Podcast Beta
Questions and Answers
What describes the sound characteristic of fine crackles in the respiratory system?
Which of the following techniques is NOT used for assessing the posterior chest?
What condition is characterized by rapid respirations greater than 24 breaths per minute?
What is a common finding in patients with COPD regarding their chest structure?
Signup and view all the answers
Which of the following best describes wheeze sounds heard during auscultation?
Signup and view all the answers
What does the visceral membrane do in relation to the lungs?
Signup and view all the answers
What is a physiological change associated with aging related to the respiratory system?
Signup and view all the answers
Which of the following landmarks is used to identify the bifurcation of the trachea?
Signup and view all the answers
Which of the following is NOT a risk factor for respiratory disease in specific populations?
Signup and view all the answers
What is the expected costal angle in a healthy adult?
Signup and view all the answers
During an assessment of the anterior chest, what is NOT typically observed?
Signup and view all the answers
What does tactile fremitus assess during a physical examination?
Signup and view all the answers
Which sound indicates overinflated lungs during percussion?
Signup and view all the answers
What is a common environmental concern that can lead to respiratory infections?
Signup and view all the answers
Which of the following describes the bronchial breath sounds?
Signup and view all the answers
What does a patient with kyphosis experience in relation to breathing?
Signup and view all the answers
What factors are important to consider for a patient’s cultural background during an examination?
Signup and view all the answers
What is a common characteristic of bronchovesicular breath sounds?
Signup and view all the answers
In assessing respiratory conditions, what is the significance of 'dyspnea'?
Signup and view all the answers
Study Notes
Thorax and Respiratory System
- The thorax is the chest cavity, which contains the lungs, heart, and other vital organs.
- The mediastinum is the central compartment of the thorax, separating the lungs and containing the heart, trachea, esophagus, and major blood vessels.
Anatomy and Physiology
- The pleural membranes are a double-layered serous membrane that lines the thoracic cavity and surrounds the lungs.
- The visceral pleura lines the outer surface of each lung.
- The parietal pleura lines the thoracic wall and the upper surface of the diaphragm.
Landmarks
-
Anterior Thorax:
-
Sternum:
- Suprasternal Notch: Also known as the jugular notch, located between the clavicles at the top of the sternum.
- Manubrium: The upper portion of the sternum, containing the sternal angle or angle of Louis.
- Sternal Angle: Located at the level of the second rib, it marks the bifurcation of the trachea and the upper border of the atria.
- Body: The middle part of the sternum.
- Xiphoid Process: The lower tip of the sternum.
- Costal Angle: The angle formed by the lower ribs at the costal margin, usually less than 90 degrees. An increased angle can indicate overinflation, common in COPD.
-
Sternum:
-
Other Landmarks:
- Midsternal: Middle of the sternum.
- Midclavicular: Middle of the clavicle.
- Anterior Axillary: Front of the armpit.
- Midaxillary: Middle of the armpit.
- Posterior Axillary: Back of the armpit.
-
Posterior Thorax:
- Vertebrae and Scapulae: Used as locators for landmarks on the posterior chest.
- C7/T1 Vertebrae: Prominent with a flexed neck.
- Lower Border of Scapula: Usually at the 7th or 8th rib.
- 12th Rib: Marks the bottom of the rib cage.
-
Trachea and Bronchi:
- The trachea bifurcates at the sternal angle, which corresponds to the level of T4.
Respiratory System with Age
-
Decreased Efficiency:
- Lungs lose elasticity.
- Skeletal muscles weaken.
- Costal cartilage calcifies, leading to decreased depth of respirations and changes in thoracic cavity diameter.
- Barrel chest (AP=T) can develop.
- Kyphosis: Curved thoracic spine, leading to decreased ability to inflate lungs.
- Less O2 for body and increased retention of CO2.
-
Increased risk for:
- Dyspnea on exertion (DOE).
- Postoperative complications.
- Pneumonia.
Respiratory System/Cultural Considerations
-
Increased incidence of respiratory diseases in certain populations:
- Asthma.
- Tuberculosis (TB), especially in recent immigrant groups or those with immunosuppression.
-
Environmental Concerns:
- Occupational:
- Asbestos exposure can lead to asbestosis.
- Air conditioning/heating systems can increase respiratory infections.
- Home:
- Secondhand smoke.
- Pet dander.
- Dust.
- Molds.
- Occupational:
Subjective Examination/Health History Questions
-
Respiratory System:
- "Are you having any problems with your respiratory system?"
- "Compare your respiratory system to the past?"
- "What makes your breathing difficult? (Exercise, lying down [orthopnea])"
- "History of respiratory illness or infection? (Treatment)"
-
Cough:
- Description of cough (dry, productive, hacking).
-
Mucous:
- Amount, color, consistency, blood, and odor.
-
Chest Pain:
- Location, duration, intensity, and associated symptoms.
-
Shortness of Breath (Dyspnea):
- Compared to baseline, triggers, position-related, time of day.
-
Wheezing:
- Musical respiratory sound.
-
Weight Loss:
- Unintentional weight loss can be a sign of underlying respiratory condition.
-
History of Respiratory Disorders:
- Infections: COVID-19, bronchitis, pneumonia, TB.
- Chronic Disorders: Emphysema, asthma.
- Colds: Frequency.
-
Environmental exposure:
- Dust, allergens, workplace hazards.
