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216 Cards in this Set
- Front
- Back
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What is the purpose of respiration?
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To keep the body adequately supplied with oxygen and prevent excess accumulation of carbon dioxide.
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The chest or thorax consists anteriorly of...
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sternum, manubrium, xiphoid process and costal cartilages.
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Which ribs attach to the sternum?
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1/7/2012
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What are the floating ribs?
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11 and 12
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The primary muscles of respiration are...
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diaphragm and intercostal muscles
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What do the external intercostals do?
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they increase the AP chest diameter during inspiration.
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What do the internal intercostals do?
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they decrease the lateral diameter during expiration.
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What are the accessory muscles to respiratory movements?
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SCM and trap
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When are accessory muscles used?
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During exercise or when there is pulmonary compromise.
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how is the interior of the chest divided?
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right and left pleural cavities and mediastinum
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What contains all of the thoracic viscera except for the lungs?
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The mediastinum
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The left lung has how many lobes?
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2. Left upper and left lower
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The right lung has how many lobes?
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3: Right upper, middle and lower
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Which lobe has an inferior tongue-like projection called the lingula?
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the left!
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What is the major fissure of each lung?
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the oblique
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Where is the right horizontal fissure located?
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at the level of the 5th rib in the axilla and the 4th rib anteriorly
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How many alveoli are in adults?
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300 million
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How far does the apex of the lung extend above the 1st rib?
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4cm
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What limits the expansion of the lung parenchyma?
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an elastic subpleural tissue
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Posteriorly the apex of the lungs rise up to the level of which vertebrae?
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T1
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The lower borders of the lung descend to what level on deep inspiration?
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T12
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The lower borders of the lung rise to what level on forced expiration?
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T9
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What are the dimensions of the trachea?
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10 to 11 cm long and about 2cm in diameter
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At what level does the trachea bifurcate?
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T4/ T5 and just below the manubriosternal joint
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Which bronchus is more susceptible to aspiration of foreign bodies and why?
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The right because it is wider, shorter and more vertically placed than the left.
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From where do the bronchial arteries branch from?
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anterior thoracic aorta and intercostal arteries.
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where is the bronchial vein formed?
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the hilum of the lung
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The upper and middle lobe of the right lung is separated by the
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horizontal fissure
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Where in the midaxillary and sternum is the horizontal fissure found?
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5th rib in midaxilla and 4th at sternum
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The oblique fissure is found where?
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5th rib at axilla and 6th at midclavicular line
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Posteriorly you can see mainly...
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the lower lobe
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The lower lobe extends posteriorly from
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T3 to T10/T12(during respiratory cycle)
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The number of each intercostal space corresponds with the rib above/below it?
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the rib immediately above
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Fetal gas exchange is mediated by...
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the placenta
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The relative decrease in pulmonary pressure leads to closure of what?
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the foramen ovale
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When does the lung grow rapidly?
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the first two years of life and slows by age 8
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The AP diameter of a newborn approximates that of...
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the lateral diameter
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During pregnancy what happens to the ribs?
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subcostal angle increases from 68.5deg to 103.5deg<br />the lower ribs flare
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During pregnancy what change is seen in the diaphragm?
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rises as much as 4 cm above its usual resting position
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What does the major work of breathing during pregnancy?
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the diaphragm
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What causes the barrel chest seen in many older adults?
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loss of muscle strength in thorax and diaphragm, and loss of lung resiliency. Also, skeletal changes emphasize dorsal curve of thoracic spine.
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Aging results in a _____ in vital capaciy and a ______ in residual volume.
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decrease in vital capacity<br />increase in residual volume
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Why do older folks have a decreased tolerance for exertion?
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Loss of respiratory muscle strength results in underventilation of the alveoli in the lower lung fields.
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Why are older adults predisposed to respiratory infections?
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their mucous membranes tend to be drier and therefore they are less able to rid themselves of mucus.
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What is dyspnea?
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difficult and labored breathing with shortness of breath.
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When is dyspnea commonly observed?
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in patients with pulmonary or cardiac compromise. or in people who are out of shape.
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What is orthopnea?
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shortness of breath that begins or increases when the patient lies down. <br />
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What is paroxysmal nocturnal dyspnea?
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a sudden onset of shortness of breath after a period of sleeping.
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what is platypnea?
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dyspnea increases in the upright position
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When does chest pain not generally originate in the heart?
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-constant achiness that lasts all day<br />-it does not radiate, <br />-made worse by pressing on precordium<br />-is a fleeting, needlelike jab, lasting a second or two<br />-situated in shoulders or b/w shoulder blades
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What is diaphoresis?
