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335 Cards in this Set
- Front
- Back
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What are the primary muscles of respirations?
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Diaphragm and intercostal muscles
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What does the external intercostal muscles do?
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Increase the AP diameter during inspiration
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What do the internal intercostal muscles do?
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Decrease the transverse diameter during expiration
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What are the accessory muscles in respiration?
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Sternocleidomastoid and trapezius
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What is the pleural cavities lined with?
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parietal and visceral pleurae, and serous membranes
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What is the lingula?
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It is an inferior tonguelike projection on the left upper lobe
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What does the lesser horizontal fissure divide and at what level?
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It divides the upper portion of the right lung into the upper and middle lobes at the level of the 5th rib in the axilla and the 4th rib anteriorly
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How far above the first rib does the apex of the lung extend?
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It extends anteriorly about 4cms into the base of the neck
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Posteriorly, the apexes of the lungs rise to what level?
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level of T1
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The lower borders of the lung descend on inspiration to what level?
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about T12
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The lower borders of the lung rise on forced expiration to what level?
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about T9
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How long is the trachea and what is its diameter?
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The trachea is 10-11cm long and about 2cm in diameter
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The trachea lies _1._________ to the esophagus and 2.____________ to the isthmus of the thyroid.
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1. anterior
2. posterior |
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At what level does the trachea divide into the right and left main bronchi?
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At the level of T4 or T5 and just below the manubriosternal joint
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Which bronchus is wider, shorter and more vertically placed therefore more susceptible to aspiration of foreign bodies?
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Right bronchus
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Where do the bronchial arteries branch from?
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The anterior thoracic aorta and the intercostal arteries
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What do the bronchial arteries supply?
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lung parenchyma and stroma
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The chemoreceptors in the medulla are sensitive to what molecule?
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Hydrogen ions
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The chemoreceptors in the carotid body at the bifurcation of the common carotid arteries are sensitive to what two molecule levels?
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Arterial oxygen and carbon dioxide levels
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Excess levels of carbon dioxide stimulates what?
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the rate and depth of respiration
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What most often leads to to closure of the foramen ovale within minutes after birth?
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The relative decrease in pulmonary pressure
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What usually stimulates the contraction and closure of the ductus arteriosus?
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The increased oxygen tension in the arterial blood
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When do the number of alveoli increase at a very rapid rate?
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During the first 2 years
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By what age goes the increase of alveoli slow down, becoming barely noticeable?
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By the age of 8
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What does barrel chest results from?
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Loss of muscle strength in the thorax and diaphragm coupled with the loss of lung resiliency
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What can cause tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax with acute chest pain?
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Cocaine
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What is the sequence of steps in the examination of the chest and lung?
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inspection, palpation, percussion, and auscultation
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Dullness on percussion and lack of breath sounds may be present in what?
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Pleural effusion
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Dullness on percussion and bronchial breath sounds may be present is what?
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Lobar pneumonia
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Absent tactile fremitus is found in what?
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effusion
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Increased tactile fremitus is found in what?
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Lobar pneumonia
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Barrel chest results from what? Give some examples of diseases
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Compromised respirations i.e. chronic asthma, emphysema, or cystic fibrosis
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Describe the bone structure found in barrel chest.
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The ribs are more horizontal, the spine at least somewhat kyphotic, and the sternal angle more prominent. Trachea may be posteriorly displaced
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Which one should be less: the AP diameter or the lateral diameter?
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The AP diameter should be less than the lateral diameter
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What is the expected thoracic ratio?
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0.70 to 0.75
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What is kyphosis?
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The spine may be deviated posteriorly
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What is scoliosis?
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The spine may be deviated laterally
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A prominent sternal protrusion is called?
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pectus carinatum (pigeon chest)
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An indentation of the lower sternum above the xiphoid process is called?
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pectus excavatum (funnel chest)
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What makes the breath smell malodorous?
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Intrathoracic infection
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What should the respiration rate be?
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12-20 respirations per minute
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The ratio of respirations to heartbeats is what?
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1:4
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What is dyspnea?
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Difficult and labored breathing
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What is dyspnea commonly observed with?
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Pulmonary or cardiac compromise
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What causes dsypnea of rapid onset? (10 Ps)
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pneumonia, pneumothorax, pulmonary constriction/asthma, peanut, pulmonary embolus, pericardial tamponade, pump failure, peak seekers, psychogenic, poisons
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What is orthopnea?
