Medical Anatomy Chapter 15: Thorax

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Questions and Answers

Which respiratory pattern is characterized by rapid, deep breaths followed by periods of apnea?

  • Bradypnea
  • Kussmaul
  • Ataxic
  • Cheyne-Stokes (correct)

Which condition is indicated by the use of accessory muscles for breathing?

  • Sighing
  • Pectus excavatum
  • Labored breathing (correct)
  • Normal sinusoidal breathing

What is a common physical sign observed in a patient with barrel chest?

  • Increased AP diameter (correct)
  • Symmetrical chest expansion
  • Decreased AP diameter
  • Clubbing of fingers

Which of the following describes 'tactile fremitus'?

<p>Vibrations felt when a patient speaks (A)</p> Signup and view all the answers

Which type of respiration would be characterized as very slow and regular?

<p>Bradypnea (A)</p> Signup and view all the answers

In which of the following cases would you expect to see tripoding?

<p>Severe respiratory distress (B)</p> Signup and view all the answers

Which of the following best describes Kussmaul's breathing pattern?

<p>Rapid, deep breathing due to low blood pH (D)</p> Signup and view all the answers

What is characterized by a gap between the ribs due to multiple rib fractures?

<p>Flail chest (D)</p> Signup and view all the answers

Which of the following is NOT a pattern of respiration discussed?

<p>Apneustic (C)</p> Signup and view all the answers

Which of the following statements about jugular venous pressure (JVP) is correct?

<p>JVP provides an estimate of right atrial pressure. (B)</p> Signup and view all the answers

What is the primary cause of transient loss of consciousness associated with syncope?

<p>Vasovagal response (C)</p> Signup and view all the answers

Which condition is characterized by episodes of dyspnea that awaken a patient 1 to 2 hours after falling asleep?

<p>Paroxysmal nocturnal dyspnea (D)</p> Signup and view all the answers

S3 and S4 heart sounds are indicative of which of the following conditions?

<p>Pathologic conditions of heart failure (C)</p> Signup and view all the answers

What characteristic distinguishes pitting edema from other types of edema?

<p>It lessens under external pressure. (B)</p> Signup and view all the answers

What does the term 'dyspnea' refer to in a health context?

<p>Abnormal or labored breathing (D)</p> Signup and view all the answers

Which of the following is NOT an anatomical descriptor of the thorax?

<p>Pericarinal (D)</p> Signup and view all the answers

What might chest pain originating from the esophagus indicate?

<p>Gastroesophageal reflux disease (A)</p> Signup and view all the answers

Which key examination component is NOT typically performed during a thorax examination?

<p>Initiate cardiopulmonary resuscitation (B)</p> Signup and view all the answers

What does 'hemoptysis' specifically refer to?

<p>Coughing up blood (D)</p> Signup and view all the answers

What anatomical location does 'supraclavicular' refer to?

<p>Above the clavicles (A)</p> Signup and view all the answers

Which of the following is commonly associated with disordered sleep that may indicate disorders of ventilation?

<p>Daytime sleepiness (C)</p> Signup and view all the answers

What is the normal range for diaphragmatic excursion during percussion?

<p>3-5 cm (A)</p> Signup and view all the answers

Which condition is indicated by the absence of diaphragmatic descent?

<p>Pleural effusion (B)</p> Signup and view all the answers

What type of breath sounds are classified as soft and relatively low in pitch?

<p>Vesicular (C)</p> Signup and view all the answers

Which instrument should be used for detecting high frequency sounds during auscultation?

<p>Stethoscope diaphragm (C)</p> Signup and view all the answers

Which of the following is true regarding crackles (rales) during auscultation?

<p>They are brief and intermittent. (D)</p> Signup and view all the answers

What sound is described as sinusoidal, musical, and prolonged during auscultation?

<p>Wheezes (A)</p> Signup and view all the answers

What does transmitted voice sounds testing involve when instructing a patient?

<p>Saying 'eee' (C)</p> Signup and view all the answers

Which of the following descriptions best fits bronchial breath sounds?

<p>Loud and relatively high pitch (A)</p> Signup and view all the answers

What is the best positioning for the pleximeter finger during percussion?

<p>Firmly on the chest wall with one finger (B)</p> Signup and view all the answers

What type of lung sounds may be indicative of fluid in the alveoli?

<p>Crackles (Rales) (A)</p> Signup and view all the answers

What is the primary indication of consolidation in the lung based on auscultation findings?

