Thorax and Lung PDF

- Midsternal line: drops vertically along sternum - Midclavicular line: drops vertically from the midpoint of the clavicle - Anterior axillary line: drops vertically from anterior axillary fold - Midaxillary line: drops vertically from the apex of the axilla - Right lung has 3 lobe...

- Midsternal line: drops vertically along sternum - Midclavicular line: drops vertically from the midpoint of the clavicle - Anterior axillary line: drops vertically from anterior axillary fold - Midaxillary line: drops vertically from the apex of the axilla - Right lung has 3 lobes and left lung has 2 lobes - Oblique fissure runs from T3 spinous process around the chest to the 6^th^ rib at the midclavicular line - Horizontal fissure- anteriorly, the fissure runs close to the 4^th^ rib and meets the oblique fissure in the midaxillary line near the 5^th^ rib - Trachea bifurcates at level of sternal angle anteriorly and posteriorly at the T4 spinous process - Aspiration pneumonia is more common in the right lobe because the right main bronchus is more vertical/ if endotracheal tube is advanced too far during intubation, it will more likely enter the right main bronchus - Principle muscle of inspiration is the diaphragm - Accessory muscles: SCM and scalenes - Shortness of Breath (Dyspnea) - Wheezes: occurs in partial lower airway obstruction from secretions and tissue inflammation in asthma, or a foreign body - Cough: reflex response to stimuli that irritate receptors in larynx, trachea, or large bronchi - Cough can signal left-sided heart failure - Acute cough viral (most common), ACE-inhibitors, pneumonia, asthma - Subacute cough postinfectious cough, acid reflux, asthma, bacterial sinusitis - Chronic cough postnasal drip, GERD, chronic bronchitis asthma - Cough can be dry or productive - Purulent sputum: yellow or green; often accompanies bacterial pneumonia - Mucoid sputum: translucent, white, or gray and seen in viral infections and cystic fibrosis - Foul-smelling sputum: present in anaerobic lung abscess - Thick, tenacious sputum: cystic fibrosis - Large volumes of sputum present in lung abscesses - Diagnostically helpful symptoms: - Pneumonia -- fever and productive cough - Asthma -- wheezing - Acute coronary syndromes -- chest pain, dyspnea, orthopnea - Percussion notes: - Flat: large pleural effusion - Dull: lobular pneumonia - Resonant: simple chronic bronchitis - Hyper-resonant: COPD, pneumothorax - Tympanitic: large pneumothorax - Absent descent of diaphragm pleural effusion; elevated hemidiaphragm from atelectasis or phrenic nerve paralysis - Adventitious Sounds: - Crackles (AKA as Rales) - Discontinuous - Intermittent, non-musical, brief - Like dots in time - Fine or coarse - Fluid in alveoli - Pneumonia, pulmonary fibrosis, atelectasis, heart failure - Wheezes and Rhonchi - Continuous - Sinusoidal, musical, prolonged - Like dashes in time - Wheezes- high pitched narrowed airways of asthma, COPD, and bronchitis - Rhonchi- low pitched sounds from secretions in large airways that may change with coughing - Fluid in the larger airways - Stridor - Audible high-pitched inspiratory whistling - Upper airway obstruction in the larynx or trachea urgent! - Loudest over the neck - Louder over consolidation: bronchophony, whispered pectoriloquy, egophony (sounds like a) - Consolidation = something that replaces air-filled tissue in the lung, like pneumonia, bleeding, atelectasis or tumor - Forced expiratory time = slowed in COPD, patients aged over 60 years with an expiratory time of less than 9 seconds are 4 times more likely to have COPD - Cyanosis = signals hypoxia - Lung cancer: cough, dry to productive, sputum may be bloody, weight loss, hx of smoking - PE: dry cough with blood sometimes, tachypnea, chest or lung pain, fever, syncope - Asthma: cough sometimes with thick mucoid sputum, episodic wheezing and dyspnea - TB: cough with mucoid or purulent sputum, may be bloody, early no sx, but later anorexia, fatigue, fever, night sweats - Barrel chest: increased AP diameter, often accompanies aging and COPD