Respiratory System Anatomy
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Questions and Answers

What is the approximate location of the base of the lungs?

  • T5
  • T10 (correct)
  • L1
  • T7

    • What is the purpose of pinching a small fold of skin between the thumbs during palpation?

  • To ensure the patient's comfort during the examination
  • To note the movement of the thumbs during inhalation (correct)
  • To measure the distance between the thumbs
  • To assess the patient's skin tone

    • What is the difference between the left and right lung in terms of lobes?

  • The left lung has one more lobe than the right lung
  • The left lung is larger than the right lung
  • The left lung has two lobes, while the right lung has four lobes
  • The right lung has one more lobe than the left lung (correct)

    • What is the significance of unequal expansion during palpation?

    <p>It is indicative of pneumothorax, rib fracture, pneumonia, or trauma</p> Signup and view all the answers

    Where should the thumbs be placed during anterolateral assessment?

    <p>Along the coastal margins with thumbs pointing towards the xiphoid process</p> Signup and view all the answers

    What is the approximate location of the apex of the lung?

    <p>About 3 cm above the clavicle</p> Signup and view all the answers

    The lungs are paired but not precisely ______.

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

    The left lung contains only two ______ which separates at the 6th rib.

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

    The right lung contains upper, middle and lower ______.

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

    The apex of the lung is approximately ______ cm above the clavicle.

    <p>3</p> Signup and view all the answers

    During palpation, the patient is asked to ______ and then inhale, noting movement between thumbs.

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

    Unequal expansion during palpation is indicative of ______ or trauma.

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

    Tactile fremitus is a palpation ______ that can be felt using the palmar aspect of the hand.

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

    Decreased fremitus occurs when anything obstructs transmission of ______ – effusions, pneumothorax, emphysema.

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

    Increased fremitus occurs with ______ or consolidation of lung tissue – pneumonia.

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

    Bronchial breath sounds are ______ pitched and loud, heard on inspiration and expiration over the trachea and larynx.

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

    Vesicular breath sounds are ______ pitched soft sounds heard on inspiration and expiration, sounds like wind rustling in the trees.

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

    The patient is asked to state “” or “” to detect changes in the intensity of the vibration.

    <p>99, blue moon</p> Signup and view all the answers

    What is the primary location where the vibration of tactile fremitus is most prominent?

    <p>Between the scapulae and around the sternum</p> Signup and view all the answers

    What is the effect of compression or consolidation of lung tissue on tactile fremitus?

    <p>It increases the vibration</p> Signup and view all the answers

    What is the characteristic of bronchovesicular breath sounds?

    <p>Medium pitched and blowing sounds of medium intensity</p> Signup and view all the answers

    What is the purpose of asking the patient to state a specific phrase during palpation for tactile fremitus?

    <p>To detect changes in the intensity of the vibration</p> Signup and view all the answers

    What is the effect of effusions, pneumothorax, or emphysema on tactile fremitus?

    <p>It decreases the vibration</p> Signup and view all the answers

    What is the characteristic of vesicular breath sounds?

    <p>Low pitched soft sounds, sounds like wind rustling in the trees</p> Signup and view all the answers

    Tactile fremitus is a palpation vibration that can be felt using the dorsal aspect of the hand.

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

    Bronchovesicular breath sounds are best heard over the peripheral lung fields.

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

    Increased fremitus occurs with effusions or pneumothorax.

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

    The patient is asked to state 'hello' to detect changes in the intensity of the vibration during palpation for tactile fremitus.

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

    Vesicular breath sounds are heard only during inspiration.

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

    Tactile fremitus is most prominent at the apex of the lung.

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

    The apex of the lung is marked by the 5th cervical vertebra (C5)

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

    The base of the lungs sits at approximately the 12th thoracic spine (T12) on expiration

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

    The upper lobes are accessible from the apex at C7 to T5

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

    The posterior lung landmarks are primarily upper lobes

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

    The apex of the lungs begins 1-2 cm above the clavicle

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

    The apex of the lungs begins ______ cm above the clavicle.

    <p>3-4</p> Signup and view all the answers

    The apex of the lungs is marked by the ______ cervical vertebra (C7) in the posterior.

    <p>7th</p> Signup and view all the answers

    The base of the lungs sits at approximately the ______ thoracic spine (T10) on inspiration.

    <p>10th</p> Signup and view all the answers

    In the posterior, the lungs are primarily ______ lobes!

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

    The upper lobes are accessible from apex at C7, to ______ where the oblique fissures begin.

    <p>T3</p> Signup and view all the answers

    What is the approximate location of the apex of the lungs in the posterior?

