Podcast
Questions and Answers
When describing the location of an abnormality on a patient's chest, which anatomical landmark provides the BEST guidance for vertical location?
When describing the location of an abnormality on a patient's chest, which anatomical landmark provides the BEST guidance for vertical location?
- The sternal angle. (correct)
- The suprasternal notch.
- The costal angle.
- The xiphoid process.
A physician needs to perform needle insertion for a tension pneumothorax. Using surface anatomy, where should the physician aim the needle?
A physician needs to perform needle insertion for a tension pneumothorax. Using surface anatomy, where should the physician aim the needle?
- Along the 8th intercostal space.
- Along the 4th intercostal space.
- Along the 6th intercostal space.
- Along the 2nd intercostal space. (correct)
When examining a patient, you note a finding located between the scapulae. Using proper anatomical terminology, how would you document this location?
When examining a patient, you note a finding located between the scapulae. Using proper anatomical terminology, how would you document this location?
- Supraclavicular.
- Infraclavicular.
- Interscapular. (correct)
- Infrascapular.
During a physical exam, a medical student palpates the vertebra prominens. Which anatomical landmark is the medical student palpating?
During a physical exam, a medical student palpates the vertebra prominens. Which anatomical landmark is the medical student palpating?
At what anatomical location does the trachea bifurcate into the main stem bronchi?
At what anatomical location does the trachea bifurcate into the main stem bronchi?
During a medical procedure involving rib access, where should needles and tubes be strategically placed relative to the rib margin to minimize the risk of iatrogenic injury to neurovascular structures?
During a medical procedure involving rib access, where should needles and tubes be strategically placed relative to the rib margin to minimize the risk of iatrogenic injury to neurovascular structures?
When initially evaluating a patient presenting with a chief complaint of chest pain, which of the following is the MOST effective opening question to broadly capture the patient's experience?
When initially evaluating a patient presenting with a chief complaint of chest pain, which of the following is the MOST effective opening question to broadly capture the patient's experience?
A patient describes their chest pain as sharp, localized to a single point, and notably worsened by deep inspiration. Which of the following conditions is MOST strongly suggested by this symptom description?
A patient describes their chest pain as sharp, localized to a single point, and notably worsened by deep inspiration. Which of the following conditions is MOST strongly suggested by this symptom description?
When assessing dyspnea, which of the following initial questions is MOST appropriate for eliciting a comprehensive understanding of the patient's breathing difficulty?
When assessing dyspnea, which of the following initial questions is MOST appropriate for eliciting a comprehensive understanding of the patient's breathing difficulty?
When evaluating a patient's cough, quantifying sputum production is crucial. Which of the following volume descriptors is the MOST specific and clinically useful when asking a patient to estimate their 24-hour sputum production?
When evaluating a patient's cough, quantifying sputum production is crucial. Which of the following volume descriptors is the MOST specific and clinically useful when asking a patient to estimate their 24-hour sputum production?
When describing a patient's condition, which anatomical descriptor is MOST appropriate for an area superior to the clavicles?
When describing a patient's condition, which anatomical descriptor is MOST appropriate for an area superior to the clavicles?
When assessing the lungs, which anatomical landmark is MOST useful for locating the trachea's bifurcation into the main stem bronchi from a posterior approach?
When assessing the lungs, which anatomical landmark is MOST useful for locating the trachea's bifurcation into the main stem bronchi from a posterior approach?
When preparing to insert a chest tube, selecting the insertion site at the 4th intercostal space requires careful consideration of which adjacent anatomical structure to avoid iatrogenic injury?
When preparing to insert a chest tube, selecting the insertion site at the 4th intercostal space requires careful consideration of which adjacent anatomical structure to avoid iatrogenic injury?
A patient presents with a lung condition primarily affecting the lower portions of the lungs. Which anatomical term BEST describes the location of this condition?
A patient presents with a lung condition primarily affecting the lower portions of the lungs. Which anatomical term BEST describes the location of this condition?