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shortness of breath that begins or increases when the patient lies down
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What is paroxysmal nocturnal dyspnea?
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a sudden onset of shortness of breath after a period of sleep; sitting upright is helpful
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What is platypnea?
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dyspnea increases in the upright posture
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What is tachypnea?
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persistent respiratory rate approaching 25 respirations/minute; faster than 20 breaths/minute
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Rapid, shallow breathing may occur during?
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Hyperventilation
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Rapid, shallow breathing may be a symptom of?
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protective splinting from pain of a broken rib or pleurisy.
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What can produce a similar rhythm of rapid, shallow breathing?
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massive liver enlargement or abdominal ascites may prevent descent of the diaphragm
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What is bradynpea?
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respiration rate slower than 12 breaths per minute
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Bradynpea may indicate what?
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neurologic or electrolyte disturbance, infection, or sensible response to protect against the pain of pleurisy or other irritative phenomena
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What is hyperpnea?
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Breathing laboriously, as if forced and deeply
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It a patient is hyperpnea and the respirations are also rapid what might result?
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hyerventilation
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What can cause hyperpnea?
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exercise, anxiety and CNS and metabolic disorders
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What is Kussmaul breathing and what is it associated with?
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It is always deep and most often rapid, is the eponym applied to the respiratory effort associated with metabolic acidosis
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What is hypopnea?
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Abnormally shallow breaths
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What is Cheyne-Stokes respiration?
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A regular periodic pattern of breathing, with intervals of apnea followed by a crescendo/decrescendo sequence of respiration
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In what kind of lesion would you see Cheyne-Stokes respiration?
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It is seen in patients with brain damage at the cerebral level or with drug-caused respiratory compromise
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What is an occasionally deep, audible sigh associated with?
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Emotional distress or an incipient episode of more severe hyperventilation
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What is air trapping?
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It is the result of a prolonged but inefficient expiratory effort
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What is biot respiration?
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Somewhat irregular respirations respirations varying in depth and interrupted by intervals of apnea, but lacking the repetitive pattern of periodic respiration
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What is biot respiration associated with?
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With severe and persistent increased intracranial pressure, respiratory compromise resulting from drug poisoning or brain damage at the level of the medulla
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In more extreme expression what is biot respiration referred to as?
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Ataxic
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What is apnea?
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The absence of spontaneous respiration
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What are common contributors to apnea?
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Seizures, central nervous system trauma or hypofusion, a variety of infections of the respiratory passageway, drug ingestions and obstructive sleep disorders
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Does Cheyne-Stokes respiration have characteristic moments of apnea?
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Yes
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What is deglutition apnea?
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Absence of breathing when one is swallowing
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What is primary apnea?
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It is a self-limited condition, and not uncommon after a blow to the head
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In what individual what you especially note primary apnea?
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A newborn who will breathe spntaneously when sufficient carbon dioxide accumulates in the circulation
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What is reflex apnea?
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If irritating and nausea-provoking vapors or gas are inhaled, there can be an involuntary, obviously temporary halt to respiration
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What is secondary apnea?
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Breathing stops and it will not being spontaneously unless resuscitative measures are immediately instituted
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What kind of event will lead to secondary apnea?
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Any event that severely limits the absorption of oxygen into the bloodstream
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What is sleep apnea?
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Characterized by periods of absence of breathing effort during sleep
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What is selective apnea?
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It affects only a part of the breathing cycle
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What is apneustic breathing
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Characterized by a long inspiration and what amounts to expiration apnea
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Where is the neural control is apneustic breathing?
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Pons
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What is the apnea of prematurity?
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It is a more intense version of periodic apnea of the newborn
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What is periodic apnea of the newborn?
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An normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one usually associates with REM sleep
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Thoracic (costal) respiration is primarily the result of the use of what muscles?
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intercostals muscles
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What is daphragmatic respiration?
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is primarily the result of the movement of the diaphragm responding to intrathoracic pressure
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Abdominal respirations involves what?
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Contraction of the diaphragm and the interplay of the abdominal muscles
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What results from abdominal respirations?
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The expansion and recoil of the abdominal walls
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Which type of respiration is typically the rule?
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Thoracic respiration
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Men are more likely to use what kind of respiration?
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diaphragmatic respiration
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Women, particularly when pregnant, use what kind of respirations?
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Thoracic respiration
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Chest asymmetry can be associated with what?