    <p>7th cervical vertebra (C7)</p> Signup and view all the answers

    What is the approximate location of the base of the lungs in the anterior?

    <p>7th rib</p> Signup and view all the answers

    What is the region where the oblique fissures begin in the posterior?

    <p>T3</p> Signup and view all the answers

    What is the extent of the base of the lungs on inspiration in the posterior?

    <p>T12</p> Signup and view all the answers

    What is the region of the lungs that is primarily accessible in the posterior?

    <p>Lower lobes</p> Signup and view all the answers

    What is the primary reason for decreased breath sounds in a patient?

    <p>Obstruction by secretions or loss of lung elasticity</p> Signup and view all the answers

    What is the characteristic of breath sounds in a patient with pneumonia?

    <p>Increased and louder sounds</p> Signup and view all the answers

    What is the sensation felt during palpation of a patient with subcutaneous emphysema?

    <p>Coarse crackling sensation</p> Signup and view all the answers

    What is the primary difference between bronchial and vesicular breath sounds?

    <p>Bronchial sounds are louder and vesicular sounds are softer</p> Signup and view all the answers

    What is the effect of consolidation of lung tissue on tactile fremitus?

    <p>Increased tactile fremitus</p> Signup and view all the answers

    There are 4 types of breath sounds – bronchial, bronchovesicular, vesicular and tracheal.

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

    Increased fremitus occurs with pneumonia or consolidation of lung tissue.

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

    Vesicular breath sounds are loud and high-pitched, heard on inspiration and expiration over the trachea and larynx.

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

    Crepitus is a normal breath sound that occurs during inspiration and expiration.

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

    Decreased breath sounds occur when there is consolidation or fluid (pneumonia) in the lung tissue.

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

    As air passes through the ______ tree, it creates a characteristic set of audible sounds

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

    There are 3 types of ______ sounds – bronchial, bronchovesicular and vesicular

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

    Crepitus is a coarse crackling sensation that is palpable over the chest due to ______ emphysema

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

    Increased ______ breath sounds are louder than normal and occur with consolidation or fluid (pneumonia)

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

    Decreased or absent ______ sounds occur when obstructed by secretions or loss of lung elasticity

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

    What is the oxygen concentration range provided by a Venturi Mask?

    <p>24-50%</p> Signup and view all the answers

    What is the maximum flow rate of a High Flow Nasal Cannula?

    <p>60 LPM</p> Signup and view all the answers

    What is the oxygen concentration range for a Low Flow Nasal Cannula at 5-6 L/min?

    <p>40-44%</p> Signup and view all the answers

    What is a contraindication for using a Simple Face Mask?

    <p>Patients who retain CO2</p> Signup and view all the answers

    What is a complication of using a High Flow Nasal Cannula?

    <p>Risk of infection</p> Signup and view all the answers

    What is a characteristic of a Full Non-Rebreather?

    <p>Delivers up to 80-100% oxygen</p> Signup and view all the answers

    A Venturi Mask can provide a specific O2 with humidity at a range of 21-100%.

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

    High Flow Nasal Cannula can be used on adults and children but not on infants.

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

    Low Flow Nasal Cannula can deliver a maximum of 60 LPM of oxygen.

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

    A Simple Face Mask can deliver a maximum of 100% FiO2.

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

    A Partial Rebreather Mask can deliver a maximum of 60-80% FiO2.

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

    High Flow Nasal Cannula is contraindicated for patients who retain CO2.

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

    High flow devices control the FiO2 with complete dependence on the patient’s breathing pattern.

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

    Venturi masks are an example of low flow devices.

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

    Partial rebreather masks are an example of high flow devices.

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

    Blender masks can deliver a range of inspired oxygen concentrations (FiO2).

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

    Oxygen conserving nasal cannula is an example of high flow devices.

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

    Which type of device is less dependent on the patient's breathing pattern?

    <p>High flow nasal cannula</p> Signup and view all the answers

    What is the primary difference between high flow and low flow devices?

    <p>Dependence on patient's breathing pattern</p> Signup and view all the answers

    Which of the following is an example of a high flow device?

    <p>Venturi mask</p> Signup and view all the answers

    What is the primary advantage of high flow devices over low flow devices?

    <p>Improved oxygen control</p> Signup and view all the answers

    Which type of device is commonly used for patients who require a specific inspired oxygen concentration?

    <p>Blender mask</p> Signup and view all the answers

    Study Notes

    Lung Structure

    • The lungs are paired but not precisely symmetrical.
    • The left lung has two lobes: upper and lower, which separate at the 6th rib.
    • The left lung is smaller due to the space occupied by the heart.
    • The right lung has three lobes: upper, middle, and lower, with the middle lobe extending from the 4th to 6th rib.
    • The apex of the lung is approximately 3 cm above the clavicle, pointing towards the substernal notch.
    • The base of the lungs lies at around T10.

