Assessment of the Thorax and Lungs

Question 1

ASSESSMENT TECHNIQUE

This is the first step of the examination. This is a very important part of the exam, since many abnormalities can be detected by merely inspecting the thorax as the patient is breathing.

Answer 1

Visual Inspection

Question 2

ASSESSMENT TECHNIQUE

This is the second step of the assessment, where we will touch the patient. Many breathing difficulties can be assessed during this step. Some systemic problems can be detected during this part of the exam as well as just mechanical breathing problems.

Answer 2

Palpation

Question 3

ASSESSMENT TECHNIQUE

This is usually helpful only in a limited capacity to the examiner.

Answer 3

Percussing

Question 4

ASSESSMENT TECHNIQUE

This is the process of listening to the breath sounds with the use of a stethoscope. In this text, we will describe the characteristics of normal and common abnormal breath sounds.

Answer 4

Auscultation

Question 5

This identifies the portion of the body extending from the base of the neck superiorly to the level of the diaphragm inferiorly.

Answer 5

Thorax

Question 6

The lungs, distal portion of the trachea, and the bronchi are located in the thorax and constitutes the _______________.

Answer 6

Lower respiratory system

Question 7

The outer structure of the thorax is referred to as the ________.

Answer 7

Thoracic cage

Question 8

The ____________ contains the respiratory components.

Answer 8

Thoracic cavity

Question 9

The sternum lies in the center of the chest anteriorly and is divided into 3 parts. What are these?

Answer 9

1. Manubrium
2. Body
3. Xiphoid process

Question 10

VERTICAL REFERENCE LINES

ANTERIOR (Front side)

Answer 10

1. Anterior Median Line (Midsternal)
2. Right Midclavicular line
3. Left Midclavicular line

Question 11

VERTICAL REFERENCE LINES

LATERAL (Side)

Answer 11

1. Anterior axillary line
2. Midaxillary line
3. Posterior axillary line

Question 12

VERTICAL REFERENCE LINES

POSTERIOR (Back)

Answer 12

1. Posterior Midspinal Line (Vertebral Line)
2. Posterior Left Scapular Line
3. Posterior Right Scapular Line

Question 13

These are 2 cone-shaped organs located in the pleural spaces in the right and left sides of the bony thorax.

Answer 13

Lungs

Question 14

The right lung is divided into how many lobes?

Answer 14

3 Lobes

1. Superior lobe
2. Middle lobe
3. Inferior lobe

Question 15

The left lung is divided into how many lobes?

Answer 15

1. Superior lobe
2. Inferior lobe

Question 16

What do you call the tip on the top of the lungs?

Answer 16

Apex

Question 17

What do you call the tip of the bottom of the lungs?

Answer 17

Base

Question 18

The purpose of the lungs is most importantly the _______________ in the body.

Answer 18

exchange of gases

Question 19

This is most important in breathing.

Answer 19

Diaphragm

Question 20

The lungs expand during Inspiration and this causes the diaphram to _________.

Answer 20

Lower

Question 21

The lungs deflate during expiration which causes the diaphragm to ___________.

Answer 21

rise

Question 22

Abnormal breathing is also known as ___________.

Answer 22

Diaphragmatic breathing

Question 23

• The amount of air inhaled and exhaled during a normal breath.
• Approx. 500 mL
• Example: The air you breathe in and out while sitting quietly.

Answer 23

Tidal Volume (TV)

Question 24

• The air that remains in the lungs even after a forceful exhalation.
• Approx. 1200 mL
• Example: Even after exhaling deeply, some air remains in your lungs to keep them from collapsing.

Answer 24

Residual Volume (RV)

Question 25

* The **extra air you can inhale** after taking a normal breath (forced inspiration). * Approx. **3000 mL** * Example: Taking a deep breath before diving into a pool.

Answer 25

Inspiratory Reserve Volume (IRV)

Question 26

* The **extra air you can exhale** after a normal breath (forced expiration). * Approx. **1100 mL** * Example: Blowing out candles forcefully after exhaling normally.

Answer 26

Expiratory Reserve Volume (ERV)

Question 27

* The **maximum amount of air you can inhale** after taking a normal breath. * **Formula: Tidal Volume + Inspiratory Reserve Volume** * Approx. **3500 mL** * Example: Taking a deep breath before shouting or singing loudly.

Answer 27

Inspiratory Capacity (IC)

Question 28

* The amount of air left in the lungs after a **normal exhalation.** * **Formula: Expiratory Reserve Volume + Residual Volume** * Approx. **2300 mL** * Example: The air remaining in your lungs after normal breathing, ensuring gas exchange continues.

Answer 28

Functional Residual Capacity (FRC)

Question 29

* The **total amount of air you can forcibly inhale and exhale.** * **Formula: IRV + TV + ERV** * Approx. **4600 mL** * Example: The maximum breath capacity when taking in as much air as possible and then forcefully exhaling.

