Respiratory Surface anatomy and Respiratory examination

Question 1

what are the 4 techniques when examining surface anatomy

Answer 1

Visual inspection
palpation
percussion
auscultation

Question 2

landmarks of the thorax

where does the jugular notch corresponds to in males vs females

Answer 2

In MALES:
- 2rd thoracic vertebra

In females:
- 3rd thoracic vertebra

Question 3

what 4 things does the sternal angle correspond with

Answer 3

correspondes with:

• connecting the 2nd costal cartilage laterally
• being the lower border of 4th thoracic vertebra
• the bifurcation of the trachea in adults
• the beginning of the aortic arch

Question 4

what is the joint found in the xiphoid process what where does it lie

Answer 4

• Joint is xiphisternal synchondrosis
• lies opposite side of the body to the 9th thoracic vertebra

Question 5

what can be palpated in the inferior fossa of the clavicle?

Answer 5

the coracoid process

Question 6

what are the 2 angles in the costal arch

Answer 6

• intrasternal angle
• xiphocostal angle

Question 7

organisation and functions of the respiratory system

what does the conducting portion of the respiratory system transport

Answer 7

air

Question 8

what does the respiratory portion of the respiratory system carry out

Answer 8

carries out gaseous exchange

Question 9

Tracheo-bronchial tree

what vertebral level is the Hila situated?

Answer 9

situated in T5/6

Question 10

why is the hilum opaque on radiographs?

Answer 10

due to presence of fluid (blood vessels)

Question 11

why is it clinically significant that the right bronchus is more vertical than the left

Answer 11

• this is clinically significant because foreign bodies are more likely to enter the right bronchus than the left

Question 12

what is the only thing that occupies the costodiaphragmatic recess (it is otherwise empty), and when is the only time this occurs

Answer 12

• lungs occupy costadiaphragmatic recess
• only during deep inspiration

Question 13

lungs: surface markings

where does the apex of the lungs lie

Answer 13

2cm superior medial third of the clavicle

Question 14

what are the 2 lung fissures that have lung surface markings and outline how they run

Answer 14

oblique fissure:

• T3/T4 spinous process to the 6th costal cartilage

Horizontal fissure:

• follows the 4th intercostal space from the sternum to meet the oblique fissure at 5th rib

Question 15

how does the oblique fissure run in the both of the lungs

Answer 15

T3/T4 spinous process to the 6th costal cartilage

Question 16

how does the horizontal fissure run for the right lung

Answer 16

• follows the 4th intercostal space from the sternum to meet the oblique fissure at the 5th rib

Question 17

pleura

why can’t the visceral pleura be separated from the lungs

Answer 17

visceral pleura tightly covers the lungs

Question 18

what 4 places does the parietal pleura cover and what is the name of the parietal pleura in these areas

Answer 18

Thoracic cage:
- costal pleura

mediastinum:
- mediastinal pleura

cervical region:
- cervical pleura

diaphragm:
- diaphragmatic pleura

Question 19

which pleura senses pain?

Answer 19

the parietal pleura

Question 20

how much fluid is found between the pleural membranes and what is its protein concentration?

Answer 20

fluid volume: 10-20ml
protein concentration: less than 1.5g/dL

Question 21

what holds the pleura together

Answer 21

• surface tension

Question 22

END OF RESPIRATORY SURFACE ANATOMY

Answer 22

END OF RESP SURFACE ANATOMY

Question 23

respiratory examination

what are the 4 steps of respiratory examination

Answer 23

1. Inspect
2. palpate
3. percuss
4. auscultate

Question 24

examination: palpation

what 3 things can lateralisation of the trachea suggest in palpation during respiratory examination

Answer 24

• Pneumothorax
• Tumour (superior lobe)
• Atelectasis

Question 25

outline what 6 things you would assess in **visual inspection** on a patient

Answer 25

assess: - respiratory effort/rate - if patient is using any accessory muscles of respiration - if the patient's cough is dry or productive - if their breathing sounds are normal and if they have rhonchi sounds - thoracic shape: is it normal, symmetrical or hyperinflated? - colour: Cyanonsis? look at mucous membranes like lips gums around eyes nails - finger clubbing

Question 26

outline 3 steps for how **palpation** of the **trachea** and **suprasternal notch** works in respiratory examination

Answer 26

1. explain to the patient that the procedure may be uncomfortable 2. palpate the trachea by your index and middle fingers at the supra-sternal notch in between the **sternal heads of sternomastoid** 3. assess if trachea is centrally placed

Question 27

outline **4 steps** of assessment of **chest expansion** by palpation in **respiratory surface anatomy**

Answer 27

1. explain what you will do to the patient 2. place thumbs at level of **T10** with fingers grasping and level with rib cage 3. ask patient to take a deep breath in through their mouth 4. assess movement of your hands - **anteriorly** or with a tape measure.