<p>Increased sounds of whispered pectoriloquy (B), E to A change in egophony (C)</p> Signup and view all the answers

Which condition is primarily associated with a high-pitched inspiratory sound?

<p>Stridor (C)</p> Signup and view all the answers

What symptom is common in patients with COPD?

<p>Cough with scant mucoid sputum (B)</p> Signup and view all the answers

What is the condition called when there is a collection of pus in the pleural space?

<p>Empyema (B)</p> Signup and view all the answers

Which of the following describes the sound produced during expiration associated with narrowed airways?

<p>Wheezing (D)</p> Signup and view all the answers

What characterizes the cough associated with lung cancer?

<p>Dry to productive cough, might be blood-streaked (A)</p> Signup and view all the answers

What is an expected finding in a patient diagnosed with pneumonia?

<p>Increased bronchophony (C)</p> Signup and view all the answers

Which term describes coughing up blood?

<p>Hemoptysis (D)</p> Signup and view all the answers

In what condition is forced expiratory time typically prolonged?

<p>COPD (D)</p> Signup and view all the answers

How is cyanosis primarily defined in a clinical setting?

<p>Reduced oxygen saturation leading to bluish discoloration (C)</p> Signup and view all the answers

Flashcards

Supraclavicular

Located above the collarbones (clavicles).

Dyspnea

Abnormal or labored breathing, increased work of breathing

Hemoptysis

Coughing up blood.

Wheezing

A whistling sound made while breathing out.

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IPPA

A method for examining the chest. (Inspection, Palpation, Percussion, Auscultation)

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Myocardial sources of chest pain

Chest pain originating from the heart muscle.

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Possible causes of chest pain

A wide range of conditions, from heart problems to digestive issues, to musculoskeletal problems.

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Cyanosis or pallor

Blue or pale skin color, indicating low oxygen levels in the blood. Cyanosis is blue, pallor is pale.

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Stridor

A high-pitched, whistling sound heard during inhalation, usually caused by narrowing of the airway.

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Tactile fremitus

Vibrations felt on the chest wall when the patient speaks.

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Accessory muscle use

Using muscles in the neck, shoulders, and abdomen to help with breathing, indicating difficulty.

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Barrel chest

A rounded chest shape, often seen in conditions like emphysema, where the lungs are overinflated.

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Cheyne-Stokes breathing

A pattern of breathing with alternating periods of rapid, deep breaths followed by apnea (no breathing).

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Kussmaul breathing

Deep, rapid breathing often seen in diabetic ketoacidosis, trying to blow off excess acid in the blood.

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Flail chest

A section of the chest wall moves opposite to the normal breathing pattern, indicating multiple rib fractures.

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Pleximeter Finger

The finger placed firmly on the chest wall during percussion to transmit sound vibrations.

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Percussion Technique

A method of tapping the chest wall to assess lung sounds and underlying structures. It involves placing a finger firmly on the chest and striking it with another finger.

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Diaphragmatic Excursion

The movement ofthe diaphragm between inspiration and expiration, normally 3-5 cm.

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Absent Diaphragmatic Excursion

Lack of movement of the diaphragm during breathing, suggesting a potential problem like pleural effusion.

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Liver Dullness

A dull sound produced when percussing over the liver, indicating solid tissue.

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Gastric Tympany

A hollow, drum-like sound produced when percussing over the stomach, indicating air-filled space.

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Diaphragm (Auscultation)

The part of the stethoscope used to listen to high-pitched sounds.

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Bell (Auscultation)

The part of the stethoscope used to listen to low-pitched sounds.

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Crackles (Rales)

Discontinuous, brief sounds heard during auscultation, often due to fluid in the alveoli.

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Wheezes & Rhonchi

Continuous, musical sounds heard during auscultation, indicating airway obstruction.

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Consolidation

A condition where air-filled lung tissue is replaced by solid material like fluids, blood, or tumors.

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Egophony

A voice sound that changes from 'E' to 'A' when auscultated over a consolidated lung area.

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Bronchophony

The spoken word 'ninety-nine' sounding louder over a consolidated lung area.

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Whispered Pectoriloquy

Whispered words being heard more clearly over a consolidated lung area.

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Ronchi

Low pitched sound heard during expiration, typically caused by airway narrowing.

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Empyema

A collection of pus in the pleural space, the area between the lung and the chest wall.

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JVD

Jugular venous distention, a condition where the external jugular veins are visibly bulging out in the neck, especially when the patient is lying at a 30-45 degree angle. It indicates elevated jugular venous pressure.