    Palpation Techniques

    • To confirm symmetrical chest expansion, stand behind the patient and place warmed hands at T10/Tenth rib.
    • Point thumbs towards the spine and fingers laterally, with palms lightly contacting the posterolateral surfaces.
    • Pinch a small fold of skin between the thumbs, keeping them about 5cm apart.
    • Ask the patient to exhale and then inhale, noting the movement between the thumbs.
    • Symmetrical movement indicates normal expansion, while unequal expansion may indicate pneumothorax, rib fractures, pneumonia, or trauma.
    • For anterolateral assessment, place hands along the coastal margins with thumbs pointing towards the xiphoid process.
    • Thumbs should move apart symmetrically by 3-5 cm when the patient inhales deeply.

    Lung Structure

    • The lungs are paired but not precisely symmetrical.
    • The left lung has two lobes: upper and lower, which separate at the 6th rib.
    • The left lung is smaller due to the space occupied by the heart.
    • The right lung has three lobes: upper, middle, and lower, with the middle lobe extending from the 4th to 6th rib.
    • The apex of the lung is approximately 3 cm above the clavicle, pointing towards the substernal notch.
    • The base of the lungs lies at around T10.

    Palpation Techniques

    • To confirm symmetrical chest expansion, stand behind the patient and place warmed hands at T10/Tenth rib.
    • Point thumbs towards the spine and fingers laterally, with palms lightly contacting the posterolateral surfaces.
    • Pinch a small fold of skin between the thumbs, keeping them about 5cm apart.
    • Ask the patient to exhale and then inhale, noting the movement between the thumbs.
    • Symmetrical movement indicates normal expansion, while unequal expansion may indicate pneumothorax, rib fractures, pneumonia, or trauma.
    • For anterolateral assessment, place hands along the coastal margins with thumbs pointing towards the xiphoid process.
    • Thumbs should move apart symmetrically by 3-5 cm when the patient inhales deeply.

    Tactile Fremitus

    • Palpation vibration felt using the palmar aspect of the hand
    • Most prominent between the scapulae and around the sternum, where major bronchi are closest to the chest wall
    • Decreases as you progress down the chest
    • Decreased fremitus occurs when anything obstructs transmission of vibrations, such as:
      • Effusions
      • Pneumothorax
      • Emphysema
    • Increased fremitus occurs with compression or consolidation of lung tissue, such as:
      • Pneumonia
    • Note the correct placement of hands for palpating for a vibration
    • Use the patient's vocalization of "99" or "blue moon" to detect changes in the intensity of the vibration

    Breath Sounds (Normal)

    • Bronchial Sounds
      • High-pitched and loud
      • Heard on inspiration and expiration over the trachea and larynx
      • Best heard over the trachea
    • Bronchovesicular Sounds
      • Medium-pitched and blowing sounds of medium intensity
      • Heard on inspiration and expiration over the major bronchi
      • Located at the upper sternum anteriorly and posteriorly between the scapulae (especially on the right side)
    • Vesicular Sounds
      • Low-pitched and soft
      • Heard on inspiration and expiration
      • Sounds like wind rustling in the trees
      • Best heard over peripheral lung fields (except over scapula)
      • Located where air flows through smaller alveoli and bronchioles

    Tactile Fremitus

    • Palpation vibration felt using the palmar aspect of the hand
    • Most prominent between the scapulae and around the sternum, where major bronchi are closest to the chest wall
    • Decreases as you progress down the chest
    • Decreased fremitus occurs when anything obstructs transmission of vibrations, such as:
      • Effusions
      • Pneumothorax
      • Emphysema
    • Increased fremitus occurs with compression or consolidation of lung tissue, such as:
      • Pneumonia
    • Note the correct placement of hands for palpating for a vibration
    • Use the patient's vocalization of "99" or "blue moon" to detect changes in the intensity of the vibration

    Breath Sounds (Normal)

    • Bronchial Sounds
      • High-pitched and loud
      • Heard on inspiration and expiration over the trachea and larynx
      • Best heard over the trachea
    • Bronchovesicular Sounds
      • Medium-pitched and blowing sounds of medium intensity
      • Heard on inspiration and expiration over the major bronchi
      • Located at the upper sternum anteriorly and posteriorly between the scapulae (especially on the right side)
    • Vesicular Sounds
      • Low-pitched and soft
      • Heard on inspiration and expiration
      • Sounds like wind rustling in the trees
      • Best heard over peripheral lung fields (except over scapula)
      • Located where air flows through smaller alveoli and bronchioles

