4. ANATOMY
1. TRACHEA
-midline to slight right side deviation
-bifurcates anteriorly at the level of
sternal angle,posteriorly at T4 spinous
pr.
2. BRONCHI
-the left is longer than right
-the right is more straight
5. Cont…….
3. CHEST WALL
a] sternum- 3 parts;
-(manubrium, body & xyphoid pr.)
-sternal angle( angle of louis), which is a
bony ridge 5 cm from the notch &
junction b/n manubrium and body.
b] ribs,interspaces& costal cartilages;
-obliquely palpate 9 interspaces & 10 ribs
6. Cont………
-the costal cartilages of the 1st 7 ribs
articulate with the sternum.
-8th ,9th and 10th with the costal cartilages
just above them.
-11th and 12th are floating i.e no anterior
attachment.( felt laterally and posteriorly,
respectively)
c] scapulae;
-inferior tips lie at the level of 7th rib or
interspace
7. Cont……….
4. LUNGS, FISSURES & LOBES
-anterioly,apex of each lung rises 2-4cm
above inner 3rd of the clavicle.
-fissures:--oblique(major)
--horizontal(minor)
-rt lung( 2 fissures,3 lobes)
-lt lung( 1 fissure,2 lobes)
-lungs:--anterioly down to 6th rib/space
--laterally,8th
--posteriorly,T10
10. COMMON SYMPTOMS & SIGNS
Cough
Dyspnea( breathlessness,SOB)
Chest pain
Hemoptysis
Wheezing
Hoarseness of voice
Cyanosis
Clubbing
11. Con……..
1. COUGH
-dry or productive vs purulent or tenacious ,
faul smelling.
-febrile or not
-acute or chronic
-time preferrance
-exacerbating and relieving factors
-family history of asthma
-occupation,smoking,drugs,foreign body
aspiration
13. Cont……..
2. DYSPNEA
-at rest,exertional or both( in case of
anxiety)
-pulmonary or cardiac causes
BREATHING
•Controlled by brainstem
•Mediated by respiratory ms.
•Diaphragm is primary ms.of inspiration
•Normal adult RR 14-20 breathes/min.
14. cont………
INSPIRATION
• Diaphragmatic ms.
Contracts & descends
• Thoracic cavity enlarges
• Ms of neck & rib cage
expand
• Intra thoracic pressure
decreases
• Oxygen diffuses into the
blood of pulm.capp &
CO2 from blood to
alveoli.
EXPIRATION
•Chest recoils
•Diaphragm relaxes &
rises
•Intra thoracic pressure
increases
15. Cont………
Breathing patterns:-( rate/rhythm/depth/effort
a) rapid shallow breathing/tachypnea
-restrictive lung ds.
-pleuritic chest pain
-elevated diaphragm
b) rapid deep breathing/hyperpnea
-exercise,anxiety,
-hypoglycemia,hypoxia(comatous pts)
-metabolic acidosis( kussmaul breath)
16. Cont…….
c) slow breathing/bradypnea
-diabetic coma
-drug induced
-respiratory depression
-increased ICP
d) cheyne stokes/deep breathing
alternating with periods of apnea
-drug induced,CHF,uremia,bilateral
brain damage
18. Cont……
3. CYANOSIS
-central or periferal
-due to pulmonary or congenital heart ds
4.HEMOPTYSIS
-pulm.TB, PTE,mitral stenosis
5.CLUBBING
-heart disease(chronic hypoxia)
-lung ds.(lung abscess, pul fibrosis, cystic
fibrosis, bronchiectasis, lung ca )
19. Cont……..
Grading of clubbing:-
Grade1- spongy proximal nail fold
Grade2- obliteration of an angle b/n
proximal nail fold & nail plate
Grade3- convex nail plate
Grade4- drum stick appearance
6. HOARSENESS OF VOICE
-laryngitis, tumors
-irritn.of Lt.recurrent laryngeal nerve
20. Cont…….
7. CHEST PAIN
myocardium(MI,ANGINA PECTORIS)
-squeezing,retrosternal pain
Pericardium(pericarditis)
-sharp knife like pain
Aorta(dissecting aortic aneurysm)
-ripping or tearing type of pain
Trachea &bronchi(bronchitis)
-burning type of pain
26. •Tectile fermitus is palpable vibration that
transmits through the bronchopulmanry tree
to chest wall as the pt is speaking and is
normally symmetrical.
29. Tracheal Alignment Abnormalities
•Pneumothorax – shifts to unaffected side
•Pleural Effusion – shifts to unaffected side
•Fibrosis or Atelectasis – shifts towards
affected side
•Pulmonary consolidation – no shift
30. Percussion Notes
•Resonance – normal
•Dullness – increased density
•Atelectasis, alveolar filling/consolidation,
pleural effusion, fibrosis
•Hyperresonance – decreased density
•Hyperinflation (COPD), Pneumothorax
31. PERCUSSION
* Diaphragmatic excurssion
-descent of diaphragm during resp.
-normal gap=3 to 5.5cm
-abnormally high level means;(effusion,
atelectasis or paralysis)
* PERCUSSION NOTES(5 TYPES)
- flat,dullness,resonant,hyperresonant
& tympanic
