Please identify the sections that make up the sternum
- 1. Suprasternal Notch
- 2. Manubrium
- 3. Sternal Angle (Angle of Louis - @ the level of 2nd intercostal space / 2nd rib)
- 4. Body
- 5. Xiphoid Process
- 6. Sternocostal Angle
How many sets of ribs do we have? How many "true ribs"? "false ribs"? "floating ribs"?
- 7 True Ribs
- 3 False Ribs
- 2 Floating Ribs
What vertebral levels are the angles of the scapula laying on?
- Superior Angle - T2
- Root of Scapula Spine - T3
- Inferior Angle - T7
At what level is the vertebral prominens located?
- DU-14 / C7 spinous process
- *but can sometimes be T1 spinous process
Where is the Lung apex located?
2-4 cm above medial third of clavicle
What level is the inferior border of the lung found?
- Varies with respiration due to diaphragmatic excursion
- *generally lower with COPD
How many lobes does the Left Lung have? Right Lung?
- Left - 2 lobes
- Right - 3 lobes
What vertebral level is the Carina located?
T4 spinous process posteriorly
This lines the outside of the Lung, it is not the part of the respiratory system
How may layers does the pleural membrane have?
Air entering pleural space is called?
When air is introduced into the pleural space (during chest trauma from motor vehicle accident (MVA), or puncture of thoracic cavity as with an acupuncutre needle), a pleural cavity is created and the lung collapses (partially or totally)
Water entering the pleural space is called?
Pleural Effusion (edema)
What monitors CO2 levels of the blood?
Respiratory Control Center (RCC)
How long can one hold his breath?
Until CO2 gets to critical levels
Where does O2 and CO2 perform gas exchange?
Is breathing entirely voluntary or involuntary?
What is hyperactive in Hyperactive Airway Disease?
Bronchial Smooth Muscle
What are the most common Respiratory Conditions (Hyperactive Airway Disease)?
- Asthma - the inability to exhale (bronchospasm / wheezing) (occurs during childhood --> early adulthood)
- Chronic Bronchitis - inpairment of mucocilliary escalator - persistant cough, esp. in smokers (occurs during age >= 40-50 years)
- COPD - Chronic Obstructive Pulmonary Disease - lose the abiltiy of elastic recoil (occurs during age >= 60 years)
A 5 year old child playing outdoors for hours and develops sudden wheezing. What does this person have?
A 60 year old smoker with shortness of breath and periodic wheezing. What does this person have?
A 45 year old with smokers cough. What does the person have?
What are the causes of bronchospasms?
Environmental Pollution (i.e. Dust Mites, Pollen, Animal products(dander, feces, saliva, urine), cigarette smoke(including second-hand smoke)
What is the difference between COPD and Emphysema?
- COPD - Diagnosed clinically
- Emphysema - Diagnosed by Biopsy
Which two western examinations are most specific to the chest and abdomen?
This percussion note has a soft intensity, high pitch and short duration. Heard over the Muscles. Which kind is this?
This percussion note has a medium intesnity, pitch and duration. Heard over the Liver and pathological fluid. Which kind is this?
This percussion note has a loud intensity, low pitch and long duration. Heard over Normal Lung. Which kind is this?
This percussion note has a loud, short duration, high pitch. Heard over Gastric Air Bubbles. Which kind is this?
This percussion note has a very loud intensity, lower pitch and longer duration. Heard over the Emphasematous Lung. Which kind is this?
On examination, what is the difference between pleural effusion and a pathological process (i.e. pneumonia)?
- Ask patient to lie flat (supine or sideways)
- Pleural Effusion - fluid moves based on body positioning
- Pneumonia - fluid doesn't move based on body positioning
What are 3 types of Added Breath / Lung Sounds?
- 1. Crackles - collapses lung tissue attempting to expand (typically found with pneumonia)
- 2. Wheezing - bronchospasms (typically found with asthma)
- 3. Friction Rub - inflammation of one (or both) pleural linings causing a "sandpaper"-like effect (sharp pain) (typically found with pleuritis)
Elderly male woken up in the middle of the night because of stabbing chest pain. What is the preliminary diagnosis?
Patient goes to hospital and is diagnosed with Myocardial Infarction. Three days later he suffers from palpiations. What condition could this be?
Which vessel has the most concern of blockage?
- Prelim: Unstable Angina
- Three days later: Atrial Fibrillation
- Vessel: LAD (Left Anterior Descending artery - nourishes the Left Ventricle)
A disease of the heart valves in which the opening of the aortic valve is narrowed. Who does it commonly affect?
- Aortic Stenosis (type of murmur)
- Affects elderly mostly
A disease of the heart valves in which the mitral valve is weakened. Who does it commonly affect?
- Mitral Valve Prolapse (type of murmur)
- Affect young women mostly
20 year old male with chest pain; has strong history of cocaine abuse. What condition does this patient have?
Variant / Prinzmetal Angina
What are some methods to check for heart conditions?
- Bruce Protocol Stress Test (treadmill)
What are the functions of vasoconstriction / vasodilation?
- 1. Regulate blood pressure
- 2. Regulate body temperature
- 3. Regulate fluid levels
What is the difference between a Significant DVT and an Insignificant DVT?
- Significant DVT - clot formation above the knee (veins are larger in above the knee than below, more serious)
- Insignificant DVT - clot formation below the knee (veins are smaller than above the knee, less likelihood of embolism)
What are some methods to diagnosis a patient with DVT?
- Unilateral Edema
- Homan's Sign to check for pain (squeeze / palpate calf, dorsiflex foot, if pain is present in calf it is positive indication for DVT -- works 20% of the time)
- Venous Ultrasound
What are some methods for treating DVT / Embolism?
- Blood Thinners
- Physical Therapy (promoting circulation)