After a traumatic injury, a patient requires immediate needle thoracostomy for a tension pneumothorax. Which intercostal space is the MOST appropriate target for needle insertion?
After a traumatic injury, a patient requires immediate needle thoracostomy for a tension pneumothorax. Which intercostal space is the MOST appropriate target for needle insertion?
To minimize iatrogenic injury to neurovascular structures during a procedure requiring rib access, where should needles and tubes be strategically placed in relation to the rib margin?
To minimize iatrogenic injury to neurovascular structures during a procedure requiring rib access, where should needles and tubes be strategically placed in relation to the rib margin?
A patient reports chest pain. What initial question is MOST effective in broadly capturing the patient's experience of this symptom?
A patient reports chest pain. What initial question is MOST effective in broadly capturing the patient's experience of this symptom?
A patient presents with a chief complaint of dyspnea. Which of the following questions is MOST appropriate for initiating a comprehensive assessment of the patient's breathing difficulty?
A patient presents with a chief complaint of dyspnea. Which of the following questions is MOST appropriate for initiating a comprehensive assessment of the patient's breathing difficulty?
When evaluating a patient's cough, detailed characterization of sputum production is essential. Which of the following approaches is MOST effective for quantifying the volume of sputum produced over a 24-hour period?
When evaluating a patient's cough, detailed characterization of sputum production is essential. Which of the following approaches is MOST effective for quantifying the volume of sputum produced over a 24-hour period?
A young, healthy adult presents with a sudden onset of dyspnea and pleuritic chest pain. Which of the following conditions is MOST likely?
A young, healthy adult presents with a sudden onset of dyspnea and pleuritic chest pain. Which of the following conditions is MOST likely?
During vigorous exercise, a patient exhibits increased use of accessory muscles to aid respiration. Heightened activity in which of the following muscle groups would MOST likely be observed?
During vigorous exercise, a patient exhibits increased use of accessory muscles to aid respiration. Heightened activity in which of the following muscle groups would MOST likely be observed?
A patient reports experiencing significant daytime sleepiness. Which of the following associated symptoms would MOST strongly suggest the need to evaluate for a sleep-related breathing disorder?
A patient reports experiencing significant daytime sleepiness. Which of the following associated symptoms would MOST strongly suggest the need to evaluate for a sleep-related breathing disorder?
A patient being evaluated for dyspnea demonstrates paradoxical movement in the lower chest during inspiration. Which of the following underlying mechanisms is MOST likely contributing to this observation?
A patient being evaluated for dyspnea demonstrates paradoxical movement in the lower chest during inspiration. Which of the following underlying mechanisms is MOST likely contributing to this observation?
A patient presents with a persistent, non-productive cough. What aspect of their history would MOST suggest the cough is related to an underlying cardiovascular issue rather than a primary respiratory condition?
A patient presents with a persistent, non-productive cough. What aspect of their history would MOST suggest the cough is related to an underlying cardiovascular issue rather than a primary respiratory condition?
Following a motor vehicle accident, a patient exhibits shallow and rapid breathing patterns. What immediate physiological effect is MOST likely contributing to this observed change in respiratory mechanics?
Following a motor vehicle accident, a patient exhibits shallow and rapid breathing patterns. What immediate physiological effect is MOST likely contributing to this observed change in respiratory mechanics?
During auscultation, you ask a patient to say "ee," and you hear a sound that resembles "A" with a nasal quality. Which condition is MOST likely indicated by this finding?
During auscultation, you ask a patient to say "ee," and you hear a sound that resembles "A" with a nasal quality. Which condition is MOST likely indicated by this finding?
When performing auscultation on a patient suspected of having pneumonia, which finding, when combined with fever and cough, MOST strongly suggests the presence of lobar consolidation?
When performing auscultation on a patient suspected of having pneumonia, which finding, when combined with fever and cough, MOST strongly suggests the presence of lobar consolidation?
You are assessing a patient for whispered pectoriloquy. Which instruction to the patient is MOST appropriate for eliciting this sign?
You are assessing a patient for whispered pectoriloquy. Which instruction to the patient is MOST appropriate for eliciting this sign?
