Chest and Lung Exam

Where is the trachea located?

lower neck and upper chest anterior to esophagus

Where does the trachea bifurcate into mainstem prochi?

sternal angle anteriorly and T4 spinous processs anteriorly

Where does the apex of each lung rise?

2 t 4cm above inner third of clavicle

Where does the lower border of the lungs cross?

6th rib and midclavicular line, 8th rib at midaxillary lie
Posterior: T10 spinous process

What are some things I might forget about doing the chest and lung exam?

1)nail bed color on both hands
2) chest expansion

During chest inspection what are we looking for?

1) rate, rhythm, depth and effort of breathing
2) shape and movement of chest

What are you looking for in the chest/lung using palpation?

1) identify tender areas
2) chest expansion
3) tactile fremitus

What are the wheezes?

high pitched continous hissing or whistling sound

What are crackles?

brief intermittend stocatto sounds

What are Rhonchi?

low pitched continous snoring or snorting sound

What are transmitted sounds?

when lung loses its air, replaced by fluid or solid mass transmitted sounds are easier to hear

What is bronchophony

pathology: spoken words such as ninety nine are clear usually they are muffled and indistinct

What is egophony?

spoken ee heard as "ay" when it is normally muffled and long "ee"

is whispered pectoriloquy?

whispered wrods sound clearer. Normally they are faint/inaudible

What are the differences in the findings of a chest and lung exam in ped patients vs older adults?

1) thorax of infant is more found
2) infant uses diaphragm to breath and will protrude abdomen during respiration
3) faster respiratory rate
3) breath sounds may be louder or more harsh (thinner chest wall)

What is different in the older adult with regards to the chest and lung exam?

prolonged expiratory phase during forced expiration

to integrate this with chest lung cadiovascular and abdominal what do you do?

1) head and neck behind patient
2) posterior chest and lugn exam and CVAT
3) supine - anterior chest
4) supine abdomen

How do you pick out a bronchial breath sound?

inspiratory sounds last longer than expiratory sound

How do you pick out a bronchovesicular breath sounds?

inspiratory and expiratory sounds are equal

What does a bronchial breath sound sound like?

expiratory is longer than inspiratory

WHat is a tracheal breath sound

really loud and sounds are equal

which adventitious breath sounds are discontinous and which are continous

crackles - discontinous
wheezes and ronchi - continous

What is the inferior border of the lung?

T10 spinous process

Where is the oblique fissure in both lungs

T3 spinous process to 6th rib at mid clavicular line

Where is the horizontal/minor fissure in the right lung?

near 4th rib and meets oblique fissure at mixaxillary line near 5th rib

can you access the right lobe from the back?

no

Are the lower lobes usually in the back or the front?

mostly in the back just a little bit in the front

HOW DO YOU DIFFERENTIATE VESICULAR BREATHE SOUND?

inspiration is longer than expiration