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S3 Heart Sound

A heart sound typically associated with systolic heart failure. It occurs during early diastole and is caused by rapid deceleration of blood flow across the mitral valve.

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S4 Heart Sound

A heart sound typically associated with diastolic heart failure. It occurs in late diastole just before S1 and is caused by increased stiffness of the left ventricle, making it harder for the atria to pump blood.

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Pitting Edema

A type of edema characterized by a depression (pit) that remains after pressing your finger into the swollen area. It indicates fluid buildup in the interstitial space.

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Study Notes

Chapter 15: Thorax - Anatomic Descriptors

  • Chest Anatomy:
    • Supraclavicular (above clavicles)
    • Infraclavicular (below clavicles)
    • Interscapular (between scapulae)
    • Infrascapular (below scapulae)
    • Apices of lungs (uppermost portions)
    • Bases of lungs (lowermost portions)
    • Upper, middle, and lower lung fields

Health History and Chest Pain

  • Dyspnea: Abnormal or labored breathing
  • Wheezing: Expiratory whistling sound
  • Cough: Sputum production (e.g., blood-soaked sputum, hemoptysis = coughing up blood)
  • Chest pain: Can indicate disorders of the heart, disorders of ventilation, etc.
  • Daytime sleepiness, snoring, and sleep disturbances: Symptoms possibly related to ventilation disorders

Sources of Chest Pain and Possible Causes

  • Myocardium: Angina pectoris, myocardial infarction, myocarditis
  • Pericardium: Pericarditis
  • Aorta: Aortic dissection
  • Trachea and Large Bronchi: Bronchitis
  • Parietal Pleura: Pericarditis, pneumonia, pneumothorax, pleural effusion, pulmonary embolus, connective tissue disease, costochondritis, herpes zoster
  • Chest Wall: Costochondritis, musculoskeletal and neurologic systems
  • Esophagus: Gastroesophageal reflux disease, esophageal spasm, esophageal tear

Key Examination Components

  • Survey respiration: Observation of breathing rate, rhythm, depth, and effort; ability to speak without stopping to breath
  • Inspection: Rate, rhythm, depth, and effort of breathing; Cyanosis or pallor; Stridor or tactile fremitus (palpatory); Accessory muscle use; AP ratio, barrel chest
  • Patterns of Respiration:
    • Normal Sinusoidal: Even inspirations and expirations.
    • Cheyne-Stokes: Alternating periods of rapid deep breaths and apnea.
    • Kussmaul: Rapid, deep breaths, frequently seen in diabetic ketoacidosis.
    • Bradypnea: Slow breathing.
    • Tachypnea: Rapid breathing
    • Sighing: Interrupted breaths.
    • Apnea: Breathing cessation.
    • Ataxic/Biot: Irregular periods of apnea and breathing
  • Deformities: Barrel chest, Pectus Carinatum (Pigeon chest), Pectus Excavatum (Funnel chest).

Inspection - Labored Breathing

  • Cyanosis: Bluish discoloration of the skin
  • Abdominal retractions: Abdomen pokes out during inspiration
  • Tachypnea: Increased respiratory rate
  • Tripoding: Using arms to lift shoulders to facilitate breathing
  • Abnormal position of comfort: Unusual posture indicating potential respiratory distress
  • Accessory muscle use: Use of muscles besides the primary breathing muscles
  • Intercostal muscle use: Involvement of muscles between the ribs in breathing.
  • Dyspnea: Difficulty breathing
  • Vocal quality: Raspy or hoarse voice
  • Flail chest: Instability of a section of the chest wall

Palpation - Chest Expansion and Tactile Fremitus

  • Assess chest expansion (symmetrical expansion with each breath).
  • Palpate tactile fremitus (vibrations during speaking).

Percussion

  • Sounds like Flat, Dull, Resonant, Hyperresonant, Tympanitic
  • Possible causes
  • Description

Auscultation - Breath Sounds

  • Normal breath sounds
  • Abnormal breath sounds: Crackles/rhonchi/wheezes

Diaphragmatic Excursion

  • Measure excursion during inspiration and expiration (3-5cm) to assess for changes
  • Perform before and after to check whether it changes in inspiration and expiration

Other Important Terms

  • Extrathoracic Structures: Neck, gallbladder, and stomach structures influencing chest complaints.
  • Pathologic conditions: E.g., Aortic dissection, esophageal reflux, costochondritis, trauma
  • Additional diagnostic findings: egophony, bronchophony, whispered pectoriloquy, adventitious sounds and their causes

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