18 Questions
Where can findings in the thorax be located along the vertical axis?
Sternal angle
What should be avoided when assessing intercostal spaces in a woman?
Pressing too hard on the tender breast tissue
Which rib is directly adjacent to the sternal angle?
2nd rib
What runs along the inferior margin of each rib in the thorax?
Neurovascular structures
Where should needles and tubes be placed in relation to the ribs in the thorax?
At the superior rib margins
What is a key anatomical landmark for needle insertion for tension pneumothorax?
2nd intercostal space
Where are the supraclavicular locations found?
Above the clavicles
What is the anatomical descriptor for below the scapulae?
Infrascapular
Where do signs in the right upper lung field originate from?
Right upper lobe
Which main bronchus is wider, shorter, and more vertical in comparison to the other?
Right main bronchus
Where does the left main bronchus extend inferolaterally from?
Aortic arch
At what levels does the trachea bifurcate into its mainstem bronchi?
$T4$ spinous process
Which of the following muscles are considered accessory muscles used during exercise or certain diseases?
Sternocleidomastoid and scalene muscles
Which of the following statements accurately describes normal breathing?
Normal breathing is quiet and easy - barely audible near the open mouth.
In a healthy person lying supine (on their back), which movements are more prominent?
Abdominal movements
Which of the following is NOT listed as a common or concerning symptom related to the thorax and lungs?
Fever and chills
Which symptom raises concerns about both the heart and the thorax and lungs?
Chest pain
Which of the following is NOT a structure mentioned in the text as a potential source of chest pain?
Stomach
Study Notes
Anatomical Terms for Locating Chest Findings
- Supraclavicular: above the clavicles
- Infraclavicular: below the clavicles
- Interscapular: between the scapulae
- Infrascapular: below the scapulae
- Bases of the lungs: the lowermost portions
- Upper, middle, and lower lung fields: used to locate chest findings
The Trachea and Major Bronchi
- Trachea bifurcates into mainstem bronchi at the levels of the sternal angle anteriorly and the T4 spinous process posteriorly
- Right main bronchus is wider, shorter, and more vertical than the left main bronchus
- Right main bronchus directly enters the hilum of the lung
- Left main bronchus extends inferolaterally from below the aortic arch and anterior to the esophagus and thoracic aorta and then enters the lung hilum
Locating Findings on the Chest
- Describe chest findings in two dimensions: along the vertical axis and around the circumference of the chest
- Use the sternal angle (or angle of Louis) as a reference point to locate the 2nd rib and its costal cartilage
- Count the ribs and intercostal spaces to locate specific areas on the chest
- Note that the ribs at the lower edge of the sternum may be too close together to count correctly
Important Landmarks on the Chest
- Sternal angle (Angle of Louis)
- Suprasternal notch
- 2nd rib
- 4th intercostal space for chest tube insertion
- T4 for the lower margin of an endotracheal tube on a chest x-ray
Breathing and Accessory Muscles
- Normal breathing is quiet and easy
- Breathing movements of the thorax are relatively slight when lying supine
- In the sitting position, movements of the thorax become more prominent
- Accessory muscles (sternocleidomastoids and scalenes) may become visible during exercise or in certain diseases
The Health History
- Common or concerning symptoms: chest pain, shortness of breath, wheezing, cough, blood-streaked sputum, daytime sleepiness or snoring and disordered sleep
- Chest pain can arise from various structures in the thorax and lungs, and must be investigated for both thoracic and cardiac causes
Learn to describe chest findings in two dimensions: along the vertical axis and around the circumference of the chest. Practice locating abnormalities in the thorax by numbering the ribs and intercostal spaces. Enhance your understanding of abnormal chest anatomy.
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