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excessive sweating
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If adult or adolescent complains of severe acute chest pain... then ask about what?
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Cocaine use! it causes tachycardia, HTN, coronary arterial spasm, and pneumothorax
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What is the traditional sequence of steps of chest examination?
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Inspect, palpate, percuss, auscultate
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Compromised respirations leading to barrel chest are...
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chronic asthma, emphysema, or cystic fibrosis
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What happens to the ribs, spine and sternal angle with barrel chest?
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ribs are more horizontal<br />spine is more kyphotic<br />sternal angle is more prominent
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What should the thoracic ration be?
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0.7-0.75
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When the thoracic ratio approaches what ratio should you be concerned for chronic condition?
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as it approaches 1 you should be concerned
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What is pectus carinatum?
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pigeon chest, prominent sternal protrusion
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what is pectus excavatum?
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funnel chest, indentation of the lower sternum above the xiphoid process
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What is a normal respiratory rate (adult)?
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12 to 20 respirations per minute
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What should the ratio of respirationg to heartbeats be?
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respirations : heartbeats<br />1:4
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What is bradypnea?
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slower than 12 breaths per minute
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what is tachypnea?
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faster than 20 breaths per minute
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What is hyperventilation?
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faster than 20 breaths per minute, deep breathing
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What is sighing?
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frequently interspersed deep breathing
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what is air trapping?
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increased difficulty in getting breath out
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what is Cheyne- stokes?
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varying periods of increasing depth interspersed with apnea.
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What is Kussmaul breathing?
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Rapid, deep, labored breathing
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What is Biot breathing?
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irregularly interspersed periods of apnea in a disorganized sequence of breaths
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What is ataxic breathing?
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significant disorganization with irregular and varying depths of respiration.
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Rapid, shallow breathing can occur during hyperventilation. this could be a symptom of...
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protective splinting from pain of a broken rib or pleurisy
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Bradypnea may indicate...
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neuro or lectrolyte imbalance , infection, or sensible response to pain of pleurisy. Also could indicate a splendid level of cariorespiratory fitness!
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Tachypnea is...
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breathing rapidly
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hyperpnea is...
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breathing deeply
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Kussmaul breathing is the respiratory effort associated with...
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metabolic acidosis
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What is hypopnea?
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abnormally shallow respirations
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Cheyne stokes respiration is normal in what circumstances?
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children and older adults may breathe in this pattern when they are sleeping.
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What is Cheyne-Stokes Respiartion associated with?
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brain damage at the cerebral level or with drug associated respiratory compromise
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Air trapping results from...
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prolonged but inefficient expiratory effort. rate of respiration increases in order to compensate. can lead to barrel chest.
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Biot respiration is generally associated with...
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-severe and persistent increased intracranial pressure<br />-resp compromise from drug poisoning <br />-brain damage at level of medulla
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Biot respiration is called _____ in its more extreme expression.
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ataxic
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The rate and depth of breathing increases with:
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-acidosis (metabolic)<br />-CNS lesions (pons)<br />-anxiety<br />-aspirin poisoning<br />-oyxgen need (hypoxemia)<br />-pain
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The rate and depth of breathing decreases with:
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-alkalosis (metabolic)<br />-CNS lesions (cerebrum)<br />- myasthenia gravis<br />-narcotic overdose<br />-obesity (extreme)
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What does apnea mean?
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the absence of spontaneous respiration
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What is primary apnea?
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A self-limited condition common after a blow to the head. especially noted after birth of baby. -> breathe spontatneously when excess CO2 accumulates.
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What is secondary apnea?
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Breathing stops and will not begin spontaneously unless resuscitative measures are imm. instituted. Cause by any event that severly limits absorption of oxygen in the bloodstream.
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What is reflex apnea?
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an involuntary, temporary halt to respiration due to irritating and nausea-provoking vapors
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What is sleep apnea?
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periods of absence of breathing and oxygenation during sleep. Can be caused by obstruction to airflow?
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What is apeustic breathing?
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long inspiration with expiration apnea. When pons is affected, breathing can become gasping bec inspirations are prolonged and expiration is constrained.
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What is periodic apnea of newborn?
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norm condition characterized by irregular pattern of brehating interspersed by brief periods of apnea associated with REM sleep
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Chest asymmetry can be associated with...
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collapsed lung or limitation of expansion caused by extrapleural air, fluid, or mass.
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A prolonged expiration and bulging on expiration are probably caused by...