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unequal expansion and respiratory comprimise
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Chest asymmetry can be caused by what?
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collapsed lung or limitation of expansion by extrapleural air, fluid, or a mass
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Unilateral or bilateral bulging can be reaction of what to what?
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A reaction of the ribs and interspaces to respiratory obstruction
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A prolonged expiration and bulging on expiration are probably caused by what?
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Outflow obstruction or the valvelike action of compression by a tumor, aneurysm, or enlarged heart
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What does retractions suggest?
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An obstruction to inspiration at any point in the respiratory tract
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When the obstruction is high in the respiratory tree, breathing is characterized by?
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stridor, and the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles and at the lowest costal margins
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Paradoxic breathing occurs when?
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negative intrathoracic pressure is transmitted to the abdomen by a weakened, poorly functioning diaphragm
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A foreign body in one or the other of the bronchi causes what?
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unilateral retraction, but the suprasternal notch is not involved
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Retraction of the lower chest occurs with?
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Asthma and bronchiolitis
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What peripheral clues suggest pulmonary or cardiac difficulty?
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Cyanotic lips and nails, the pursed lips, clubbing and flared alae nasi
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Clubbing, enlargement of the terminal phalanges of the fingers and/or toes is associated with?
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Chronic fibrotic changes within the lungs, the chronic cyanosis of congenital heard disease, or cystic fibrosis
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Name two diseases not associated with clubbing?
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Asthma and emphysema
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Flaring of the alae nasi during inspiration is a common sign of?
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Air hunger, particularly when the alveoli are considerable involved
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What is crepitus?
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A crackly or crinkly sensation, can be both palpated and heard - a gentle, bubbly feeling
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What does crepitus indicate?
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Air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas-producing organism (Clostridium)
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Does crepitus require attention?
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Yes
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What suggest a pleural friction rub?
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A palpable, coarse, grating vibration, usually on inspiration
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What causes pleural friction rub?
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inflammation of the pleural surfaces
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What is tactile fremitus?
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The palpable vibration of the chest wall the results from speech or other verbalizations
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Where is fremitus best felt?
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parasternally at the second intercostal space at the level of the bifurcation of the bronchi
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Decreased or absent fremitus may be caused by?
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excess air in the lungs or may indicate emphysema, pleural thickening or effusion, massive pulmonary edema, or bronchial obstruction
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Increased fremitus occurs when?
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In the presence of fluids or a solid mass within the lungs and may be caused by lung consolidation, heavy but nonobstructive bronchial secretions, compressed lung or tumor
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Gentle, more tremulous fremitus than expected may occur with?
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some lung consolidations and some inflammatory and infectious processes
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What can displace the trachea?
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atelectasis, thyroid enlargement, significant parenchymal and/or pleural fibrosis, or pleural effuction
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What can push the trachea to one side?
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tension pneumothorax, a tumor, or nodal enlargement on the contralateral side; It may be pulled by a tumor on the side to which it deviates
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What may push the trachea posteriorly?
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Anterior mediastinal tumors
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What may push the trachea anteriorly?
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mediastinitis
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What is a "tug"?
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A palpable pull out of midline with respiration
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For all positions, where do you percuss?
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At 4-5cm intervals over the intercostal spaces
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What is the expected sound and where is it heard.
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The expected sound is resonance and it can usually be heard over all areas of the lungs
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What is hyperresonance associated with?
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hyperinflation
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What might hyperresonance indicate?
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emphysema, pneumothorax, or asthma
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Dullness or flatness may indicate what?
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atelectasis, pleural effusion, pneumothorax, or asthma
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What is tympany sound usually associated with?
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Percussion over the abdomen
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What can limit the descent of the diaphragm?
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pulmonary lesions due to emphysema etc, abdominal lesions (massive ascites, tumor) or superficial painful (fractured rib)
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Sweet, fruity
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Diabetic ketoacidosis: starvation, ketosis
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Fishy, stale
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Uremia (trimethylamines)
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Ammonia-like
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Uremia (ammonia)
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Foul, feculent
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Intestinal obstruction/diverticulum
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Foul, putrid
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Nasal/sinus pathology: infection, foreign body, cancer; respiratory infection: empyema, lung abscess, bronchiectasis
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Halitosis
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Tonsillitis, gingivitis, respiratory infections, Vincent angina, gastroesophageal reflux
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Cinnamon
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Pulmonary tuberculosis
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Head over the most of the lung fields; low pitch; more prominent in a thin person or child, diminished in the overweight or very muscular patient? What is the breath sound?
