdominal Assessment - Auscultation (Vascular Sounds)

    • Assess for bruits in the following locations:
      • Aorta
      • Renal arteries
      • Iliac arteries
      • Femoral arteries

    Abdominal Assessment - Percussion

    • Splenic Dullness: Percuss in the 9th-11th intercostal space, just behind the Left Midaxillary Line.

    Abdominal Assessment - Costovertebral Angle Tenderness

    • Instructions: The patient should be sitting upright.
    • Procedure:
      • Place the non-dominant hand over the 12th rib at the costovertebral angle on the back.
      • Thump that hand with the ulnar edge of your other fist.
    • Result: The patient should not experience pain.

    Abdominal Assessment - Palpation

    • Palpation is helpful for assessing the size, location and consistency of underlying organs, as well as for detecting masses and tenderness.
    • Ensure the patient is relaxed for accurate assessment.
    • Avoid deep palpation of an enlarged or tender liver or spleen due to the potential for rupture.

    Abdominal Assessment - Light Palpation

    • Assess the skin surface and superficial abdominal muscles.
    • Use four fingers, depressing about 1 cm.
    • Perform circular motions.
    • Palpate painful areas last.

    Abdominal Assessment - Voluntary Guarding

    • May occur when the patient is cold, tense, or ticklish.
    • Bilateral.
    • Muscles relax slightly during exhalation.

    Abdominal Assessment - Involuntary Rigidity

    • Indicates peritoneal inflammation.
    • May be unilateral.
    • Pain is exacerbated with increased intra-abdominal pressure.

    Abdominal Assessment - Deep Palpation

    • Same technique as light palpation, but push down 5-8 cm.
    • For obese patients, use the bimanual technique.
    • Note the location, size, consistency, and mobility of any palpable organs.
    • Note any enlargement, tenderness, or masses.

    Abdominal Assessment - Palpation of the Liver

    • Instructions: Place the left hand under the patient's right back, parallel to the 11th and 12th ribs. Place your right hand on the RUQ with fingers parallel to the midline.
    • Procedure: Push down and under the right costal margin with your right hand. As the patient breathes slowly, move your right hand up 1-2 cm for each exhalation.
    • Result: The edge of the liver may be felt with the fingertips.

    Abdominal Assessment - Palpation of the Aorta

    • Location: On the upper abdomen, slightly left of midline.
    • Procedure: Use your thumb and fingers.
    • Result: Palpate the aortic pulsation.
    • Note: If the palpated area of the aorta is wider than 2.5-3 cm (approximately 1 inch), it may indicate an aneurysm.

    Abdominal Assessment - Rebound Tenderness (Blumberg Sign)

    • Procedure:
      • Hold your hand 90° to the abdomen (McBurney Point).
      • Push down slowly and deeply, then quickly lift up.
    • Positive Result: Pain indicates peritoneal irritation.

    Abdominal Assessment - Inspiratory Arrest (Murphy's Sign)

    • Instructions: Hold your fingers under the liver border.
    • Procedure: Ask the patient to take a deep breath.
    • Positive Result: Pain indicates cholecystitis (gallbladder inflammation).

    Abdominal Assessment - Ascites

    • Signs:
      • Everted umbilicus.
      • Taut, glistening skin.
      • Diminished bowel sounds over the fluid.
      • Dullness over the fluid (percussion findings).
      • Limited palpation.

    Abdominal Assessment - Aortic Aneurysm

    • Most aneurysms are located below the renal arteries and extend to the umbilicus.
    • A pulsating mass > 5 cm may indicate an aneurysm.
    • Auscultate for a bruit.
    • Note: Femoral pulses will be present but decreased.

    Abdominal Assessment - Enlarged Spleen

    • Usually enlarges down and toward the midline.
    • Mononucleosis: Enlarged, soft, and rounded edge.
    • Chronic Causes (like cirrhosis): Firm with sharp edges.
    • Usually not tender, unless the peritoneum is inflamed.
    • The spleen must be three times its normal size for it to be palpable.

    Surface Landmarks

    • Abdomen lies between the diaphragm and the top of the pelvis.
    • Back side of abdomen consists of the vertebral column and paravertebral muscles.
    • Front and side are made up of the lower rib cage and abdominal muscles.
    • The abdominal wall contains four layers of large flat muscles.
    • Abdominal muscles protect and hold organs in place.

    Structure & Function

    • Viscera are organs within the abdominal cavity.
    • **Solid viscera ** keep a consistent shape. Examples include the liver, pancreas, spleen, adrenal glands, kidneys, and ovaries.
    • Hollow viscera change shape as they fill. Examples include the stomach, gallbladder, small intestine, colon, and bladder.

    Structures

    • Liver: Mostly located in the right upper quadrant (RUQ).
    • Stomach: Located between the liver and spleen, positioned below the diaphragm.
    • Gallbladder: Lies below the liver, just lateral to the right midclavicular line.
    • Small Intestine: Occupies all four quadrants of the abdomen.
    • Spleen: Sits lateral to the left midaxillary line, covering the 9th to 11th rib.
    • Aorta: Located just left of midline, with its bifurcation occurring 2 cm below the umbilicus.
    • Pancreas: Lies behind the stomach in the RUQ.
    • Kidneys: Found at the costovertebral angle.

