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Questions and Answers
What is the name of the bony structure that forms the front of the chest?
What is the name of the bony structure that forms the front of the chest?
What is the name of the angle formed where the manubrium and body of the sternum meet?
What is the name of the angle formed where the manubrium and body of the sternum meet?
Manubriosternal angle
The right lung has two lobes.
The right lung has two lobes.
False
What is the name of the landmark that is often used as a starting point for counting ribs?
What is the name of the landmark that is often used as a starting point for counting ribs?
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What is the name of the muscle that separates the thoracic cavity from the abdominal cavity?
What is the name of the muscle that separates the thoracic cavity from the abdominal cavity?
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Which of the following is a sign of extra heart sounds?
Which of the following is a sign of extra heart sounds?
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What is the name of the sound that is heard when the AV valves close?
What is the name of the sound that is heard when the AV valves close?
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What is the name of the sound that is heard when the semilunar valves close?
What is the name of the sound that is heard when the semilunar valves close?
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Murmurs are always a sign of heart disease.
Murmurs are always a sign of heart disease.
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The Allen test is used to assess the patency of the carotid arteries.
The Allen test is used to assess the patency of the carotid arteries.
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What is the name of the condition that is characterized by a sensation of tightness or pressure in the chest?
What is the name of the condition that is characterized by a sensation of tightness or pressure in the chest?
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Which of the following is NOT a symptom of a heart attack?
Which of the following is NOT a symptom of a heart attack?
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What is the name of the condition that is characterized by the accumulation of fluid in the lungs?
What is the name of the condition that is characterized by the accumulation of fluid in the lungs?
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The Horman's sign is a positive sign for deep vein thrombosis (DVT).
The Horman's sign is a positive sign for deep vein thrombosis (DVT).
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Raynaud's phenomenon is a condition that affects the veins.
Raynaud's phenomenon is a condition that affects the veins.
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What is the name of the condition that is characterized by the swelling of tissues due to the accumulation of lymph fluid?
What is the name of the condition that is characterized by the swelling of tissues due to the accumulation of lymph fluid?
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Which of the following is NOT a common symptom of arterial insufficiency?
Which of the following is NOT a common symptom of arterial insufficiency?
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Venous insufficiency is a condition that is caused by the malfunction of the vein valves.
Venous insufficiency is a condition that is caused by the malfunction of the vein valves.
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What is the name of the condition that is characterized by a bluish discoloration of the skin, especially in the hands and feet?
What is the name of the condition that is characterized by a bluish discoloration of the skin, especially in the hands and feet?
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The lymphatic system is fully developed at birth.
The lymphatic system is fully developed at birth.
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Match the following types of sputum with their possible causes.
Match the following types of sputum with their possible causes.
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Arterial insufficiency is a condition that is caused by the narrowing or blockage of arteries.
Arterial insufficiency is a condition that is caused by the narrowing or blockage of arteries.
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Which of the following is a normal change in the cardiovascular system that occurs with aging?
Which of the following is a normal change in the cardiovascular system that occurs with aging?
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Venous insufficiency is a condition that is more common in women than in men.
Venous insufficiency is a condition that is more common in women than in men.
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What is the name of the condition that is characterized by the accumulation of fluid in the abdominal cavity?
What is the name of the condition that is characterized by the accumulation of fluid in the abdominal cavity?
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Which of the following is NOT a common sign of peripheral vascular disease?
Which of the following is NOT a common sign of peripheral vascular disease?
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The lymphatic system is responsible for filtering waste products and excess fluid from the body.
The lymphatic system is responsible for filtering waste products and excess fluid from the body.
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Swelling in the legs is always a sign of a serious medical condition.
Swelling in the legs is always a sign of a serious medical condition.
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What is the name of the condition that is characterized by the dilation of veins, often in the legs?
What is the name of the condition that is characterized by the dilation of veins, often in the legs?
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Which of the following is NOT a risk factor for cardiovascular disease?
Which of the following is NOT a risk factor for cardiovascular disease?
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What is the name of the test that is used to assess the patency of the arteries in the arms?
What is the name of the test that is used to assess the patency of the arteries in the arms?
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A heart murmur is always a sign of a serious heart condition.
A heart murmur is always a sign of a serious heart condition.
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Which of the following is NOT a common symptom of heart failure?
Which of the following is NOT a common symptom of heart failure?
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Study Notes
Thorax and Lungs
- The thoracic cage is a bony structure composed of the sternum, 12 pairs of ribs, thoracic vertebrae, and diaphragm.
- The costo-chondral junction connects the rib cartilage to the sternum.
- The sternum comprises the manubrium (top), body, and xiphoid process.
- The manubriosternal angle (sternal angle) is a point where the manubrium and body meet.
- The costal angle is where the lower margins of the ribs meet at the xiphoid process.
- The right lung has 3 lobes, and the left lung has 2 lobes.
- The lungs are not perfectly symmetrical. The right lung is shorter, and the left lung is narrower.
- Anatomical landmarks are used for identifying respiratory assessment findings. The angle of Louis is a useful starting point for counting ribs.
Respiratory System
- During inspiration, the chest size increases, the diaphragm contracts, and air flows into the lungs.
- The passive phase of expiration occurs when the diaphragm relaxes, becoming dome-shaped, and air flows out.
- Personal health history should include questions about prior respiratory problems (asthma, COVID, pneumonia), thoracic surgery, allergies, medications, TB exposure, and recent travel outside the US.
- Family history should include questions about lung diseases (pulmonary disorders) and smoking habits in family members.
- Healthy lifestyle choices including diet, exercise and avoidance of smoking are important.
- Environmental exposures and any use of herbal/alternative medications should be documented.
Inspection
- Facial expressions, lips, skin color, nailbeds, clubbing, and quality/effort of respirations must be evaluated.
- Accessory muscles, retractions, shape, configuration, spinous process, downward or upward sloping ribs, and the presence of a 90-degree costal angle are important factors to observe.
- Sitting or postural positioning (tripod position) should also be assessed.
Palpation
- Tenderness, sensation of temperature, presence of crepitus (sounds like rice cakes), masses, and level of chest expansion are palpated for evaluation.
Percussion
- Normal lungs produce a clear, hollow resonance sound.
- Hyperresonance indicates an abnormal increase in air content, while dullness suggests increased density, as occurs with pneumonia.
Auscultation
- Listen for normal bronchial, bronchovesicular, and vesicular lung sounds in several locations.
- Abnormal findings such as wheezes, rales (crackles), stridor, rhonchi, and diminished breath sounds need further evaluation.
- Additional pulmonary auscultation like bronchophony, egophony, and whispered pectoriloquy are useful for further evaluation.
Pediatric Lifespan Considerations
- Chest circumference should be less than head circumference in infants until age 6.
- Palpation should include encircling the thorax.
- Respiratory assessments may need adjustments for infants and pregnant women
Pregnant and Geriatric Considerations
- Pregnant women may have a wider thoracic cage and deeper, faster breathing.
- Geriatric individuals may have a barrel chest.
- Geriatrics tend to tire easily.
- Chest expansion may be decreased, although still symmetric.
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