Note special landmarks:● 2nd intercostal space for● 4th intercostal space for ● T4 for the lower margin of an
needle insertion for tension pneumothorax.
chest tube insertion.
endotracheal tube on a chest x-ray.
Note the T7–T8 intercostal space as alandmark for
thoracentesis with needle
insertion immediately superior to
the 8th rib.
Anteriorly, the apex of each lung rises approximately
2 to 4 cm
above the inner third of the clavicle
The lower border of the lung
crosses the _____ rib at the midclavicular line and the _____ rib at the midaxillary line.
6th
8th
Aspiration pneumonia is more commonin the
right middle and lower lobe
because the right main bronchus is
more vertical.
The trachea bifurcates into its mainstem bronchi at the levels of the _____ anteriorly and the _______ posteriorly
sternal angle
T4 spinous process
Accumulations of pleural fluid, or pleural
effusions, may be ______ , seen
in heart failure, cirrhosis, and nephrotic
syndrome, or ________ , seen in numerous
conditions including pneumonia,
malignancy, pulmonary embolism,
tuberculosis, and pancreatitis.
transudates
exudates
Irritation of the parietal pleura produces __________, as in viral pleurisy, pneumonia, pulmonary embolism, pericarditis, and collagen vascular diseases.
pleuritic pain with deep inspiration
The muscles in the rib cage also expand the thorax, especially
the _______ , which run from the cervical vertebrae to the first two ribs, and
the ____________ , which cross obliquely
from the sternum to the ribs.
scalenes
parasternal intercostal muscles, AKA parasternals
Lung tissue has no pain fibers. Pain in conditions such as pneumonia or pulmonary infarction usually arises from inflammation of the adjacent ________?
parietal pleura
Cough can signal?
left-sided heart failure
______ sputum is translucent, white, or gray and seen in viral infections and cystic fibrosis
_______ sputum is yellow or green and often accompanies bacterial pneumonia.
Mucoid
Purulent
Clearing of crackles, wheezes, or rhonchi
after coughing or position change
suggests ___________ , seen
in bronchitis or atelectasis.
inspissated (thickened) secretions
Foul-smelling sputum is present in _________.
Thick tenacious sputum is present in _________.
anaerobic lung abscess
cystic fibrosis
Large volumes of _________ are present in bronchiectasis and lung abscess.
purulent sputum
Diagnostically helpful symptoms:
________ and ________ in pneumonia;
________ in asthma;
________, _________ and _______
in acute coronary syndromes.
fever and productive cough
wheezing
chest pain, dyspnea, and orthopnea
These symptoms, especially__________ and __________, are hallmarks of obstructive sleep apnea
daytime sleepiness and snoring
- ______in the lips, tongue, and oral mucosa signals hypoxia.
- ______ are common in heart failure.
- ______occurs in bronchiectasis, congenital heart disease, pulmonary fibrosis, cystic fibrosis, lung abscess, and malignancy.
Cyanosis
Pallor and sweating (diaphoresis)
Clubbing of the nails
The ratio of the anteroposterior (AP) diameter to the lateral chest diameter is usually ______ up to 0.9 and increases with aging
This ratio may exceed 0.9 in _______,
producing a barrel-chest appearance,
although evidence of this correlation
is conflicting.
0.7 to 0.75
COPD
Asymmetric expansion occurs in large ________.
pleural effusions
Retraction occurs in ________.
severe asthma, COPD, or upper airway obstruction
Intercostal tenderness can develop over ________
inflamed pleurae
Unilateral impairment or lagging suggests pleural disease from _________; it is also seen in phrenic nerve damage or trauma.
asbestosis or silicosis
Test chest expansion. Place your
thumbs at about the level of the
_____ ribs, with your fingers loosely
grasping and parallel to the lateral
rib cage
10th
_______is decreased or absent when
the voice is higher pitched or soft or
when the transmission of vibrations
from the larynx to the surface of the
chest is impeded by a thick chest wall,
an obstructed bronchus, COPD, or
pleural effusion, fibrosis, air (pneumothorax),
or an infiltrating tumor.
Fremitus
Asymmetric decreased fremitus raises the likelihood of ________, which decreases transmission of low-frequency sounds; asymmetric increased fremitus occurs in unilateral pneumonia which increases transmission through consolidated tissue.
unilateral pleural effusion, pneumothorax, or neoplasm
An abnormally high diaphragm level found during percussion suggests a ______ or ______ from atelectasis or phrenic nerve paralysis.
pleural effusion or an elevated hemidiaphragm
Is there a silent gap between the inspiratory and expiratory sounds?
A gap suggests?
bronchial breath sounds.
Normal breath sound heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration?
Vesicular, or soft and low pitched
Normal breath sound, with inspiratory and expiratory sounds about equal in length, at times separated by a silent interval. Detecting differences in pitch and intensity is often easier during expiration.
Bronchovesicular
Normal breath sounds that are louder, harsher and higher in pitch, with a short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.
Bronchial
Normal breath sounds that are loud, harsh sounds heard over the trachea in the neck.
Tracheal
Fine late inspiratory crackles that persist from breath to breath suggest?
abnormal lung tissue.
The crackles of heart failure are usually best heard in the?
posterior inferior lung fields.
Stridor and laryngeal sounds are loudest over the neck, whereas true wheezes and rhonchi are ________ over the neck.
faint or absent
Pleural rubs may be heard in?
pleurisy, pneumonia, and pulmonary embolism.
Increased transmission of voice sounds
suggests that embedded airways are?
blocked by inflammation or secretions
Localized bronchophony and egophony are seen in_______ .
In patients with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood?
lobar consolidation of pneumonia
pneumonia
The hyperresonance of COPD during percussion may obscure ______
dullness over the heart.
Breathing is irregular—periods of apnea
alternate with regular deep breaths
which stop suddenly for short intervals.
Causes include meningitis, respiratory
depression, and brain injury, typically at
the medullary level.
Ataxic Breathing (Biot Breathing)
Periods of deep breathing alternate with
periods of apnea (no breathing). This
pattern is normal in children and older
adults during sleep. Causes include heart
failure, uremia, drug-induced respiratory
depression, and brain injury (typically
bihemispheric).
Cheyne–Stokes Breathing
In obstructive lung disease,
expiration is prolonged due to
narrowed airways increase the
resistance to air flow. Causes include
asthma, chronic bronchitis, and
COPD.
Obstructive Breathing
Kussmaul breathing is compensatory overbreathing due to?
systemic acidosis.