    Midline Structures

    • Aorta: Descends along the midline.
    • Renal Artery: Branching from the aorta.
    • Uterus (if enlarged).
    • Bladder (if distended).

    The Aging Adult

    • Increased fat deposits in the abdomen.
    • Decreased salivation, leading to dry mouth.
    • Diminished sense of taste.
    • Delayed esophageal emptying.
    • Reduced gastric acid secretion.
    • Increased risk of gallstones formation.
    • Decreased blood flow to the liver.
    • Increased susceptibility to constipation.

    Subjective Data

    • Adult: Ask about appetite, dysphagia, food intolerance, pain, nausea/vomiting, bowel habits, GI history, medications, and nutrition.
    • Older Adult: In addition to adult questions, also ask about grocery and meal preparation habits, whether they eat alone, and assess their food diary and bowel movements.

    Objective Data

    • Inspection: Observe abdominal contour, symmetry, umbilicus, skin, peristalsis, pulsations.
    • Auscultation: Listen to bowel sounds starting in the right lower quadrant (RLQ). Assess vascular sounds (bruits) over the aorta, renal, iliac, and femoral arteries.
    • Percussion: Percuss to assess splenic dullness and perform costovertebral angle tenderness.
    • Palpation: Gently feel the abdomen for masses, tenderness, and organ enlargement.

    Objective Data Preparation

    • Draping: Cover the patient appropriately.
    • Relaxation: Encourage a relaxed state by emptying the bladder, keeping the room warm, positioning the patient supine with knees slightly bent, and using a warm stethoscope.
    • Painful Areas: Assess painful areas last.

    Inspection

    • Contour: Assess the overall shape and contour of the abdomen.
    • Symmetry: Observe for any asymmetry by shining a light across the abdomen.
    • Umbilicus: Note any abnormalities in the position or appearance of the umbilicus.
    • Skin: Evaluate the skin for striae (stretch marks), nevi (moles), scars, rashes, and lesions.
    • Peristalsis: Observe for any visible wave-like movements of the intestines.
    • Pulsations: Note any visible pulsations in the aorta or other major vessels.

    Auscultation

    • Bowel Sounds: Normal bowel sounds range from 5 to 30 sounds per minute. Sounds can be normoactive, hypoactive, hyperactive, or absent. Borborygmus refers to loud gurgling bowel sounds.
    • Vascular Sounds (Bruits): Listen over the aorta, renal arteries, iliac arteries, and femoral arteries for any abnormal whooshing sounds indicating turbulent blood flow.

    Percussion

    • Splenic Dullness: Percuss the area between the 9th to 11th intercostal space just behind the left midaxillary line to assess for splenic dullness.
    • Costovertebral Angle Tenderness (CVA): Perform indirect fist percussion on the costovertebral angle on the back to assess for tenderness indicating possible kidney inflammation.

    Palpation

    • Light Palpation: Gently palpate the abdomen to assess skin surface, superficial abdominal muscles, and for any tenderness.
    • Voluntary Guarding: Bilateral muscle tension due to coldness, tension, or ticklishness. Relaxes slightly with exhalation.
    • Involuntary Rigidity: Muscle rigidity related to peritoneal inflammation. May be unilateral. Pain with increased intra-abdominal pressure.
    • Deep Palpation: Use deeper pressure to assess organs, masses, and tenderness.
    • Obese Abdomen: Use bimanual technique for deep palpation in obese patients.

    Palpation of Liver

    • Place your left hand under the patient's right back, paralleling the 11th and 12th ribs.
    • Place your right hand on the RUQ, fingers parallel to the midline.
    • Push down and under the right costal margin.
    • As the patient breathes slowly, move your right hand up 1-2 cm with each exhalation.
    • The edge of the liver may be felt with your fingertips.

    Palpation of Aorta

    • Palpate slightly left of midline in the upper abdomen.
    • Feel for the aortic pulsation in a 2.5-3 cm area.
    • A wider pulsating area may indicate an aneurysm.

    Rebound Tenderness (Blumberg Sign)

    • Test for rebound tenderness if the patient complains of abdominal pain or tenderness during palpation.
    • Push down slowly and deeply, then quickly lift your hand up.
    • Pain on release is a sign of peritoneal irritation.

    Inspiratory Arrest (Murphy's Sign)

    • Place your fingers under the liver border.
    • Ask the patient to take a deep breath.
    • Pain during inspiration suggests cholecystitis (gallbladder inflammation).

    Ascites

    • May present with an everted umbilicus, taut glistening skin, diminished bowel sounds, and dullness to percussion over fluid.
    • Palpation may be limited.

    Aortic Aneurysm

    • Most aneurysms are located below the renal arteries and extend to the umbilicus.
    • May present with a pulsating mass more than 5 cm wide.
    • Auscultate for a bruit.
    • Femoral pulses may be diminished.

    Enlarged Spleen

    • Enlarges downward and toward the midline.
    • In mononucleosis, the spleen is enlarged, soft, and rounded.
    • Chronic causes (cirrhosis) lead to a firmer spleen with sharp edges.
    • Usually not tender unless peritoneum is inflamed.
    • The spleen needs to be three times its normal size to be palpable.

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    Description

    This quiz covers the anatomy and physiology of thoracic landmarks, including visceral and parietal membranes, and key anatomical structures. Identify and locate various landmarks to enhance your understanding of human anatomy related to the thorax. Ideal for students studying anatomy and physiology.

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