During a lung examination, you ask the patient to repeat "ninety-nine," and upon auscultation, the sounds are louder and clearer than normal. How should you document this finding?
During a lung examination, you ask the patient to repeat "ninety-nine," and upon auscultation, the sounds are louder and clearer than normal. How should you document this finding?
In a patient presenting with signs of respiratory distress, which position is MOST likely to be adopted to ease their breathing and increase respiratory excursion?
In a patient presenting with signs of respiratory distress, which position is MOST likely to be adopted to ease their breathing and increase respiratory excursion?
When comparing vocal resonance findings, you note decreased intensity over the left lower lobe compared to the right. Which factor is LEAST likely to contribute to this difference?
When comparing vocal resonance findings, you note decreased intensity over the left lower lobe compared to the right. Which factor is LEAST likely to contribute to this difference?
Which of the following techniques is MOST effective in differentiating between mild bronchophony and normal vocal resonance?
Which of the following techniques is MOST effective in differentiating between mild bronchophony and normal vocal resonance?
In which anatomical location are tracheal breath sounds normally auscultated?
In which anatomical location are tracheal breath sounds normally auscultated?
What is the typical duration of expiratory sounds relative to inspiratory sounds in bronchial breath sounds?
What is the typical duration of expiratory sounds relative to inspiratory sounds in bronchial breath sounds?
Where are bronchovesicular breath sounds typically located?
Where are bronchovesicular breath sounds typically located?
If bronchial breath sounds are auscultated in a location distant from their normal location, what does this suggest?
If bronchial breath sounds are auscultated in a location distant from their normal location, what does this suggest?
Which of the following describes the pitch of expiratory sounds in tracheal breath sounds?
Which of the following describes the pitch of expiratory sounds in tracheal breath sounds?
What intensity is typical of tracheal breath sounds?
What intensity is typical of tracheal breath sounds?
Which of the following best describes the intensity and pitch of bronchovesicular breath sounds?
Which of the following best describes the intensity and pitch of bronchovesicular breath sounds?
In which locations are vesicular breath sounds predominantly heard?
In which locations are vesicular breath sounds predominantly heard?
What is the relative pitch of expiratory sounds in bronchial breath sounds?
What is the relative pitch of expiratory sounds in bronchial breath sounds?
How would you best describe the duration of inspiratory and expiratory sounds in tracheal breath sounds?
How would you best describe the duration of inspiratory and expiratory sounds in tracheal breath sounds?
Which physical finding is MOST indicative of pectus excavatum?
Which physical finding is MOST indicative of pectus excavatum?
In assessing tactile fremitus, increased vibrations are MOST likely due to which of the following conditions?
In assessing tactile fremitus, increased vibrations are MOST likely due to which of the following conditions?
Which statement BEST describes how chest expansion is assessed and interpreted during a respiratory examination?
Which statement BEST describes how chest expansion is assessed and interpreted during a respiratory examination?
In a patient with COPD, what percussion finding would you MOST likely expect?
In a patient with COPD, what percussion finding would you MOST likely expect?
During auscultation, you notice a continuous, low-pitched sound that seems to clear partially with coughing. Which adventitious sound is MOST likely?
During auscultation, you notice a continuous, low-pitched sound that seems to clear partially with coughing. Which adventitious sound is MOST likely?
In a patient with a suspected retropharyngeal abscess, which adventitious breath sound would be MOST indicative of this condition?
In a patient with a suspected retropharyngeal abscess, which adventitious breath sound would be MOST indicative of this condition?
Identify whether the abnormality of vocal resonance is increased or decreased for the following pathological conditions: Consolidation, Segmental Atelectasis, Pleural Effusion and Hyperinflation, Pneumothorax, COPD, and Asthma.
Identify whether the abnormality of vocal resonance is increased or decreased for the following pathological conditions: Consolidation, Segmental Atelectasis, Pleural Effusion and Hyperinflation, Pneumothorax, COPD, and Asthma.
