Thoracic Anatomy and Respiratory Process Quiz

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Questions and Answers

What triggers inspiration in the respiratory process?

Drop in blood CO2 levels

Rise in blood CO2 levels (correct)

Decrease in oxygen demand

Increased lung elasticity

Which structure is NOT part of the thoracic cavity?

Heart

Lungs

Liver (correct)

Esophagus

During expiration, which of the following statements is true?

It occurs simultaneously with inhalation.

It requires significant muscular effort.

It is a passive process. (correct)

Lung fields descend by 2 rib spaces.

What is the role of the thymus gland in the thoracic cavity?

Produces T-cells for the immune system Signup and view all the answers

Which of the following describes the pleural space?

It separates visceral pleura from parietal pleura. Signup and view all the answers

Which muscle is primarily responsible for the contraction during inspiration?

Diaphragm Signup and view all the answers

What is the costal margin?

The inferior rib border Signup and view all the answers

How many pairs of ribs are present in the thoracic cage?

12 Signup and view all the answers

What does a barrel chest indicate in a patient?

COPD Signup and view all the answers

What is the correct inspection method for assessing respiratory movement?

Rate, rhythm, depth, and quality of breathing Signup and view all the answers

In which situation is tactile fremitus most likely to be reduced?

Lung disease concerns Signup and view all the answers

What is assessed using the ulnar surface of the hand during palpation?

Tactile fremitus Signup and view all the answers

What shape should the thorax ideally present according to the anterior-posterior to transverse ratio?

1:2 Signup and view all the answers

When would you note tenderness, masses, and crepitus during a thorax assessment?

During palpation Signup and view all the answers

What does hyper resonance during percussion indicate?

Air trapping conditions Signup and view all the answers

What are the signs of dyspnea?

Feeling of shortness of breath Signup and view all the answers

What is the optimal technique for assessing diaphragmatic excursion during percussion?

Instruct the patient to exhale and hold before percussing Signup and view all the answers

Which lung sounds are continuous and usually more pronounced on expiration?

Wheeze Signup and view all the answers

Where should auscultation be performed for the lower lobes of the lungs?

Laterally and posteriorly Signup and view all the answers

What is the expected inspiratory to expiratory (I:E) ratio for bronchial breath sounds?

1:2 or 1:3 Signup and view all the answers

Which part of the stethoscope is recommended for performing auscultation?

Diaphragm Signup and view all the answers

What should patients be instructed to do to provide clearer breath sounds during auscultation?

Breathe more deeply through their mouth Signup and view all the answers

What type of lung sounds are characterized as brief, discontinuous popping sounds?

Crackles Signup and view all the answers

What is the minimum expected change in percussion dullness to indicate normal diaphragmatic movement?

At least 1-2 rib spaces (3-5 cm) Signup and view all the answers

What structures are primarily responsible for inspiration?

Intercostal Muscles and Diaphragm Signup and view all the answers

Which statement accurately describes the right main bronchus?

Shorter, wider, and more vertical than the left bronchus Signup and view all the answers

At which rib level can the lung fields be typically assessed in the supraclavicular region?

6th rib Signup and view all the answers

During expiration, what is the primary nature of the process?

Passive under normal circumstances Signup and view all the answers

What is the size relationship between the right upper lobe (RUL) and the left upper lobe (LUL)?

RUL size plus RML equals LUL size Signup and view all the answers

What is the primary function of alveoli in the respiratory system?

Gas exchange between oxygen and carbon dioxide Signup and view all the answers

Which condition would be classified under respiratory-specific history?

Pleuritic Pain Signup and view all the answers

What nerve is primarily responsible for innervating the diaphragm?

Phrenic nerve Signup and view all the answers

Study Notes

Thorax, Lungs, and Respiratory

Thorax, lungs, and respiratory system are discussed.
Copyright material is reproduced under Canadian Copyright Act.
Further distribution may infringe copyright.

Giddens (2017) Concepts

Homeostasis and Regulation
- Gas exchange
- Ventilation
- Oxygenation
- Transport
- Perfusion
Respiratory Assessment
- Vital Signs
  - Skin, hair
  - Head, Neck, CNS (peripheral nervous system)
  - Mouth, Nose, Throat
  - Thorax and Lungs
  - CVS/PVS

Video of Gas Exchange

Video link provided for gas exchange
https://www.youtube.com/watch?v=WzrN6sJli_g

Inspiration vs Expiration

Inspiration is triggered by a rise in blood CO2.
- Inspiratory muscles contract
- Lung fields descend by 2 rib spaces
- 500-800 mL of air intake
Expiration is longer and passive (takes twice as long)

Respiratory Anatomy

Diagrams and labels of respiratory anatomy are provided.
Structures like pharynx, nasal cavity, lungs, trachea, and bronchial tubes are shown.
Capillaries, diaphragm, and pleural space.
Anatomy of the lungs and respiratory system is visually illustrated.

Thoracic cage

Clavicles
Manubrium (sternal angle at 2nd rib)
Sternum
12 pairs of ribs, 12 vertebra posteriorly
Count rib spaces starting below the first rib
Costal margin = inferior rib border

The Thoracic Cavity

Heart
Lungs
Thymus (immune system gland)
- Shrinks after puberty
- Produces T-cells
Trachea
Esophagus
Aorta & great vessels
Location of the right and left lungs in the thoracic cavity.