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outflow obstruction or compression by tumor, aneurysm, or enlarged heart.
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With prolonged expiration and breathing the costal angle widens beyond...<br />
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90 degrees
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What are retractions and what do they suggest?
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When the chest wall seems to cave in at the sternum, b/w ribs, at suprasternal notch, above clavicles and at the lowest costal margins.
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When there is an obstruction high in the respiratory tree (tracheal or laryngeal involvement) breathing is characterized by...
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stridor: high pitched wheezing sound
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What is paradoxic breathing?
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on inspiration the lower thorax is drawn in.<br />on expiration the lower thorax is pushed out.
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What causes paradoxic breathing?
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-weakened poorly functioning diaphragm<br />-obstructive airway disease<br />-during sleep due to upper airway obstruction
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A foreign body in the bronchus causes...
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unilateral retraction, without suprasternal notch involvement
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Retraction of the lower chest occurs with..
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asthma and bronchiolitis
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Pursing of the lips is and accompaniment of...
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increased expiratory effort.
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Clubbing is associated with...
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-chronic fibrotic changes within the lung<br />-emphysema<br />-lung cancer<br />-cyanosis of congenital heart disease<br />-cystic fibrosis
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Flaring of the alae nasi is a sign of...
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air hunger
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What is crepitus?
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a crackly or crinkly sensation, can be both palpated and heard
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Crepitus in the thoracic region indicates...
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air in the subcutaneous tissue from a rupture in the respiratory system or by a gas producing organism.
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A palpable, coarse, grating, vibration (usually on inspiration) suggests...
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a pleural friction rub caused by inflammation of the pleural surfaces. think of leather rubbing on leather.
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How do you evaluate thoracic expansion during respiration?
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Stand behind the patient and place your thumbs along the spinal processes at the level of the 10th rib.
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What is tactile fremitus?
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palpable vibration of the chest wall that results from speech or other verbalizations.
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Where is fremitus best felt?
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parasternally at the 2nd intercostal space at the level of the bifurcation of the bronchi. (on back)
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With what do you feel fremitus?
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with palmar surfaces of fingers or ulnar aspects of hand
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Decreased or absent fremitus may be caused by...
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-excess air in the lungs<br />-emphysema<br />-pleural thickening or effusion<br />-massive pulmonary edema<br />-bronchial obstruction
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Increased fremitus occurs with...
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-presence of fluids<br />-solid mass within lungs<br />-lung consolidation<br />-heavy, nonobstructive bronchial secretions<br />-compressed lung<br />-tumor
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Gentle, tremulous fremitus can be expected with..
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some inflammatory and infectious processed
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What are the characteristics of an upper airway obstruction?
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-inspiratory stridor<br />-hoarse cough or cry<br />-flaring of the alae nasi<br />-retraction at supersternal notch
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What are the characteristics of a sever upper airway obstruction?
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-stridor is inspiratory and expiratory<br />-cough is barking<br />-retractions also involve the subcostal and intercostal spaces<br />-cyanosis is obvious even with supplemental oxygen
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Characteristics of airway obstruction above the glottis...
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-stridor tends to be quieter<br />-voice is muffled<br />-swallowing is more difficult<br />-cough is not a factor<br />-head and neck may be awkwardly positioned to preserve airway.
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In what position would the head/neck be with a retropharyngeal abscess?
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extended
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In which position would the head/neck be with a peritonsillar absess?
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head to the affected side with the absess
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Characteristics of airway obstruction below the glottis...
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- stridor tends to be louder, more rasping<br />-voice is hoarse<br />-swallowing is not affected<br />-cough is harsh, barking<br />-positioning of head is not a factor
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What are the most useful findings for pleural effusion?
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dullness to percussion and tactile fremitus (reduced)
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A slight, barely noticeable deviation of the trachea to the right is not unusual. T/F
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TRUE
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What would be the symptoms of a patient with an anterior mediastinal mass?
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-harsh sound of stridor<br />-difficulty breathing<br />-may sit up and lean forward to relieve compression
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Volume loss (from fibrosis or atelectasis) has what effect on the trachea?
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it pulls the trachea toward the affected side
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Thyroid enlargement and pleural effusion have what effect on the trachea?
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causes the trachea to deviate away from the affected side.
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What is a pneumothorax?
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collection of air in the area surrounding the lung
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what effect does a pneumothorax have on the trachea?
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it depends..<br />-tension pneumo --> away from affected side<br />-collapsed lung --> toward affected side
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Effect of anterior mediastinal tumors on trachea<br />
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pushes it posteriorly
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Mediastinits affect on trachea...