When evaluating a patient presenting with hemoptysis, what is the MOST critical initial step in the diagnostic process?
When evaluating a patient presenting with hemoptysis, what is the MOST critical initial step in the diagnostic process?
Which element, if found in a patient's history, would MOST strongly suggest tuberculosis as a potential etiology for a persistent cough?
Which element, if found in a patient's history, would MOST strongly suggest tuberculosis as a potential etiology for a persistent cough?
In assessing a patient's past medical history for pulmonary issues, which detail would be MOST relevant in understanding the patient's current respiratory status?
In assessing a patient's past medical history for pulmonary issues, which detail would be MOST relevant in understanding the patient's current respiratory status?
When assessing a patient for potential respiratory compromise, which of the following findings during inspection would warrant the MOST immediate concern?
When assessing a patient for potential respiratory compromise, which of the following findings during inspection would warrant the MOST immediate concern?
During physical examination of a patient with suspected COPD, which breathing pattern would you MOST likely observe?
During physical examination of a patient with suspected COPD, which breathing pattern would you MOST likely observe?
Which of the following physical findings is MOST indicative of advanced COPD?
Which of the following physical findings is MOST indicative of advanced COPD?
What is the MOST likely underlying cause of an increased anterior-posterior (AP) diameter in a patient's thorax?
What is the MOST likely underlying cause of an increased anterior-posterior (AP) diameter in a patient's thorax?
A patient with pectus carinatum presents for an examination. Which of the following physical findings is MOST consistent with this condition?
A patient with pectus carinatum presents for an examination. Which of the following physical findings is MOST consistent with this condition?
What underlying condition is MOST associated with the development of Pectus Carinatum?
What underlying condition is MOST associated with the development of Pectus Carinatum?
When percussing the chest to assess for lung consolidation versus pleural effusion, which percussion note transition would be MOST indicative of pleural effusion?
When percussing the chest to assess for lung consolidation versus pleural effusion, which percussion note transition would be MOST indicative of pleural effusion?
A patient presents with a chief complaint of a persistent cough. Which historical detail would MOST suggest the need to evaluate for underlying bronchiectasis?
A patient presents with a chief complaint of a persistent cough. Which historical detail would MOST suggest the need to evaluate for underlying bronchiectasis?
During auscultation, you identify a high-pitched, whistling sound primarily during expiration. Which intervention is MOST appropriate for further characterizing this adventitious sound?
During auscultation, you identify a high-pitched, whistling sound primarily during expiration. Which intervention is MOST appropriate for further characterizing this adventitious sound?
A patient reports experiencing a dry, hacking cough that is exacerbated when transitioning from a warm indoor environment to the cold outdoors. Alongside cough, which other symptom is MOST indicative of reactive airway disease?
A patient reports experiencing a dry, hacking cough that is exacerbated when transitioning from a warm indoor environment to the cold outdoors. Alongside cough, which other symptom is MOST indicative of reactive airway disease?
While palpating the chest wall, you notice a coarse, grating vibration. Which action should you take to further evaluate this finding?
While palpating the chest wall, you notice a coarse, grating vibration. Which action should you take to further evaluate this finding?
Following a motor vehicle accident, a patient exhibits paradoxical chest wall movement. Which of the following scenarios is MOST likely responsible for this observation?
Following a motor vehicle accident, a patient exhibits paradoxical chest wall movement. Which of the following scenarios is MOST likely responsible for this observation?
During an examination, a patient has increased tactile fremitus over the right lower lobe. Which one of the following conditions corresponds with this?
During an examination, a patient has increased tactile fremitus over the right lower lobe. Which one of the following conditions corresponds with this?
When educating patients on monitoring techniques, which characteristic of sputum should be MOST emphasized as warranting immediate medical attention?
When educating patients on monitoring techniques, which characteristic of sputum should be MOST emphasized as warranting immediate medical attention?
A patient with a known history of chronic obstructive pulmonary disease (COPD) presents for a routine check-up. What are the MOST important counseling topics to address during this visit to optimize their respiratory health?