Question 28

outline how you would examine **chest expansion** in palpation and what should it be from full expiration to full inspiration

Answer 28

**step:** ask **patient** to inspire **maximally** and then measure how much the chest expands outwardly and antero-posteriorly - should be equal to or **> 5cm expansion** from **full expiration to full inspiration**

Question 29

what **5 things** can cause a **reduction** in chest expansion **upon palpation of chest** in respiratory surface anatomy?

Answer 29

- fibrosis - collapse - consolidation - effusion - pneumothorax

Question 30

how do you examine **vocal fremitus** in a patient in **palpation examination**

Answer 30

1. place p**alm/ulnar side** of the hand on the **chest wall** 2. ask patient to **repeat** word **"ninety-nine"** 3. feel for **vibrations in chest wall and compare left and right sides** 4. it is abnormal if the **left and right vibrations** are **different**

Question 31

what does abnormal **vocal fremitus** suggest if the differences are increased vibration on one side vs decreased vibration?

Answer 31

**increased** vibration on one side: - consolidation/ masses **decreased vibration:** - effusion of some kind

Question 32

**outline** the steps to perform percussion examination

Answer 32

1. place left 3rd digit (**finger pad**) in the intercostal spaces 2. tap the left middle phalanx (phalanges) with the **3rd** digit of the right hand 3. withdraw the middle finger quickly after the tap wiht a brisk, relaxed, bouncy movement 3. keep tapping and listen to the sound produced

Question 33

if these sounds are produced in the lungs, what disorders does it denote: **- Resonant** **- Hyper-Resonant** **- Tympanic** **- Dull** **- Stony dull**

Answer 33

**resonant:** - normal lungs **hyper-resonant:** - pneumothorax **- tympanic:** over hollow viscera **Dull:** - consolidation/collapse **stony dull:** - effusion/mass

Question 34

what 3 sounds do you look out for upon **auscultation**

Answer 34

- **quality of breath** sounds - **intensity of breath** sounds - **additional/adventitious** breath sounds

Question 35

what are 3 **vesicular** breath sound features you will look out for upon ascultation?

Answer 35

- if inspiration is longer than expiration - if there is no pause between inspiration and expiration - if expiration is short

Question 36

what are 2 **bronchial** breath sound features you will look for upon auscultation?

Answer 36

- if **blowy** sound is heard in peripheral lung when alveolar air is replaced by solid lung tissue - equal length of expiration and inspiration but with a gap

Question 37

what are 4 disorders where you can hear the **bronchial breath sounds** in other parts of the lung

Answer 37

- consolidated lung - collapsed lung - pleural effusion - fibrotic lung

Question 38

what are 4 adventitious sounds that could be heard upon auscultation?

Answer 38

- wheeze - stridor - rhonchi - pleural rub

Question 39

what is wheezing

Answer 39

adventitious sound with a high pitch and occurs during **inspiration**, **expiration or both**

Question 40

what is stridor

Answer 40

**wheeze** that is heard **ONLY** in **INSPIRATION**

Question 41

what does stridor indicate?

Answer 41

stridor indicates partial obstruction of the **trachea** or the **larynx**

Question 42

what is rhonchi and what does it suggest?

Answer 42

**rhonchi:** - low pitched sound with snoring quality - rhonchi suggest **secretions** in the **large** airways

Question 43

what is **pleural rub** and what does it suggest

Answer 43

**pleural rub:** produced due to 2 **inflamed** pleural surfaces being rubbed together - it suggests **pneumonia** or **pulmonary embolism**

Question 44

why would inflammation in the diaphragmatic pleura cause shoulder pain

Answer 44

because it will stimulate the phrenic nerve, which would cause shoulder or neck pain