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pushes trachea forward.
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A palpable pull out of midline with respiration is called a ...
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tug
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How to percuss?
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Percuss at 4-5cm interval over the intercostal spaces, move systematically sup to inf and med to lat.
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What is the sound usually associated with percussion over the abdomen?
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tympany
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Hyperresonance associated with hyperinflation may indicate...
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emphysema, pneumothorax, asthma
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Dullness or flatness on percussion indicates...
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pneumonia, atelectasis, pleural effusion, pneumothorax, asthma
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Resonant tone: intensity, pitch, duration, quality
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intensity: loud<br />pitch: low<br />duration: long<br />quality: hollow
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Flat tone: intensity, pitch, duration, quality
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intensity: soft<br />pitch: high <br />duration: short<br />quality:very dull
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Dull tone: intensity, pitch, duration, quality
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intensity: medium<br />pitch: medium to high<br />duration: medium<br />quality: dull thud
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Tympanic tone:
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intensity: loud<br />pitch: high<br />duration:medium<br />quality:drumlike
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hyperresonant:
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intensity: very loud<br />pitch: very low<br />duration: longer<br />quality:booming
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Tone over heavy muscles and bone...
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flat
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tone over lungs.
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resonant
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Tone over liver and heart...
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dullness
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Tone over stomach...
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tympany
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Tone over spinous processes
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flat
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What is normal diaphragmatic excursion distance?
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3-5 or 6cm
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Why is the diaphragm usually higher on the right?
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because it sits on the diaphragm
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When assessing diaphragmatic excursion how do you know you have reached the diaphragm?
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percuss along the scapular line until you notice a change from resonance to dullness.
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Sweet, fruity breath indicates...
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diabetic acidosis; starvation ketosis
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Fishy, stale breath indicates...
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uremia (trimethylamines)
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ammonia-like breath indicates...
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uremia (ammonia)
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musty fish, clover breath indicates...
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fetor hepaticus; hepatic failure, portal vein thrombosis, portacaval shunts
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Foul, feculent breath...
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intestinl obstructino
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foul, putrid breath...
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nasal/sinus pathology. infection, foreign body, cancer, resp infections, empyema, lung abscess, bronchiectasis
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Halitosis
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tonsillitis, gingivitis, respiratory infection, vincent angina, gastroesophageal reflux,
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cinnamon
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pulmonary tuberculosis
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Why when auscultating should you examine the lung bases first?
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bec most pulmonary pathologic conditions occur there.
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Which side of the stethoscope should you use for listening to the lungs and why?
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Use the diaphragm bec it transmits high-pitched sounds better and provides a broader are of sound.
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Why do you have patients cross their arms in front of them when percussing or auscultating?
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because this moves the scapulae laterally, enlarging the listening area
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Where are the sounds of the right middle lobe and left lingula best heard?
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in the respective axillae
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If you suspect that your patient has congesitve heart failure, where should you start auscultation?
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At the base of the lungs to detect crackles that may disappear with continued exaggerated respiration.
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What are vesicular breath sounds and where are they found?
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low-pitched, low-intensity sounds found over healthy lung tissue
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What are bronchovesicular sounds and where are the found?
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-moderate in pitch and intensity<br />-heard over major bronchi
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What are bronchial breath sounds and where are they found?
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high in pitch and intensity<br />-found only over the trachea
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What is amphoric breathing and what is it usually associated with?
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It resembles the noise made by blowing across the mouth of a bottle. Most often heard with a large, stiff walled pulmonary cavity or a tension pneumothorax with bronchopleural fistula.
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What is cavernous breahting and what is it usually associated with?
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Sounds as if it is coming from a cavern. Commonly heard over pulmonary cavity in which the wall is rigid.
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How are breath sounds when fluid or pus accumulates in the pleural space?
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Breath sounds are absent or difficult to hear
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How are breath sounds if the lungs are consolidated?
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They are easier to hear. ie; mass around the tube of the respiratory tree promotes sound transmission better than do air-filled alveoli.
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Describe the continuity of crackles (rales), rhonchi, and wheezes.
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crackles: discontinuous<br />rhonchi and wheezes: continuous<br />
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What causes crackles?
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disruptive passage of air through small airways in the respiratory tree.
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High pitched crackles are described as...
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sibilant
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Low pitched crackles are described as...
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sonorous
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Crackles with a dry quality, more crisp than gurgling, occur where?