A patient with a known history of chronic obstructive pulmonary disease (COPD) presents for a routine check-up. What are the MOST important counseling topics to address during this visit to optimize their respiratory health?
Which physical characteristic is the MOST indicative of pectus excavatum?
Which physical characteristic is the MOST indicative of pectus excavatum?
When evaluating a patient with suspected pectus excavatum, which associated finding is MOST likely to be observed?
When evaluating a patient with suspected pectus excavatum, which associated finding is MOST likely to be observed?
In a patient with kyphosis, which observation would be MOST consistent with this condition?
In a patient with kyphosis, which observation would be MOST consistent with this condition?
Which statement accurately describes the assessment and interpretation of chest expansion during a respiratory examination?
Which statement accurately describes the assessment and interpretation of chest expansion during a respiratory examination?
In which condition is increased tactile fremitus LEAST likely to be observed?
In which condition is increased tactile fremitus LEAST likely to be observed?
Which adventitious breath sound suggests upper airway obstruction?
Which adventitious breath sound suggests upper airway obstruction?
To best reduce the risk of iatrogenic injury during central line placement, which anatomical landmark should be identified for appropriate positioning?
To best reduce the risk of iatrogenic injury during central line placement, which anatomical landmark should be identified for appropriate positioning?
What is the MOST important recommendation to give to a 65-year-old patient with a history of bronchitis regarding immunizations to prevent pulmonary infections?
What is the MOST important recommendation to give to a 65-year-old patient with a history of bronchitis regarding immunizations to prevent pulmonary infections?
In assessing the circumference of the chest for abnormalities, what is the primary methodological approach for locating findings?
In assessing the circumference of the chest for abnormalities, what is the primary methodological approach for locating findings?
Which vaccination should be administered repeatedly to an adult patient to protect against common respiratory infections?
Which vaccination should be administered repeatedly to an adult patient to protect against common respiratory infections?
During a respiratory examination, where would you palpate to locate the vertebra prominens?
During a respiratory examination, where would you palpate to locate the vertebra prominens?
After a traumatic injury, a patient requires rapid sequence intubation. Using anatomical landmarks, at which vertebral level should the lower margin of the endotracheal tube be positioned on a chest X-ray?
After a traumatic injury, a patient requires rapid sequence intubation. Using anatomical landmarks, at which vertebral level should the lower margin of the endotracheal tube be positioned on a chest X-ray?
According to the guidelines, which statement is LEAST accurate regarding tobacco cessation strategies?
According to the guidelines, which statement is LEAST accurate regarding tobacco cessation strategies?
Where should a provider aim to insert a needle for tension pneumothorax decompression, referencing intercostal space?
Where should a provider aim to insert a needle for tension pneumothorax decompression, referencing intercostal space?
A patient presents with hemoptysis. What is the MOST critical FIRST step in determining the cause of the bleeding?
A patient presents with hemoptysis. What is the MOST critical FIRST step in determining the cause of the bleeding?
Which historical finding in a patient presenting with a chronic cough and hemoptysis would MOST strongly raise suspicion for lung cancer?
Which historical finding in a patient presenting with a chronic cough and hemoptysis would MOST strongly raise suspicion for lung cancer?
When taking a patient's past medical history, which detail would be MOST relevant in evaluating the current respiratory status?
When taking a patient's past medical history, which detail would be MOST relevant in evaluating the current respiratory status?
During the physical examination of a patient, which of the following signs of respiratory distress necessitates IMMEDIATE intervention?
During the physical examination of a patient, which of the following signs of respiratory distress necessitates IMMEDIATE intervention?
Upon observation, which breathing pattern is MOST indicative of obstructive lung disease?
Upon observation, which breathing pattern is MOST indicative of obstructive lung disease?
Which physical finding is MOST indicative of advanced COPD?
Which physical finding is MOST indicative of advanced COPD?
In a patient presenting with an increased anterior-posterior (AP) diameter, which underlying condition is MOST likely?
In a patient presenting with an increased anterior-posterior (AP) diameter, which underlying condition is MOST likely?
