Thorax Assessment Spring 2024 - Chest Shape, Size, and Palpation

What is the normal shape of the chest?

In chronic conditions, what happens to the anterior-posterior (AP) diameter of the chest?

During normal chest expansion, how much should the thumbs separate during inspiration?

What is tactile fremitus?

What is the purpose of percussion in a thorax assessment?

Which percussion sound is most likely to be heard in a patient with COPD?

What is the best location to auscultate vesicular breath sounds?

What is the characteristic feature of barrel chest deformity?

Which condition is most likely to present with yellow mucopurulent sputum?

Where are bronchovesicular breath sounds typically auscultated?

What condition is characterized by impaired gas exchange due to decreased functional lung tissue?

Which abnormal breath sound is commonly heard at the bases on inspiration and is associated with bronchitis, pneumonia, emphysema, and heart failure?

What condition is suggested by continuous, low-pitched, coarse, harsh sounds predominantly heard over the trachea and bronchi?

Which breath sound indicates a superficial grating or creaking sound, occurring when visceral and parietal pleural surfaces are damaged?

What condition is characterized by continuous, high-pitched, squeaky musical sounds that are not cleared by coughing?

Normal Chest Shape and Changes in Chronic Conditions

The normal shape of the chest is typically elliptical in adults.
In chronic conditions, the anterior-posterior (AP) diameter of the chest increases, leading to a more rounded shape.

Chest Expansion and Physical Assessment

During normal chest expansion, the thumbs should separate approximately 5-10 cm during inspiration.
Tactile fremitus refers to the vibration felt on the chest wall when a patient speaks; it helps assess lung density and air presence.

Purpose of Percussion and Breath Sounds

Percussion is used in thorax assessment to determine underlying lung conditions by identifying resonance or dullness.
In patients with COPD, dull or hyper-resonant percussion sounds are commonly heard.

Auscultation Locations and Breath Sounds

Vesicular breath sounds are best auscultated over the peripheral lung fields, particularly at the bases.
Bronchovesicular breath sounds are typically heard over the main bronchus area and at the sternum.

Conditions and Associated Symptoms

Barrel chest deformity is characterized by an increased AP diameter with a more rounded appearance.
Yellow mucopurulent sputum is most commonly associated with bacterial infections, such as pneumonia or bronchitis.
Impaired gas exchange due to decreased functional lung tissue is commonly seen in conditions like pulmonary fibrosis or severe emphysema.

Abnormal Breath Sounds

Abnormal breath sounds, such as crackles (rales), are often heard at lung bases during inspiration and can indicate conditions like bronchitis, pneumonia, emphysema, and heart failure.
Continuous, low-pitched, coarse, harsh sounds over the trachea and bronchi suggest bronchial obstruction or inflammation.
Pleural friction rub occurs as a superficial grating or creaking sound when visceral and parietal pleural surfaces are damaged.
Continuous, high-pitched, squeaky musical sounds indicate conditions like asthma or bronchospasm that are not relieved by coughing.

This quiz covers assessment of the thorax including chest shape, size, and palpation. Topics include normal chest characteristics, AP diameter, and posterior thorax palpation techniques.