Lungs and Thorax

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Lungs and Thorax
2010-11-16 21:49:36
Lungs Thorax

Lungs and Thorax
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  1. Three parts of sternum
    • 1. Manubrium
    • 2. Body
    • 3. Xiphoid process
  2. Costochondral junction
    Where rib attaches to cartilage
  3. Costal angle
    Nml less than or equal to 90 degrees

    Abn when angle increases. Hyperinflation (e.g. emphysema)
  4. Vertebral Prominences
    C7. Palpate with head flexed. If two bumps then C7 and T1
  5. Location of lower tip of scapula
    inferior border at 7th-8th rib
  6. What is contained in the mediastinum
    • heart
    • great vessels
    • esophagus
    • trachea
  7. Location of anterior apex (top) of lung border
    3-4cm above 1st rib
  8. Location of anterior base (bottom) of lung border
    • Right: at 5th ICS, MCL
    • Left: at 6th ICS, MCL
  9. Location of lateral lung border
    From apex of axilla to 7th-8th ribs
  10. Location of posterior upper lobes
    T1 to T3/4
  11. Location of posterior lower lobe of lung borders
    T3 to T10 (expiration) or T12 (inspiration)
  12. How many lobes does the right lung have
    • 3 (upper, middle, lower)
    • Shorter d/t liver
  13. How many lobes does the left lung have
    2 (upper and lower). Narrower d/t heart border
  14. Location of horizontal fissures (right side of heart)
    • 4th rib right sternal border to 5th rib MAL.
    • Separates upper and middle lobe
  15. Location of anterior oblique fissues (bilateral)
    5th rib MAL to 6th rib MCL

    • Right: separates middle and lower lobes
    • Left: separates upper and lower lobes
  16. Visceral layer of pleura
    Lines lung surface
  17. Parietal layer of pleura
    Lines chest wall and diaphragm
  18. Pleural cavity
    Negative pressure holds lungs against chest wall
  19. Costodiaphragmatic recess
    Pleura extend 3cm below level of lung. Potential space for fluid and air which may compress lung
  20. Span of trachea
    • Anterior to esophagus
    • Starts at cricoid (10-11cm long)
    • Bifurcates at manubriosternal angle (anteriorly)
    • Bifurcates at T4 (posteriorly)
  21. Right main stem of bronchus
    Shorter and straighter. Increased risk of aspiration
  22. Dead Space
    Trachea and bronchi. Filled with air, but no gas exchange
  23. Bronchial tree lined with goblet cells (function) and cilia (function)
    • Goblet: Secrete mucus that entrap particles
    • Cilia: Sweep particles upward
  24. Acinus (functional resp unit)
    Bronchioles, alveolar ducts, alveolar sacs and alveoli
  25. How many alveoli do we have
    300 million
  26. Resp acidosis
    Retained CO2
  27. Resp alkalosis
    Excessive excretion of CO2 through resp
  28. Resp center
    Brain stem. Pons and medulla
  29. Scoliosis
    • Lateral curve
    • More common in girls, adolescents
    • Assess uneven shoulder, scapular, hip height
  30. Kyphosis
    • Hump back.
    • T spine
  31. Lordosis
    • Sway back
    • L spine
  32. Crackles
    Produced when there is a fluid inside a bronchus causing a collapse of the distal (smaller) airways and alveoli. Crackles occur when there is a sudden equalization of pressure causing some of the airways to pop open. Heard on inspiration, doesn't clear with coughing
  33. Fine crackles
    High pitched, short duration, cracking and popping sounds
  34. Coarse crackles
    Low pitched, longer duration, bubbling and gurgling sounds
  35. Tachypnea
    • Rapid, shallow, breathing >20/min.
    • Fear, anxiety, fever, exercise, resp insufficiency, PNA, alkalosis, pleurisy, lesions in the pons
  36. Bradypnea
    • Regular, show, brathing <10/min
    • depressant drugs, increased ICP, DM coma
  37. Hyperventilation
    • Rapid, deep breathing
    • Extreme exertion, fear, anxiety, DKA
  38. Cheyne-Stokes
    • Regular, cyclic.
    • Breathe 30-40sec then apnea for 20 sec
    • CHF and other causes
  39. Biots (ataxic)
    Irregular, deep, slow with periods of apnea (preceeds Cheyne Stokes)
  40. Stertorous
  41. Stridor
    Croup, foreign body, growht on vocal cords, high pitched on inspiration
  42. PEFR
    • Peak Expiratory Flow Rate
    • Max flow of air during a forced expiration
    • Useful surrogate measure of VC
  43. Atelectasis
    Collapsed alveoli. Predisposes to PNA
  44. Emphysema
    • Destruction of alveoli
    • Decreased gas exchange
  45. Asthma
    Intermittment bronchospasm and constriction.
  46. Pleural effusion
    Fluid in pleural space
  47. Pneumothroax
    • Air in pleural space
    • Collapsed lung
  48. Hemothroax
    Blood in pleural space
  49. Emphyema
    Purulent exudate in pleural space
  50. Cystic Fibrosis
    Autosomal recessive disorder of exocrine glands affecting lungs, pancrease, sweat glands
  51. Bronchiectasis
    • Chronic condition of bronchi and bronchioles caused by repeated infections
    • Serious
  52. Corpulmonale
    Lung disease that cuases hypertrophy of right ventricle and progresses to heart failure