Anatomy
This prominent anterior chest landmark corresponds to the level of the second rib and the bifurcation of the trachea.
What is Angle of Louis (sternal angle?)
In a healthy adult, the anteroposterior (AP) diameter to transverse diameter ratio of the chest wall normally measures within this range.
This is the expected normal percussion note elicited over healthy, air-filled peripheral lung tissue.
What is resonance?
These soft, low-pitched breath sounds dominate over the peripheral lung fields, with inspiration lasting longer than expiration.
What are vesicular breath sounds?
When a clinician hears a bleating "ay" sound over a lung field while the patient says "ee," they document this positive exam finding.
What is egophony?
Running vertically on the lateral chest, this reference line drops midway between the anterior and posterior axillary folds.
What is midaxillary line?
Patients with severe COPD frequently assume this characteristic posture—leaning forward with their hands resting on their knees—to increase mechanical advantage during breathing.
What is tripod position?
To maximize sensitivity when assessing tactile fremitus across the chest wall, the clinician should use this specific anatomical area of the hand.
What is ulnar surface or palm of hand?
These continuous, high-pitched, musical sounds occur predominantly during expiration due to turbulent airflow through narrowed airways.
What are wheezes?
In a patient presenting with a tension pneumothorax or massive pleural effusion, the trachea will shift in this direction relative to the lesion.
What is away from the affected side (contralateral)?
Posteriorly, the inferior angle of the scapula typically aligns with this specific rib or intercostal space.
What is the 7th rib (or 7th intercostal space)?
Characterized by deep, rapid, and labored respirations, this breathing pattern is classic for diabetic ketoacidosis as the body attempts to blow off carbon dioxide.
What is Kussmaul Respirations?
Palpation around a fresh chest tube site that yields a distinct "crackling" or bubble-wrap sensation indicates this condition.
What is subcutaneous emphysema?
Audible even without a stethoscope, this loud, high-pitched, crowing sound occurs on inspiration and signals upper airway obstruction.
What is stridor?
This specific symptom describes a sudden onset of severe dyspnea that awakens a patient from sleep, forcing them to sit or stand upright for relief.
What is paroxysmal nocturnal dyspnea (PND)?
To properly inspect and auscultate the lung apices anteriorly, the stethoscope should be placed this distance above the inner third of the clavicles.
What is 2 to 4 centimeters?
This congenital structural variant of the anterior chest wall presents as a distinct inward depression of the lower sternum.
What is pectus excavatum?
Palpating over an area of lobar pneumonia will reveal this specific alteration in tactile fremitus.
What is increased tactile fremitus?
Continuous, low-pitched, snoring or moaning sounds caused by secretions in large airways that frequently clear after a cough.
What are rhonchi?
Pleural effusion, pneumothorax, and bronchial obstruction all cause this identical change in tactile fremitus over the affected area.
What is decreased or absent tactile fremitus?
During quiet respiration, the inferior margin of the lung crosses the midaxillary line at the 8th rib. However, the parietal pleura extends further inferiorly into the costodiaphragmatic recess, crossing the midaxillary line at this specific rib.
What is the 10th rib?
Often associated with advanced heart failure or brain stem damage, this respiratory pattern consists of alternating periods of deep, rapid breathing followed by temporary apnea.
What are Cheyene-Stokes respirations?
When percussing the posterior thorax from quiet respiration to full inspiration, normal diaphragmatic excursion in a healthy adult measures in this range.
What is 3 to 5 centimeters?
This coarse, grating sound heard in both inspiration and expiration is produced by the rubbing together of inflamed pleural surfaces.
What is a pleural friction rub?
A 22-year-old patient arrives at the emergency room in acute distress. On examination, you note tracheal deviation to the right, hyperresonance on percussion over the left lung field, and absent breath sounds on the left side.
What is left sided pneumothorax?