    Tactile Fremitus

    • Palpation vibration felt using the palmar aspect of the hand
    • Most prominent between the scapulae and around the sternum, where major bronchi are closest to the chest wall
    • Decreases as you progress down the chest
    • Decreased fremitus occurs when anything obstructs transmission of vibrations, such as:
      • Effusions
      • Pneumothorax
      • Emphysema
    • Increased fremitus occurs with compression or consolidation of lung tissue, such as:
      • Pneumonia
    • Note the correct placement of hands for palpating for a vibration
    • Use the patient's vocalization of "99" or "blue moon" to detect changes in the intensity of the vibration

    Breath Sounds (Normal)

    • Bronchial Sounds
      • High-pitched and loud
      • Heard on inspiration and expiration over the trachea and larynx
      • Best heard over the trachea
    • Bronchovesicular Sounds
      • Medium-pitched and blowing sounds of medium intensity
      • Heard on inspiration and expiration over the major bronchi
      • Located at the upper sternum anteriorly and posteriorly between the scapulae (especially on the right side)
    • Vesicular Sounds
      • Low-pitched and soft
      • Heard on inspiration and expiration
      • Sounds like wind rustling in the trees
      • Best heard over peripheral lung fields (except over scapula)
      • Located where air flows through smaller alveoli and bronchioles

    Anterior Lung Landmarks

    • Apex of the lungs begins 3-4 cm above the clavicle, marking the highest point
    • Base of the lungs sits at the diaphragm, approximately at the 7th rib, marking the lowest point

    Posterior Lung Landmarks

    • Apex of the lungs is marked by the 7th cervical vertebra (C7), also known as the "big bump" at the top of the spine
    • Base of the lungs sits at approximately the 10th thoracic spine (T10), extending to approximately T12 during inspiration
    • Posterior lungs are primarily comprised of lower lobes
    • Upper lobes are accessible from the apex at C7 to T3, where the oblique fissures begin

    Anterior Lung Landmarks

    • Apex of the lungs begins 3-4 cm above the clavicle, marking the highest point
    • Base of the lungs sits at the diaphragm, approximately at the 7th rib, marking the lowest point

    Posterior Lung Landmarks

    • Apex of the lungs is marked by the 7th cervical vertebra (C7), also known as the "big bump" at the top of the spine
    • Base of the lungs sits at approximately the 10th thoracic spine (T10), extending to approximately T12 during inspiration
    • Posterior lungs are primarily comprised of lower lobes
    • Upper lobes are accessible from the apex at C7 to T3, where the oblique fissures begin

    Anterior Lung Landmarks

    • Apex of the lungs begins 3-4 cm above the clavicle, marking the highest point
    • Base of the lungs sits at the diaphragm, approximately at the 7th rib, marking the lowest point

    Posterior Lung Landmarks

    • Apex of the lungs is marked by the 7th cervical vertebra (C7), also known as the "big bump" at the top of the spine
    • Base of the lungs sits at approximately the 10th thoracic spine (T10), extending to approximately T12 during inspiration
    • Posterior lungs are primarily comprised of lower lobes
    • Upper lobes are accessible from the apex at C7 to T3, where the oblique fissures begin

    Breath Sounds

    • Air passing through the tracheobronchial tree creates a characteristic set of audible sounds
    • There are three types of breath sounds: bronchial, bronchovesicular, and vesicular

    Changes in Breath Sounds

    • Decreased or absent breath sounds occur when obstructed by secretions or loss of lung elasticity
    • Increased (louder) breath sounds occur with consolidation or fluid (pneumonia), enhancing the bronchial sound as it moves through the lung fields

    Crepitus

    • A coarse crackling sensation palpable over the chest
    • Caused by subcutaneous emphysema (air escapes the lungs and enters subcutaneous tissue)

    Breath Sounds

    • Air passing through the tracheobronchial tree creates a characteristic set of audible sounds
    • There are three types of breath sounds: bronchial, bronchovesicular, and vesicular

    Changes in Breath Sounds

    • Decreased or absent breath sounds occur when obstructed by secretions or loss of lung elasticity
    • Increased (louder) breath sounds occur with consolidation or fluid (pneumonia), enhancing the bronchial sound as it moves through the lung fields

    Crepitus

    • A coarse crackling sensation palpable over the chest
    • Caused by subcutaneous emphysema (air escapes the lungs and enters subcutaneous tissue)