Pleura & Pleural Space

Visceral pleura lines the lungs.
Parietal pleura lines the thoracic wall, mediastinum and diaphragm.
Trauma can cause lung collapse (pneumothorax or hemothorax)

Respiratory Muscles

Muscles of inspiration
- Accessory: sternocleidomastoid, scalenes, pectoralis minor (not depicted in the slide).
- Principal: external intercostals.
- Diaphragm
Muscles of expiration
- Quiet breathing: passive and elastic recoil of lungs, rib cage.
- Active breathing: internal intercostals (except interchondral part), and abdominals.
Inspiration is driven by intercostal muscles and diaphragm—innervated by phrenic nerve C3-C5, and cranial nerve X.
Expiration is mainly passive.

Internal Structures

Trachea bifurcates at sternal angle anteriorly and posteriorly at T4.
Right main bronchus is shorter, wider, and more vertical than left.
Risk for foreign body aspiration is higher on the right.
Alveoli are the sites of gas exchange.

Landmarking

Anatomical lines (midsternal, posterior axillary, midclavicular, midaxillary, anterior axillary, scapular, vertebral lines).

Lungs: Anterior

Lung fields
- Supraclavicular (6th rib midclavicular line)
- 8th rib at midaxillary line
RUL apex is 2.5 cm higher than LUL apex.
4th-6th rib at sternum, going to RLL at anterior axillary line
Size: RUL + RML = LUL
RLL size & position = LLL size & position

Lung Fields on Inspiration

Diagram showing lung fields during inspiration, on an x-ray.

Lungs: Lateral

Lung fields are located by using the supraclavicular (6th rib/8th rib midaxillary line)
RUL apex is 2.5cm higher than LUL apex.
4th-6th rib at sternum, giving way to the RLL at the anterior axillary line.
Size: RUL+RML = LUL
RLL size and position = LLL size and position

Lungs: Posterior

Lung fields: C7–T10
LUL & RUL: C7-T3
LLL & RLL: T3-T10
Inspiration descends by 2 rib spaces.

General Survey

Images of people with different conditions, likely for examples of general survey.

Health History

Respiratory-related medical history
- Sleep apnea
- Pleuritic pain
- Cough
- Sputum/hemoptysis
- Dyspnea
- Short of breath
- Wheezing
- Stridor
- Infections
- Occupational/environmental exposure
- Deep vein thrombosis/pulmonary embolism
- Asthma
- Bronchitis
- COPD
- Tuberculosis

Vital Signs

Vital signs are essential for health monitoring.

Thorax, Lungs, & Respiration: IPPA

Inspection:
- Level of consciousness
- Facial expression
- Posture
- Shape of the thorax
- Respiratory movement and effort (rate, rhythm, quality of breathing)
Palpation
Percussion
Auscultation

Inspection of the Skin; Central vs Peripheral Cyanosis

Diagrams showing central and peripheral cyanosis.

Cyanosis – You Will Learn In Pathophysiology!

Diagram illustrating the causes and different types of cyanosis.

Inspection: Thorax Shape

Normal vs. Barrel chest
- Normal: Anterior-Posterior (AP) diameter less than transverse diameter; Ratio is 1:2-5:7
- Barrel chest: AP diameter equal or nearly equal to transverse diameter (1:1); COPD

Palpation

Palpation:
- superior to inferior, 1-2-3-4-5 pattern,
- Left and right sides consecutively
- Assess for tenderness, masses, lesions, crepitus (bubble wrap sensation, air trapping)
- tactile fremitus (using ulnar surface of hand, patient repeats 99)
- Variations in findings usually reduced at bases

Palpation: Chest Expansion

Assessing chest expansion (posterior and anterior).
Used to check for muscle weakness, fractures, infections, or respiratory disease.

Percussion

Percuss from lung apex to lung base (avoid clavicle and ribs).
Compare side to side for resonance throughout.
Abnormal findings: hyper resonance (air trapping, e.g., COPD) or dullness (e.g., fluid).

Percussion: Diaphragmatic Excursion

When to use diaphragmatic excursion: for concerns with chest expansion.
- Instruct to exhale and hold
- Percuss down mid-scapular line intercostal spaces
- Mark change to dullness
- Break (breath normally)
- Instruct to inhale and hold
- Percuss from first rib down
- Should be at least 1-2 rib spaces (3-5 cm)
- Repeat on the other side

Auscultation

Assess intensity, pitch, quality, duration, and adventitious sounds.
Tips: Not over clothing
diaphragm of stethoscope
as patient breath more deeply than normal, through their mouth.
Listen to one full breath per location.
Move side to side to compare symmetry

Auscultation Reminder: Lower Lobes

Auscultate laterally and posteriorly, not anteriorly (why).

Auscultation – Don't!

Incorrect auscultation techniques (avoid these) are shown.

Auscultation – Do!

Correct auscultation techniques.

Breath Sounds

Description of different normal breath sounds (tracheal, bronchial, bronchovesicular, vesicular).
Associated location to help with diagnosis

Adventitious Lung Sounds

Descriptions of adventitious sounds (wheezes, crackles, stridor)

Red Flag: Respiratory Distress

Short sentences, few words.
Irritability (unable to focus, LOC alterations)
Positioning (leaning forward/standing/sitting leaning forward/tripod)
Work of breathing (mouth breathing, pursed lips, nasal flaring, accessory muscle use, neck and intercostal muscle use)

References

List of references, including the authors and titles of relevant work.

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Description

Test your knowledge on the structures and functions related to the thoracic cavity and the respiratory process. This quiz covers topics such as inspiration, expiration, and the role of various components within the thoracic region. Perfect for students of anatomy and physiology!