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38 Cards in this Set

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Chest anatomy terms
Manubrium, suprasternal notch, sternal angle (angle of Louis), 1st and 2nd ribs, xyphoid process.
Pectus excavatum
Depression in the lower sternum
Pectus carinatum
Anteriorly displaced sternum
Traumatic flail chest
Multiple rib fractures resulting in paradoxical movements of the thorax. On inspiration injured area caves inward and expiration outward
Thoracic kyphoscoliosis
Abnormal spine curve and vertebral rotation causing chest deformities.
2nd rib
From suprasternal notch move about 5 cm inferiorly to the sternal angle and then laterally (start counting interspaces)
2nd intercostal space is location for...
Tension pneumothorax needle insertion
4th intercostal space is location for...
Chest tube insertion
Where ribs articulate...
7th rib is last to articulate with sternum
8-10th ribs articulate with costal cartilage
11th and 12th ribs are free floating
12th rib
Palpable posteriorly and can start counting ribs/interspaces
Inferior tip of scapula
Lies at the level of the 7th rib/interspace.
T7-T8 interspace is location for thoracentesis
C7
With neck flexed the most protruding process is usually C7
Describing location on the chest
Use:
-Vertical axis – by noting rib level (counting ribs)
-Circumference around the chest – using boney land marks and vertical lines
Vertical lines
Midsternal line, Midclavicular line, Axillary lines, Anterior, Midaxillary, Posterior axillary, Vertebral line, Scapular line
Lung apex
Rises 2-4cm above clavicles
Lung bases
Extend
-6th rib midclavicular
-8th rib midaxillary
-T10 spinous process posteriorly
Oblique fissure
Find spinous process of T3
Horizontal fissure
Near 4th rib to midaxillary line near 5th rib
Tracheal bifurcation
At sternal angle anteriorly and T4 posteriorly
Common chest complaints
-Chest pain
-Shortness of breath
-Wheezing
-Cough
-Hemoptysis
Chest pain - general
History gives you significant direction for cause, always ask questions that can include or exclude sources
Chest pain - possible causes
Cardiovascular, pulmonary, GI, musculoskeletal, skin, anxiety, and others
Chest pain - questions to ask
Location, quality, quantity, timing/onset, setting, associated manifestations, aggravating/alleviating factors
Cardiovascular chest pain - location
Substernal, shoulder, jaw, neck
Cardiovascular chest pain - quality
Pressure, ache, heavy, "crushing", "ripping or tearing", sharp
Cardiovascular chest pain - quantity
Mild to severe (typically more significant)
Cardiovascular chest pain - timing
1-20 min and intermittent (angina), constant (pericarditis and dissection)
Cardiovascular chest pain - aggravating
Exertion (angina/MI), breathing and position (pericarditis)
Cardiovascular chest pain - alleviating
Rest, sitting forward (pericarditis)
Cardiovascular chest pain - associated symptoms
Dyspnea, nausea, diaphoresis (angina/MI)
Levine sign
A clenched fist over the anterior chest typical in coronary syndrome.
Tracheobronchitis
Upper chest, burning, mild-moderate, aggravated by cough/deep breathing, alleviated by lying on involved side
Pleuritic pain
Any chest wall area, sharp/stabbing, mod-severe, constant, aggravated by cough/breathing/chest wall motion
Bronchospasm
Substernal, sharp to ache, mild-severe, episodic, aggravated by cough/breathing deep, associated with wheezing/dyspnea
GERD
Substernal and to back, burning/squeezing, mild-severe, worse after meals and lying down, alleviated with antacids (some)
Esophageal spasm
Substernal to jaw or back, squeezing, mild-severe, aggravated with swallowing, improved occasionally with belching and antacids
Peptic ulcer
Substernal to back/abdomen, ache to burn, mild-severe, initially may improve with food then worsen later
Gallbladder
Substernal to back/abdomen, ache to burn, mild-severe, initially may improve with food then worsen later, worse with greasy meals.