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Vesicular
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Heard over main bronchus area and over upper right posterior lung field; medium pitch; expiration equals inspiration. What is the breath sound?
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Bronchovesicular
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Heard over trachea; high pitch; loud and long expiration, sometimes a bit longer than inspiration. What is the breath sound?
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Bronchial/tracheal
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What sounds are abnormal if they are heard over the peripheral lung tissue?
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bronchovesicular and bronchial/tracheal
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What is amphoric and when is it commonly heard?
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breathing that resembles the noise made by blowing across the mouth of a bottle. It is heard most often with a large, relatively stiff-walled pulmonary cavity or a tension pneumothorax with bronchopleural fistula
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What is canvernous breathing and when it is commonly heard?
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Sounds as if coming from a cavern. Is commonly heard over a pulmonary cavity in which the wall is rigid
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When are breath sounds more difficult to hear?
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If fluid or pus has accumulated in the pleural space, if secretions or foreign body obstructs the bronchi, if the lungs or hyperinflated or if breathing is shallow from splinting because of pain
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When are breath sounds easier to hear?
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When the lungs are consolidated; the mass surrounding the tube of the respiratory tree promotes sound transmission better than do air-filled alveoli
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Which adventitious breath sounds are discontinuous?
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Crackles
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Which adventitious breath sounds are continuous?
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Rhonchi, wheezes and friction rub
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What is crackles?
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An abnormal respiratory sound heard more often during inspiration and charactered by discrete discontinuous sounds
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What causes crackles?
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disruptive passage of air through the small airways in the respiratory tree
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What is sibilant?
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High-pitched crackes
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What is sonorous?
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Low pitched crackles
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What is rhonchi?
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coarse low-pitched; may clear with cough
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What is wheeze?
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Whistling, high-pitched bronchus
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What is bronchial?
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coarse; loud; heard with consolidation
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What is crackles?
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fine crackling high-pitched
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High-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough. What is it?
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Fine crackles
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Lower, more moist sound heard during the midstage of inspiration; not cleared by a cough. What is it?
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Medium crackles
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Loud, bubbly noise heard during inspiration; not cleared by a cough. What is it?
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Coarse crackles
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Loud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound. What is it?
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Rhonchi
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Musical noise sounding like a squeak; most often heard continuously during inspiration or expiration; usually louder during expiration. What is it?
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Wheeze
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dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface. What is it?
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Pleural friction rub
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What causes rhonchi?
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Passage of air through an airway obstructed by thick secretion, muscular spams, new growth, or external pressure
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The more sibilant, higher-pitched rhonchi are found in what?
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asthma
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The more sonorous, lower-pitched rhonchi are found in?
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trancheobronchitis
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What causes wheezes?
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high-velocity air flow through a narrowed or obstructed airway
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What can cause a wheeze that is heard bilaterally?
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bronchospasm of asthma or acute or chronic bronchitis
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Unilateral or more sharply localized wheezing or stridor may occur with?
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foreign body
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What can create a consistent wheeze or whistle of single pitch at the site of compression?
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a tumor compressing a part of the bronchial tree
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If infection is the source of wheezing, the organism is usually ?
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a virus
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A friction rub heard over the heart or lungs is caused by what?
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inflamed, roughened surfaces, rubbing together
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How do you differentiate between a respiratory rub and a cardiac rub?
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Respiratory rub disappears when the breath is held; cardiac rub will not
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Why is mediastinal crunch found?
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Mediastinal emphysema
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What is mediastinal crunch (Hamman sign)?
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There is a great variety of noise-loud crackles and clicking and gurgling sounds. These are synchronous with the heartbeat and the sounds can be more pronounced toward the end of expiration
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What is a clue to a mediastinal mass?
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The patient may sit up and lean forward to relieve the compression
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Where is transmitted sound better heard?
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Medially
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What is bronchopony?
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Greater clarity and increased loudness of spoken sounds
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What is whispered pectorliquy?
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Whispers can be heard clearly and intelligibly through the stethoscope
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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, and auditory quality is called egophony
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When is egophony, bronchopony, and whispered pectorliquy present?
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Any condition that consolidates lung tissue
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When does vocal resonance diminish and lose its intensity?