-
Self-care behaviors:
- Pneumococcal vaccine (recommended for those 65 or older).
- COVID-19 and influenza immunization.
- Protective wear.
-
Tobacco Use:
- Smoking cigarettes or cigars (packs/day x years).
- Exposure to secondhand smoke.
Inspection
-
Signs of respiratory difficulty:
- Skin color (lips and nail beds).
- Breathing sounds (rate, rhythm, depth, effort).
- Neck assessment.
- Facial expression.
- Level of consciousness.
Inspection of the Posterior Chest
-
Shape and Configuration:
- AP:T diameter (should be 1:2).
-
Muscles:
- Any muscle wasting or bulging.
-
Skin:
- Color, lesions, scars, or deformities.
Palpation of the Posterior Chest
-
Symmetrical Chest Expansion:
- Assess for equal movement of both sides of the chest during inspiration.
Inspection of the Anterior Chest
-
Shape and Configuration:
- Costal angle.
- Rib shape.
- Deformities.
- Symmetry.
-
Respirations and Chest Movement:
- Rate, rhythm, depth, and effort of breathing.
Palpation of the Anterior Chest
-
Palpation of Sternum, Ribs, and Intercostal Areas:
- Count ribs and intercostal spaces.
- Tenderness (indicates inflammation).
- Masses.
- Crepitus (air in subcutaneous tissues).
-
Palpate for Chest Expansion:
- Symmetry of chest movement during inspiration.
- Asymmetry or decreased expansion, which could indicate pain, pneumothorax, or fibrotic changes.
-
Tactile Fremitus:
- Palpable vibrations felt during speech.
- Diminished vibrations suggest obstruction.
- Increased vibrations suggest increased density.
Percussion of the Anterior Chest
- Begin in the supraclavicular area and move across and down, percussing over intercostal spaces.
-
Expected Percussion Notes:
- Resonance: Normal lung sound over healthy lungs.
- Hyperresonance: Overinflated lungs (COPD).
- Dullness: Solid tissue like organs (heart, liver).
- Tympany: Air-filled structures (stomach).
- Flat: Bones or muscles.
Auscultation of the Anterior Chest
-
Listen to at least one full breath in each location:
- Apices of lungs to the 6th intercostal space.
- Trachea, and 1st and 2nd intercostal space next to the sternum.
-
Normal Breath Sounds:
- Bronchial (Tracheal): Louder, higher in pitch, heard over the trachea and larynx. Inspiration shorter than expiration.
- Vesicular: Soft, low-pitched sound heard over smaller bronchioles and alveoli. Inspiration longer than expiration.
- Bronchovesicular: Moderate sound and pitch heard over major bronchi. Inspiration equal to expiration.
Auscultating Anterior Thorax
-
Voice Sounds:
- Bronchophony: Increased clarity of spoken sounds ("99").
- Egophony: A change to a bleating or nasal quality of the "eeeee" sound.
- Whispered Pectoriloquy: Whispered sounds heard clearly.
Palpation of Posterior Chest:
- Palpate for tenderness, masses, and abnormalities.
- Palpate for respiratory expansion.
-
Assess tactile fremitus:
- Normal vibrations felt during speech.
Percussion of Posterior Chest:
- Begin at apices and percuss over interspaces side-to-side.
- Avoid scapulae and ribs.
-
Expected Percussion Notes:
- Resonance: Normal lung sound over healthy lungs.
- Hyperresonance: Overinflated lungs (COPD).
- Dullness: Solid tissue like organs (heart, liver).
- Tympany: Air-filled structures (stomach).
- Flat: Bones or muscles.
Auscultation of Posterior Chest
-
Listen to at least one full breath in each location:
- Apices of lungs to the base of the lungs.
-
Normal Breath Sounds:
- Bronchial (Tracheal): Louder, higher in pitch, heard over the trachea and larynx. Inspiration shorter than expiration.
- Vesicular: Soft, low-pitched sound heard over smaller bronchioles and alveoli. Inspiration longer than expiration.
- Bronchovesicular: Moderate sound and pitch heard over major bronchi. Inspiration equal to expiration.
Abnormal Findings
-
Barrel Chest:
- AP=T diameter.
- Horizontal ribs.
- Usually due to COPD or aging.
-
Adventitious Lung Sounds:
-
Crackles:
- Fine Crackles: High-pitched, short, crackling, popping sounds, usually heard during inspiration. Do not clear with cough. Indicate collapsed or fluid-filled alveoli opening.
- Coarse Crackles: Louder, moist, low-pitched bubbling sounds heard during inspiration and/or expiration. May clear with cough or suctioning. Indicate air colliding with secretions in larger airways.
- Pleural Friction Rub: Low-pitched grating or creaking sound heard during inspiration and expiration. Occurs when inflamed pleural surfaces rub together.
- Wheeze (Sibilant): High-pitched, musical wheezing sound, usually heard during expiration. Caused by air passing through very narrow airways.
-
Crackles:
-
Respiratory Patterns:
- Tachypnea: Rapid breathing (greater than 24 breaths/minute). Can be caused by fever, exercise, pleuritic pain, or pneumonia.
- Bradypnea: Slow, regular breathing. Can be caused by drug overdose, head injury, or increased intracranial pressure.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the intricacies of the thorax and respiratory system in this quiz. Learn about vital structures such as the mediastinum, pleural membranes, and key landmarks like the sternum. Test your knowledge on how these components work together to support vital functions.