    Breath Sounds

    • Air passing through the tracheobronchial tree creates a characteristic set of audible sounds
    • There are three types of breath sounds: bronchial, bronchovesicular, and vesicular

    Changes in Breath Sounds

    • Decreased or absent breath sounds occur when obstructed by secretions or loss of lung elasticity
    • Increased (louder) breath sounds occur with consolidation or fluid (pneumonia), enhancing the bronchial sound as it moves through the lung fields

    Crepitus

    • A coarse crackling sensation palpable over the chest
    • Caused by subcutaneous emphysema (air escapes the lungs and enters subcutaneous tissue)

    High-Flow Delivery Devices

    • Venturi Mask provides specific O2 concentrations (24-50%) with humidity, but has a low constant O2 flow, and may irritate skin, interfere with eating, drinking, and talking.
    • High Flow Nasal Cannula offers adjustable FiO2 (21%-100%) with modifiable flow up to 60 LPM, and is suitable for adults, children, and infants, but FiO2 is dependent on patient respiratory pattern and input flow, and carries a risk of infection.

    Low-Flow Delivery Devices

    • Low Flow Nasal Cannula provides O2 concentrations of 24-28% at 1-2L/min, 32-36% at 3-4L/min, and 40-44% at 5-6L/min, and is safe, simple, and easily tolerated, but is not suitable for patients with nasal obstruction, and may cause drying of mucous membranes, dislodge easily, and skin irritation.
    • Simple Face Mask provides O2 concentrations of 40-60% at 5-10L/min, and is useful for short periods of time, but is contraindicated for patients who retain CO2, and carries an increased risk of aspiration.
    • Partial Rebreather and Partial Non-Rebreather devices provide O2 concentrations of 60-80% at 10-15L/min, and are useful for short periods of acute hypoxia, but may cause skin irritation, and the bag may twist/deflate.
    • Full Non-Rebreather device provides O2 concentrations of up to 100% at 10-15L/min, and is useful for short periods of acute hypoxia, but may cause skin irritation, and the bag may twist/deflate.

    High-Flow Delivery Devices

    • Venturi Mask provides specific O2 concentrations (24-50%) with humidity, but has a low constant O2 flow, and may irritate skin, interfere with eating, drinking, and talking.
    • High Flow Nasal Cannula offers adjustable FiO2 (21%-100%) with modifiable flow up to 60 LPM, and is suitable for adults, children, and infants, but FiO2 is dependent on patient respiratory pattern and input flow, and carries a risk of infection.

    Low-Flow Delivery Devices

    • Low Flow Nasal Cannula provides O2 concentrations of 24-28% at 1-2L/min, 32-36% at 3-4L/min, and 40-44% at 5-6L/min, and is safe, simple, and easily tolerated, but is not suitable for patients with nasal obstruction, and may cause drying of mucous membranes, dislodge easily, and skin irritation.
    • Simple Face Mask provides O2 concentrations of 40-60% at 5-10L/min, and is useful for short periods of time, but is contraindicated for patients who retain CO2, and carries an increased risk of aspiration.
    • Partial Rebreather and Partial Non-Rebreather devices provide O2 concentrations of 60-80% at 10-15L/min, and are useful for short periods of acute hypoxia, but may cause skin irritation, and the bag may twist/deflate.
    • Full Non-Rebreather device provides O2 concentrations of up to 100% at 10-15L/min, and is useful for short periods of acute hypoxia, but may cause skin irritation, and the bag may twist/deflate.

    Oxygen Devices

    • Both high flow and low flow devices can deliver a range of inspired oxygen concentrations (FiO2) to patients.

    High Flow Devices

    • Control FiO2 with less dependence on patient's breathing pattern.
    • Include device types:
      • Venturi masks
      • Large volume nebulizer
      • Blender masks
      • High flow nasal cannula

    Low Flow Devices

    • Include device types:
      • Low flow nasal cannula
      • Oxygen conserving nasal cannula
      • Simple face masks
      • Partial rebreather masks
      • Nonrebreather masks

    Oxygen Devices

    • Both high flow and low flow devices can deliver a range of inspired oxygen concentrations (FiO2) to patients.

    High Flow Devices

    • Control FiO2 with less dependence on patient's breathing pattern.
    • Include device types:
      • Venturi masks
      • Large volume nebulizer
      • Blender masks
      • High flow nasal cannula

    Low Flow Devices

    • Include device types:
      • Low flow nasal cannula
      • Oxygen conserving nasal cannula
      • Simple face masks
      • Partial rebreather masks
      • Nonrebreather masks

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    Description

    This quiz assesses knowledge of lung anatomy, including the structure and location of the left and right lungs, lobes, and their relationships with surrounding organs.

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