Answer 29

Vital Capacity (VC)

Question 30

* The **total amount of air the lungs can hold** with maximum inhalation. * **Formula: VC + RV** * Approx. **5800 mL** * Example: The maximum lung expansion possible, like when preparing for deep-sea diving.

Answer 30

Total Lung Capacity (TLC)

Question 31

It is a **structural deformity** where the **sternum (breastbone) is abnormally depressed inward**, creating a sunken appearance in the chest.

Answer 31

Funnel Chest (Pectus Excavatum)

Question 32

It is a **deformity** characterized by a **rounded, expanded chest shape**, where the **ribs are elevated, spaced farther apart than normal, and positioned more horizontally** rather than sloping downward.

Answer 32

Barrel Chest

Question 33

Commonly known as ***pigeon chest***, is a **chest wall deformity** where the **sternum (breastbone) and ribs push outward**, creating a protruding or convex appearance of the chest.

Answer 33

Pectus Carinatum (Pigeon Chest)

Question 34

It is a condition in which the **spine curves sideways** rather than remaining straight when viewed from the front. While a **normal spine has natural curves** when seen from the side, causes an **abnormal lateral (side-to-side) curvature** of the spine.

Answer 34

Scoliosis

Question 35

It is a **forward curvature of the spine**, causing a rounded or hunched back appearance.

Answer 35

**Kyphosis** ## Footnote A mild kyphotic curve is normal in the thoracic spine (middle back), but an excessive curve can lead to postural problems, discomfort, and breathing difficulties in severe cases.

Question 36

# RESPIRATION PATTERNS Regular and comfortable. 12-20 breaths per minute

Answer 36

Normal

Question 37

# RESPIRATION PATTERNS Significant disorganization with irregular and varying depths of respiration.

Answer 37

Ataxic

Question 38

# RESPIRATION PATTERNS Slower than 12 breaths per minute.

Answer 38

Bradypnea

Question 39

# RESPIRATION PATTERNS Faster than 20 breaths per minute, deep breathing.

Answer 39

Hyperpnea

Question 40

# RESPIRATION PATTERNS Frequently interspersed deeper breaths.

Answer 40

Sighing

Question 41

# RESPIRATION PATTERNS Increasing difficulty in getting breath out.

Answer 41

Air trapping

Question 42

# RESPIRATION PATTERNS Irregularly interspersed periods of apnea in a disorganized sequence of breaths.

Answer 42

Blot respirations

Question 43

# RESPIRATION PATTERNS Varying periods of increasing depth interspersed with apnea.

Answer 43

Cheyne-Strokes breathing

Question 44

# RESPIRATION PATTERNS Rapid, deep, labored breathing.

Answer 44

Kussmaul respirations

Question 45

# RESPIRATION PATTERNS Faster than 20 breaths per minute

Answer 45

Tachypnea

Question 46

# WHAT IS THE SOUND? Normal lung

Answer 46

Resonance

Question 47

# WHAT IS THE SOUND? Lung with emphysema

Answer 47

Hyper-resonance

Question 48

# WHAT IS THE SOUND? Puffed-out cheek, gastric bubble

Answer 48

Tympany

Question 49

# WHAT IS THE SOUND? Diaphragm, pleural effusion

Answer 49

Dullness

Question 50

# WHAT IS THE SOUND? Muscle, bone, thigh

Answer 50

Flatness

Question 51

# NORMAL BREATH SOUNDS * **Duration of Sounds:** Inspiratory sounds last longer than expiratory sounds. * **Location:** Over most of both lungs.

Answer 51

Vesicular

Question 52

# NORMAL BREATH SOUNDS * **Duration of Sounds:** Inspiratory and expiratory sounds are about equal. * **Location:** Often in the 1st and 2nd interspaces anteriorly and between the scapulae.

Answer 52

Broncho-vesicular

Question 53

# NORMAL BREATH SOUNDS * **Duration of Sounds:** Expiratory sounds last longer than inspiratory ones. * **Location:** Over the manubrium (larger proximal airways)

Answer 53

Bronchial

Question 54

# BREATH SOUND TEST **Procedure:** * Ask the patient to say "**ninety-nine**" while auscultating. **Normal Finding:** * Sound is faint & muffled. **Abnormal Finding (Indicates Consolidation):** * Sound is **clear & loud** (due to sound transmission through dense lung tissue).

Answer 54

Bronchophony

Question 55

# BREATH SOUND TEST **Procedure:** * Ask the patient to say "**ee**" while auscultating. **Normal Finding:** * Sounds like a prolonged "**ee**". **Abnormal Finding (Indicates Consolidation):** * Sounds like "**ay**" (fluid or lung collapse present).

Answer 55

Egophony

Question 56

# BREATH SOUND TEST **Procedure:** * Ask the patient to **whisper** "1, 2, 3" while auscultating. **Normal Finding:** * Whispered voice is **very faint** or distant. **Abnormal Finding (Indicates Consolidation):** * Whispered voice sounds **unusually clear & loud** (suggests consolidation).

Answer 56

Whispered Pectoriloquy