A patient with a known history of childhood asthma now presents with a sternal protrusion. What deformity is MOST consistent with these findings?
A patient with a known history of childhood asthma now presents with a sternal protrusion. What deformity is MOST consistent with these findings?
Flashcards
Oblique (major) fissure
Oblique (major) fissure
A fissure that divides each lung roughly in half.
Horizontal (minor) fissure
Horizontal (minor) fissure
The right lung is further divided by this fissure.
Bifurcation Point
Bifurcation Point
Where the trachea splits into the main stem bronchi.
Visceral pleura
Visceral pleura
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Parietal pleura
Parietal pleura
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Rib Neurovascular Bundle Placement
Rib Neurovascular Bundle Placement
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Dyspnea
Dyspnea
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Pericarditis Pain
Pericarditis Pain
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Pleuritic Pain
Pleuritic Pain
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Angina Pectoris/Myocardial Infarction Pain
Angina Pectoris/Myocardial Infarction Pain
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Chest Pain
Chest Pain
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GERD Pain
GERD Pain
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Pneumothorax
Pneumothorax
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Cough Investigation
Cough Investigation
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Chest Circumference Lines
Chest Circumference Lines
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Lobes of the Right Lung
Lobes of the Right Lung
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Lobes of the Left Lung
Lobes of the Left Lung
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Tracheal Bifurcation Location
Tracheal Bifurcation Location
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Supraclavicular
Supraclavicular
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Egophony
Egophony
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Bronchophony
Bronchophony
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Whispered Pectoriloquy
Whispered Pectoriloquy
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Auscultation
Auscultation
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Abnormal Vocal Resonance
Abnormal Vocal Resonance
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Positioning for Breathing
Positioning for Breathing
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Chest Inspection
Chest Inspection
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Inspiration
Inspiration
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Accessory Muscles of Breathing
Accessory Muscles of Breathing
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Expiration
Expiration
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Hemoptysis
Hemoptysis
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Bronchovesicular Breath Sounds
Bronchovesicular Breath Sounds
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Bronchial Breath Sounds
Bronchial Breath Sounds
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Tracheal Breath Sounds
Tracheal Breath Sounds
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Location of Bronchovesicular Sounds
Location of Bronchovesicular Sounds
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Location of Bronchial Sounds
Location of Bronchial Sounds
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Location of Tracheal Sounds
Location of Tracheal Sounds
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Abnormal Breath Sounds
Abnormal Breath Sounds
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Bronchial Pitch
Bronchial Pitch
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Tracheal Intensity
Tracheal Intensity
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Bronchial intensity
Bronchial intensity
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Adventitious Breath Sounds
Adventitious Breath Sounds
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Pleural Friction Rub
Pleural Friction Rub
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Wheeze
Wheeze
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Stridor
Stridor
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Rales (Crackles)
Rales (Crackles)
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Rhonchi
Rhonchi
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Tactile Fremitus & Conditions
Tactile Fremitus & Conditions
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Percussion
Percussion
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Tactile Fremitus
Tactile Fremitus
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Inspection of Thoracic Integrity
Inspection of Thoracic Integrity
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Health Promotion and Counseling
Health Promotion and Counseling
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Smoking Cessation
Smoking Cessation
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Adult Immunizations
Adult Immunizations
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Vertical Location on Chest
Vertical Location on Chest
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Barrel Chest
Barrel Chest
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Pectus Carinatum
Pectus Carinatum
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Normal AP Diameter
Normal AP Diameter