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When there is blockage of the respiratory tree for any reason
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What is asthma?
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A chronic obstructive pulmonary disease characterized by airway inflammation and generally resulting from airway hyperreactivity
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What triggers asthma?
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allergens, anxiety, upper respiratory infections, cigarette smoke or other environmental poisons or exercise
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What aggravates asthma?
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Cold air
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What results when asthma is aggravated?
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Mucosal edema, increased secretions and inspiration and bronchoconstriction. Airway resistance increases and respiratory flow is impeded
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What is episodes of asthma attacks characterized by?
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paroxysmal dyspnea; tachypnea; cough; wheezing on expiration and inspiration; and, as airway resistance increases, more prolonged expiration
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What is atelectasis?
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The incomplete expansion of the lung at birth or the collapse of the lung at any age.
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What can cause the lungs to collapse?
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compression from outside (exudates, tumors) or resorption of gas from the alveoli in the presence of complete internal obstruction
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What is bronchitis?
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inflammation of the mucous membranes of the bronchial tubes
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What may accompany acute bronchitis?
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fever and chest pain
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What is the initial stimuli in bronchitis?
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Irritation by an internal or external noxious influence
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What is a physical manifestation of chronic bronchitis?
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excessive secretion of mucus in the bronchial tree
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What is pleurisy?
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an inflammatory process involving the visceral and parietal pleura
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What is pleurisy often the result of?
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Pulmonary infections, bacterial or viral, and sometimes associated with neoplasm or asbestosis
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Why is it difficult to breathe with pleurisy?
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the pleura becomes "dry", actually edematous and fibrinous
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Patient presents with sudden acute pain, difficulty breathing. The respirations are rapid and shallow with diminished breath sounds. Pleural rub is present. What is the disorder?
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Pleurisy
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In pleurisy, if there is lower lung involvement near the diaphragm where would the pain be referred to?
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ipsilateral shoulder
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What is pleural effusion?
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excessive nonpurulent fluid in the pleural space can result in permanent fibrotic thickening
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What are some of the sources of effusion in pleural effusion?
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infection, neoplasm, and trauma
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In pleural effusion, would you hear breath sounds in the affected tissue?
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No
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What is Grocco's triangle and when can it be percussed?
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It is a right-angled area of dullness over the posterior chest, which can sometimes be percussed opposite a large pleural effusion
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What is empyema?
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Occurs when fluid collected in the pleural spaces is a purulent exudate, arising most commonly from adjacent infected, sometimes traumatized tissues
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What might complicate empyema?
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Pneumonia, a penetrating injury, simultaneous pneumothorax or bronchopleural fistulae
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Patient has distant or absent in the affected area, percussion note is dull, vocal fremitus is absent, patient is febrile and tachypneic and appears ill. What is the disorder?
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Empyema
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What is a lung abscess?
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A well-defined, circumscribed mass defined by inflammation, suppuration, and subsequent central necrosis
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The lung abscess may elude diagnosis until when?
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It invades a bronchus so that resulting drainage will allow detection of an air-fluid level
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What are the common causes of lung abscess?
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Aspiration of food or infected material from upper respiratory or dental sources of infection
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What might a lung abscess first appear like?
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It may at first appear to be a localized pneumonia
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Patient presents with distant or absent breath sounds over the affected area with dull percussion. Patient has a pleural friction rub and a cough that produces a purulent foul-smelling sputum. Patient is ill and febrile and tachypneic. What is the disorder?
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Lung abscess
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What is pneumonia?
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An inflammatory response of the bronchioles and alveolar spaces to an infective agent
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Exudates in pneumonia leads to lung consolidation which results in what 3 things?
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Dyspnea, tachypnea, crackles
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In pneumonia, involvement of the right lower lobe can stimulate what?
|
The 10th and 11th thoracic nerves to cause right lower quadrant pain and simulate an abdominal process
|
|
|
What kind of percussion sound and breath sound are found over areas of consolidation?
|
Diminished breath sounds and dullness to percussion
|
|
|
What should alert you to the possibility of acute bacterial pneumonia?
|
Flaring of the alae nasi, tachypnea, and a possibly productive cough in the absence of crackles and out of proportion to other clinical findings
|
|
|
What is the influenza characterized by?
|
Cough, fever, malaise, headache, and coryza and mild sore throat typical of the common cold
|
|
|
With the influenza, the entire respiratory tract may be overwhelmed by what?
