Untitled Quiz

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.