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Pursed Lip Breathing
Pursed Lip Breathing
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Tachypnea
Tachypnea
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Cyanosis
Cyanosis
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Pallor
Pallor
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Diaphoresis
Diaphoresis
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Accessory Muscle Use
Accessory Muscle Use
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Tobacco Cessation
Tobacco Cessation
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Sternal Angle
Sternal Angle
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Vertebra Prominens
Vertebra Prominens
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Interscapular
Interscapular
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Apices of the Lungs
Apices of the Lungs
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Bases of the Lungs
Bases of the Lungs
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Needle Insertion (Pneumothorax)
Needle Insertion (Pneumothorax)
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Pectus Excavatum
Pectus Excavatum
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Kyphosis
Kyphosis
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Asymmetric Chest Expansion
Asymmetric Chest Expansion
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Tactile Fremitus Changes
Tactile Fremitus Changes
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Percussion Purpose
Percussion Purpose
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Snoring/Gurgling Sounds
Snoring/Gurgling Sounds
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Rales
Rales
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Study Notes
Learning Outcomes
- Students will be able to obtain patient histories regarding complaints of chest pain, shortness of breath, wheezing, cough, and hemoptysis
- Students will be able to gather subjective and objective data for a problem-oriented case and develop a problem list
- Students will be able to provide health maintenance strategies for smoking cessation and adult immunizations against influenza and pneumonia
- Students will be able to identify abnormal disease pattern characteristics during the examination of the thorax and lungs
- Students will be able to utilize a problem list to generate a working differential diagnosis for common pulmonary complaints
Pulmonary Anatomy
- Locating findings on the chest needs describing abnormalities in two dimensions
- To make vertical locations, count the ribs and interspaces, use the sternal angle as a guide
- To locate findings around the circumference of the chest, have a series of vertical lines
- Each lung is divided roughly in half by an oblique (major) fissure
- The right lung is further divided by the horizontal (minor) fissure
- Fissures divide the lungs into lobes
- The right lung is divided into upper, middle, and lower lobes
- The left lung is divided into upper and lower lobes
- The trachea bifurcates into its main stem bronchi at the level of the sternal angle anteriorly and the T4 spinous process posteriorly
- The pleurae are serous membranes that cover the outer surface of each lung (visceral), and also the inner rib cage and upper surface of the diaphragm (parietal)
Topographic Markers
- Nipples and clavicles are topographic markers
- The manubriosternal junction, angle of Louis, and suprasternal notch are topographic markers
- The Costal angles and vertebra prominens or C-7 spinous process, are topographic markers
- Supraclavicular is above the clavicles
- Infraclavicular is below the clavicles
- Interscapular is between the scapulae
- Infrascapular is below the scapulae
- Apices of the lungs-the uppermost portions
- Bases of the lungs-the lowermost portions
- lung fields-upper, middle, and lower
Anatomy Pearls
- Anatomy is always relevant
- The 2nd intercostal space for needle insertion for tension pneumothorax
- The 4th intercostal space for chest tube insertion
- Use T4 for the lower margin of an endotracheal tube on a chest x-ray
- Neurovascular structures run along the inferior margin of each rib, so place needles and tubes just at the superior rib margins
Common Pulmonary Chief Complaints
- Chest pain and Dyspnea are common pulmonary complaints
- A cough, wheezing, and hemoptysis are common pulmonary complaints.
HPI - Chest Pain
- First questions should be open ended: “Do you have any discomfort or unpleasant feelings in your chest?"
- Ask patient to point to the pain.
- Chest pain may arise from cardiac, vascular, GI, musculoskeletal, skin pathology, or anxiety as well as pulmonary situations
- Attributes of the patient's symptom should be identified using PQRST or OLD CARTS.
- Sharp or stabbing pain in single location which is aggravated with inspiration may indicate Pleuritic pain or costochondritis
- Anterior chest pain with radiation to shoulder, and a pressure or squeezing sensation may indicate angina pectoris or myocardial infarction
- Sharp pain with inspiration that is relieved by siting up and leaning forward may indicate pericarditis
- Pain described as ripping or tearing may indicate dissecting aortic aneurysm
- Retrosternal pain described as burning may indicate gastrointestinal reflux disease
- Ask whether the cough is dry or produces sputum or phlegm
HPI-Dyspnea
- Dyspnea is a nonpainful awareness of breathing not related to the level of exertion
- first thing for the pt
- Open Question, pt
- Ask them "Have you had any difficulty breathing?"