|
Interstitial inflammation and necrosis extending throughout the bronchiolar and alveolar tissue
|
|
|
What are some of the respiratory findings with the influenza?
|
crackles, rhonchi, and tachypnea, cough and substernal pain
|
|
|
What is tuberculosis?
|
A chronic infectious disease that most often begins in the lung but may then have widespread manifestations in many organs and systems
|
|
|
Which tubercle bacillus causes TB?
|
Mycobacterium tuberculosis; occasionally Mycobacterium bovi or an atypical mycobacterium
|
|
|
What causes a pneumothorax?
|
Trauma or may occur spontaneously, perhaps because of rupture of a congenital bleb; the air in the pleural space may not communicate with that in the lung
|
|
|
What is a pneumothorax?
|
Air or gas in the pleural cavity
|
|
|
What happens in a tension pneumothorax?
|
Air leaks continually into the pleural space becoming trapped on expiration and resulting in increasing pressure in the pleural space
|
|
|
What are the breath sounds and percussion sounds in a pneumothorax?
|
breath sounds are distant and the percussion sounds boom
|
|
|
What is a hemothorax?
|
The presence of blood in the pleural cavity
|
|
|
What may cause a hemothorax?
|
trauma or invasive medical procedure (thoracentesis, pleural biopsy)
|
|
|
What is a hemopneumothorax?
|
Air may be present with the blood in the pleural cavity
|
|
|
What are the breath sounds and percussion sounds in a hemothorax?
|
Breath sounds will be distant or absent, the percussion note will be dull
|
|
|
What is lung cancer generally referring to?
|
bronchogenic carcinoma, a malignant tumor that evolves from bronchial epithelial structure
|
|
|
What are some of the etiologic agents for lung cancer?
|
tobacco smoke, asbestos, ionizing radiation, and other inhaled chemicals and noxious agents
|
|
|
What might lung cancer cause?
|
cough, wheezing, a variety of patterns of emphysema and atelectasis, pneumonitis and hemoptysis
|
|
|
What is cor pulmonale?
|
Is an acute or chronic condition involving right-sided heart failure.
|
|
|
What happens in the acute phase of cor pulmonale?
|
The right side of the heart is dilated and fails, most often as a direct result of pulmonary embolism
|
|
|
What happens in chronic cor pulmonale?
|
A massive disease of the lungs causes gradual obstruction that produces a more gradual hypertrophy of the right ventricle, increasing stress and ultimate heart failure
|
|
|
An isolated failure of the right side of the heart is rare except in the circumstance of?
|
pulmonary obstruction caused by emboli, primary pulmonary hypertension, or extensive infection and noxious involvement of the lung
|
|
|
What are the risk factors for a pulmonary embolism?
|
>40yrs old, a history of venous thromboembolism, surgery with anesthesia longer than 30 minutes, heart disease, cancer, fracture of the pelvis and leg bones, obesity and acquired or genetic thrombophilia
|
|
|
What is a major clue to embolism?
|
pleuritic chest pain in the absence of dyspnea
|
|
|
What is cystic fibrosis?
|
An autosomal recessive disorder of exocrine glands involving the lungs, pancreas and sweat glands
|
|
|
What is the hallmark for CF in children younger than 5 years?
|
cough with sputum
|
|
|
What are some symptoms of CF?
|
Salt loss in sweat, abnormally thick mucus may cause progressive clogging of the bronchi and bronchioles subsequent pulmonary infections
|
|
|
What is initially evident in CF?
|
Areas of hyperinflation and atelectasis
|
|
|
What happens in CF as it progresses?
|
The tolerance for exercise diminishes and pulmonary hypertension and cor pulmonale often occur
|
|
|
What is epiglottis?
|
An acute, live-threatening disease almost always caused by Haemophilus influenzae type B
|
|
|
In what age group does epilglottis mostly occur?
|
children between the age of 3-7
|
|
|
A child is sitting straight up with neck extended and head held forward, appears very anxious and ill, is unable to swallow, is drooling from an open mouth and may have a fever. What is the disorder?
|
Epiglottitis
|
|
|
If you suspect epiglottitis do you try to visualize the epiglottis with a tongue blade?
|
No
|
|
|
What is croup?
|
Results from infection with a variety of viral agents, particularly parainfluenza viruses
|
|
|
A child awakens suddenly, very frightened, with a harsh, bark-like cough, labored breathing, retraction, hoarseness, and inspiratory stridor. What is the disorder?
