fissure
line that divides the lobes
sternal angle
separates manubrium and body of sternum
interspace of each rib
located below that rib
costal angle
angle below xyphoid process
which ribs articulate directly with the sternum?
true ribs 1-7
which ribs articulate indirectly with the sternum?
8-10 (thinner and longer than others-come all the way around the body-easily fractured)
which ribs are called “floating ribs”?
11-12
costochondritis
pain and inflammation of the cartilage around the ribs
-clinically, palpate, range of motion, deep breathing will cause more pain
where is the lower lung border anteriorly?
crosses 6th rib midclavicular line and 8th rib midaxillary line
where is the lower lung border posteriorly?
T10 spinous process
when would the diaphragm lose its elasticity?
emphysema-loses its ability to move back and forth
base of the lung is where?
at the base (bottom)
apex of the lung is where?
uppermost portion of the lung
what are the major (oblique) fissures?
Right and Left lung are divided in half by them
where is the minor (horizontal) fissure located?
in the right lung
which lung is inferior?
left lobe, because it holds the heart
lingula
area where Left middle lobe should be, but is occupied by the heart
which lobe is matched with the heart space medially?
right middle lobe
where does the trachea bifurcate anteriorly?
at the sternal angle
where does the trachea bifurcate posteriorly?
T4 spinous process
what is the name of the tracheal bifurcation?
carina
why is the tracheal bifurcation important?
ET tube (endotracheal tube)-needs to sit above bifurcation
how many 2nd bronchi does the R bronchi have?
3 secondary
how many 2nd bronchi does the L bronchi have?
2 secondary
visceral pleura
serous membrane which covers outer surface of each lung including inside the fissures
parietal pleura
serous membrane which lines the thoracic cavity (inner ribcage and upper surface of the diaphragm)
pleural space
lubricated space between pleura (pleural fluid)
allows lungs to move freely
lung parankima
actually lung tissue
has not nerve endings
what are the muscles of respiration?
- diaphragm
- muscles in ribcage and neck
- parasternals
- scalenes
when diaphragm contracts, what happens?
descends in the chest, which opens thoracic cavity and air rushes into the lungs
what is happening at the alveoli?
CO2 is going out of the blood
O2 is going into the blood
what is the concentration of oxygen in the air?
18-20%
what muscles would be used if the pt needs to work harder to breathe?
sternomastoids
scalenes
abdominal muscles
intercostals
when does clubbing happen?
chronic and fairly severe hypoxemia true clubbing warrants more investigation -cystic fibrosis -COPD -emphysema
what are some causes of impaired movement
hemothorax
flail chest
fractures rib
pneumonectomy
pectus excavatum
chest that looks like it’s scooped out
- many times needs to be repaired
- partially sternum/articulations of ribs with sternum
pectus carinatum
chest that looks like to pokes out like a bird’s beak
-does allow more room
barrel chest
fairly symmetric expansion of chest area
transverse view will look like a barrel (o-shaped)
chronic
-COPD
-emphysema
-air trapping from malfunctioning alveoliq
kyphosis
major curvature of the spine
causes abnormal use of the lungs
can often cause pneumonia because of atelectasis
atelectasis
any time the lung can’t open like it’s supposed to.
scoliosis
abnormal s-type curvature in the spine
tactile fermitus
not sure yet
how far does percussion penetrate into the chest?
5-7 cm, but will not help to detect deep lesions
-not effective with obese patients
what does percussion accomplish?
establish whether underlying tissue is air filled, fluid filled, or solid
flatness
soft, high pitched, short sound
thigh
dullness
medium, medium pitched, medium length sound
liver
resonance
loud, low pitched, long length sound
healthy lung
hyperresonance
very loud, low pitched, longer length sound
abnormal in most cases
tympany
loud, high pitched sound
gastric bubbles
what is the pattern of auscultation
step-ladder approach to be able to compare bilateral sounds
what are the different types of breath sounds?
vesicular (most of lung sounds you are listening to)
bronchovesicular (lateral of central airways, in between normal lung tissue and bronchi)
bronchial (anteriorly, over the bronchi)
what is the most frequent cause of chest pain in children?
anxiety
costochronditis
what is stridor?
audible wheezing which indicates obstruction of the larynx and/or trachea
what do sinus tracts indicate?
infection of the underlying pleura and lung (TB or actinomycosis