- Pt determine level of dyspnea
- Based on daily activities
- Pt symptoms
- PQRST or OLD CARTS
- Rate
- Progression of SOB
- Pt should be laying down
- Acute illness
- Lung sounds check the pt, then it be the pt is pneumonia
- Then ask if they have Pneumonia
- Pneumothorax
- Pleruitic
- Have the pt Sudden symptoms
- Check to see if they can breathe or the rate
- Pt age younger
- Risk factors Pulmonary symptoms should be checked
HPI - Cough & Wheeze
- Ask whether the cough is dry or produces sputum or phlegm
- Describe the volume, color, odor, and consistency of any sputum
- "How much do you think you cough up in 24 hours: a teaspoon, tablespoon, quarter cup, half cup, cupful?" to determine volume
- Inspect the phlegm in a tissue
- To confirm the source of the bleeding, try to confirm with a history and exam before using the term “hemoptysis”; blood may also originate from the mouth, pharynx, or GI tract
- Episodic cough or wheeze is not always related to an illness and may indicate asthma
- Cough, hemoptysis, fever, and night sweats may indicate tuberculosis
- Cough, hemoptysis, and weight loss that is caused by pt that may indicate pt is a lung cancer pt
Past Medical History
Check for :
- Thoracic trauma and/or surgery dates of the pt should be documented
- O patient check O2 patient Patients and devices
- Pt is a COPD or something like the
- Pt with childhood diseases like test with or without asthma Check for: Testing
- Check for pt immunization and and/0r or pneumonia
Family History
Check for :
- TB
- Cystic fibrosis
- Emphysema
- Allergy Asthma
- Check for : Malignancy Should ask pt about Clotting history
Personal/Social History
Check to see
- Employment
- Home environment Tobacco Pt:
- Infections respiratory
- Tb exposure
- Nutritional status
- Have pt share to travels
- Pt Hobbies or check for pigeon
- Drugs or alcohol
- Exercise habits
- Hiv test
Physical Exam - Identify Respiratory Distress
- Tachypnea, cyanosis and pallor are signs that they in respiratory distress
- Pt:
- Diaphoresis, accessory muscle use
- breathing
Types of Breathing Patterns
-Pt should purse lip for there breathing,
- Pursed lip breathing pt needs to conrtrol it
- If is pt has Pleurisy or
- Chest check
- That would be an indication
Use of Accessory Muscles
- Pt intercostal Is a pt with Use COPD Retractions
- Diaphragm and is
- Scalene is
- Ck for neck
- Pt should have there be or fingers with or
- Pt is used to it
- Use see sck
Pt is have to pt
Inspection
Is important check pt See if have Shape pt Pt wall movement
- Superficial or not
- Is rib promenecne
- And transverse
Inspection of Thoracic Integrity
- Thorax of healthy adult with AP diameter < transverse diameter
- Increased AP diameter in COPD (barrel chest)
- Various Deformities including Pectus carinatum, Pectus excavatum,
Thoracic/Chest Expansion
- normal finding for expansion is equal and symmetrical
- Asymmetric chest expansion is always abnormal
- The abnormal side expands less & lags behind normal side
- Asymmetry implies that air cannot enter affected side
- Bilateral reduction is difficult to detect clinically
Tactile Fremitus
Consolidation pt
- Lobar and he has or pt
- bronchial secretions
- Pt ate Pt
- Thickening area
Abnormalities of Vocal Resonance
- Increased Bronchophony
- Consolidation
- Segmental atelectasis
- Pt area Deceased and is hyperinflated
Reduced Diaphragmatic Excursion
- Present in conditions which limit its descent such as: ■ Pulmonary (COPD) ■ Abdominal (Massive ascites, tumor) ■ Superficial pain (Fractured rib) ■ Tenderness, step off ■ Diaphragm paralysis
Percussion
- ntify pt pt pt lung diaphragm Pathlogic
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Description
Questions about anatomical landmarks on the chest, including the scapulae, vertebra prominens, and tracheal bifurcation. Focus on surface anatomy knowledge to guide needle placement and minimize neurovascular injury. Evaluating chest pain and related anatomy.
