Flashcards in Lecture 3 - Thorax & Cardiac Exam Deck (40)
What are the key parts from the checklist for the thorax exam?
1. Check for chest expansion
2. Percuss lung fields bilaterally and symmetrically
3. Auscultate lung fields bilaterally and symmetrically
4. Ask patient to breath through open mouth
5. Feel for axillary nodes bilaterally
How can you estimate where the sternal angle is, and what rib is lateral to the sternal angle?
Place finger in suprasternal notch and move the finger down about 5 cm to a bony ridge; this is the sternal angle
2nd rib is lateral to it
Where does the trachea bifurcate on the anterior and posterior side?
Anterior: bifurcates at the sternal angle
Posterior: at the level of T4 spinous process
At what rib does the inferior tip of the scapula lie?
Level of the 7th rib
Generally, what is examined during the inspection aspect of the thorax?
1) Rate, rhythm, depth, and effort of breathing
3) Asymmetry of breathing
4) Difficulty of breathing (is there retraction of SCM during inspiration?)
What is indicated if stridor is heard during the inspection?
Stridor is audible high pitched wheeze, indicating an upper airway obstruction in larynx or airway and is an emergency
What is indicated if the anteroposterior diameter of the chest is expanded during inspection?
COPD or emphysema (barrel chest)
What is indicated if there is asymmetry of breathing?
Can indicate phrenic nerve damage
How is chest expansion tested?
Put thumbs at the 10th rib, ask patient to breath, and the thumbs should move apart during inspiration
What is fremitus, and how is it tested?
Fremitus is a palpable vibration transmitted through the chest wall as patient is speaking
-use bony part of palm at various locations on posterior of back and ask patient to say ninety-nine
-should be symmetry
What is indicated if there is a decrease in fremitus?
Atelectasis (collapsed lung)
Pulmonary effusion (fluid in pleural space)
COPD (too much air in alveolar)
What is indicated if there is an increase in fremitus?
pneumonia/consolidation (fluid in the alveolar)
What should the sound appear as when the thorax is percussed?
Healthy lungs are resonant
What is indicated if percussion is dull or decreased?
There is solid or fluid replacing the air filled lung
indicates: lobar pneumonia, pleural effusion, atelectasis
What is indicated if percussion is increased or hyperresonant?
Indicates asthma, emphysema, or pneuomothorax
What is the normal difference of diaphragmatic excursion?
What is a vesicular sound heard when auscultating, where is it heard?
Vesicular sound is soft and low pitched
Heard throughout inspiration
Continue without pause through expiration
fade away 1/3 of way through expiration
Can be heard over most of both lungs
What is a bronchovesicular sound heard when auscultating, and where is it heard?
Intermediate sound and pitch, and inspiratory and expiratory sounds are almost equal; heard in the 1st and 2nd intercostal spaces
What is a bronchial sound heard when auscultating, and where is it heard?
Is a louder, harsher, higher in pitch sound with a short silence between inspiratory and expiratory; heard over the manubrium
What is a tracheal sound heard when auscultating and where is it heard?
loud harsh, high pitched sounds heard over the trachea in neck; inspiratory and expiratory sounds are almost equal
What are rales/crackles heard when auscultating? What do they indicate?
Discontinuous, intermittent, nonmusical sounds, brief
Indicate congestive heart failure, pneumonia, and fibrosis
What are wheezes and rhonchi heard when auscultating?
continuous, musical, prolonged sounds mainly during expiration; indicates asthma or emphysema
What are the 3 transmitted voice sounds, and what do abnormalities of these indicate?
Egophony: patient says "ee", if you hear A, egophony is present and may indicate pneumonia
Bronchophony: ask patient to say ninety-nine, increased transmission of voice sounds (normally muffled, if you hear it, bronchophony is present)
Whispered pectoriloquy: the whisper is normally heard faintly, if at all. If heard, whispered pectoriloquy is present
Each lung is divided roughly in half by:
Each lung is divided roughly in half by the oblique/major fissure. The ______ lung is further divided by the horizontal/minor fissure.
What is represented by the upper lobes of the lung?
Top part of posterior chest
"Barrel-chest" signifies what?
Asymmetry of breathing suggests what?
Underlying lung, pleural, or phrenic nerve disease
Decreased fremitus is seen in what 3 conditions?
2. Pulmonary effusion