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higher in the upper respiratory tree.
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Where could you listen for crackles without a stethoscope?
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at the open mouth
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What are high-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough?
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Fine crackles
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What are lower, more moist sounds heard during the midstage of inspiration; not cleared by a cough?
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medium crackles
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What are loud bubbly noises heard during inspiration; not cleared by cough?
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coarse crackles
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What causes ronchi (sonorous wheezes)?
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the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure.
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More sibilant (higher-pitched) ronchi result from what?
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arise from smaller bronchi as in asthma
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More sonorous (low-pitched) ronchi arise from?
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arise from larger bronchil, as in tracheobronchitis.
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Are ronchi palpable?
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yes, all ronchi are at times palpable
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How to tell the difference b/w ronchi and crackles?
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Ronchi disappear after coughing and crackles do not.
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What sounds are: loud, low, coarse like a snore, most often heard continuously during inspiration and expiration; coughing may clear sound.??
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Rhonchi (sonorous wheeze)
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What sounds are: musical noise sounding like a squeak; most often heard during inspiration or expiration. usually louder during expiration??
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Wheeze (sibilant wheeze)
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What is the difference between a rhonchi and a wheeze?
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well, sometimes a wheeze is thought of as a form of a ronchus.
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What causes a wheeze?
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a relatively high velocity air flow through a narrowed or obstructed airway.
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What usually causes B/L wheezing?
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bronchospasm of asthma, or acute/chronic bronchitis
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Unilateral or sharply localized wheezing may indicate...
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foreign body or tumor compressing part of bronchial tree
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Where does a friction rub occur?
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outside the respiratory tree.
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When does a friction rub usually have no significance?
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when it is over the liver or spleen
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What does a friction rub over the heart or lungs indicate?
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inflamed, roughened surfaces rubbing together
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What does a friction rub over the lungs indicate?
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pleurisy
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What is a mediastinal crunch (Hamman sign) and what is it indicative of?
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it encompasses a great variety of sounds- loud crackles, clicking, gurgling which are synchronous with the heartbeat and not particularly with respiration. Found with mediastinal emphysema
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What is bronchophony?
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greater clarity and increased loudness of spoken sounds. extreme bronchophony is present with consolidation of the lungs
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Where is pleural friction rub heard the loudest?
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over the lower laterl anterior surface
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What is egophony?
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when the intensity of the spoken voice is increased and there is a nasal quality, e's become a's.
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Describe the mechanics of a cough.
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preceded by a deep inspiration. followed by closure of the glottis and contraction of chest, abdomen, and pelvic muscles, and then sudden, spasmodic expiration, forcing a sudden opening of the glottis.
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A moist or productive cough may be caused by...
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infection and can be accompanied by sputum production.
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A dry or non-productive cause can be caused by...
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cardiac probles, allergies, etc..
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An acute onset of cough with fever usually indicates...
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infection
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An infrequent cough may result from...
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allergens or environmental insults
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A regular, paroxysmal is often heard with...
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pertussis (highly contagious bacterial disease that causes violent coughing
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What causes: yellow, green, rust, clear, transparent, purulent, blood streaked, mucoid, viscid sputum?
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bacterial infection
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What causes mucoid, viscid, blood streaked sputum?
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viral infections
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What causes sputum that is particularly abundant in the early morning with slight intermittent blood streaking?
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chronic infectious disease
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What causes slight persistent, intermittent blood streaking?
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carcinoma
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What causes sputum with blood clotted and large amounts of blood?
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infarction
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What causes sputum with occasional large amounts of blood?
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tuberculous cavity
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What is the normal chest circumference in a healthy full term baby?
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30 to 36 cm, usually 2 to 3 cm smaller than the head
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What is the expected respiratory rate for a newborn?
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40 to 60 respirations per minute. although rate of 80 is not uncommon
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What is periodic breathing and is it common in babies?
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it is a sequence of relatively vigorous respiratory efforts followed by apna of 10 to 15 seconds. yes it is common in babies
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By what age do children use the thoracic musculature(intercostals) for respiration?
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by 6 or 7
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What are common respiration rates for 17 years and up?
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12 to 20
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Newborn resp rate?
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30 to 80
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1 year resp rate?
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20 to 40
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3 year resp rate?
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20 to 30
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6 year resp rate?
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16 to 22
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10 year resp rate?
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16 to 20
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If the roundness of a young child's chest persists past the 2nd year of life, what should you be concerned about?
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the possibility of chronic obstructive pulmonary problem such as cystic fibrosis.
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