|
Croup
|
|
|
What may mimic the croup on occasion?
|
Aspirated foreign body
|
|
|
Respiratory distress syndrome characteristically occurs in 1.___________ because of 2.____________
|
1. preterm infants
2. surfactant deficiency |
|
|
The risks of RDS increases with?
|
decreasing gestational age, maternal diabetes, acute asphyxia, and with a family history of the problem
|
|
|
What 4 things are part of the clinical picture for RDS?
|
tachypnea, retractions, grunting, and cyanosis
|
|
|
Why is ARDS a harrowing problem?
|
Because of complications of shock, asphyxia, and aspiration
|
|
|
What is inspiratory stridor?
|
"noisy breathing" in infancy, sometimes described as wheezing
|
|
|
What is tracheomalacia?
|
A floppiness of the trachea or airway, a lack rigidity
|
|
|
What does tracheomalacia cause the trachea to do?
|
Causes the trachea to change in response to the varying pressures of inspiration and expiration
|
|
|
What is the principal characteristic of bronchiolotis?
|
Hyperinflation of the lungs
|
|
|
What causes bronchiolitis?
|
The cause is viral, usually the respiratory syncytial virus
|
|
|
What is COPD?
|
Nonspecific designation that includes a group of respiratory problem in which coughs, chronic and often excessive sputum production dyspnea are prominent features
|
|
|
What disorders are included in this group?
|
chronic bronchitis, emphysema, asthmatic bronchitis, bronchiectasis, and even CF
|
|
|
Patient presents with episodes of coughs and sputum, dyspnea and limited tolerance for exercise. Your patient is breathing through pursed lips, is barrel-chested and a smoker. What is the disorder?
|
COPD
|
|
|
If the forced expiration time is longer than 4-5 seconds, what should you suspect?
|
Airway obstruction
|
|
|
What is emphysema?
|
the most severe chronic obstructive pulmonary disorder. It is a condition in which air may take over and dominate a space in away that disrupts function
|
|
|
What is the pathophysiology of emphysema?
|
The air spaces beyond the terminal bronchioles dilate, rupturing alveolar walls, permanently destroying them, reducing their number, and permanently hyerinflating the lung. Alveolar gas is trapped, essentially in expiration and gas exchange is seriously compromised
|
|
|
What is a common precursor to emphysema?
|
chronic bronchitis
|
|
|
What are some additional contributors to emphysema?
|
aging, smoking, or impairment of the defenses mediated by alph-antitrypsin
|
|
|
What is bronchiectasis?
|
Chronic dilation of the bronchi or bronchioles is caused by repeated pulmonary infections and bronchial obstruction
|
|
|
What may bronchiectasis may lead to?
|
malfunction of bronchial muscle tone and loss of elasticity
|
|
|
What is Kartagener syndrome?
|
Autosomal recessive condition characterized by bronchiectasis, sinusitis, dextrocardia and male infertility
|
|
|
The mucus of the bronchi is chronically inflamed, recurrent bacterial infections are common, dyspnea may be present though not severe and cough and sputum are impressive. What is the disorder?
|
Chronic bronchitis
|
|
|
Severe chronic bronchitis may result in what?
|
Right ventricular failure with dependent edema
|
|
|
Patient comes in with flu-like fever, achiness, sniffles and pleural effusion. What is the disorder?
|
Anthrax
|
|
|
What species causes anthrax?
|
Bacillus anthracis
|
|
|
Patient comes in with nonspecific headache, chills, fever and generalized aches and pains. What is the disorder?
|
Smallpox
|
|
|
What virus causes smallpox?
|
Variola virus
|
|
|
What begins with nonspecific fever and malaise, and even mental confusion and a possible staggering gait?
|
Plague
|
|
|
What causes the plague?
|
Yersinia pestis
|
|
|
What would cause a moist cough?
|
Infection and can be accompanied by sputum production
|
|
|
What can cause a dry cough?
|
Cardiac problems, allergies, HIV infection
|
|
|
Acute onset of a cough with fever suggest what?
|
infection
|
|
|
Acute onset of a cough without a fever suggest what?
|
foreign body or inhaled irritants
|
|
|
An infrequent cough may be the result of?
|
allergens or environmental insults
|
|
|
A regular, paroxysmal cough is heard in what?
|
pertussis
|
|
|
What can cause an irregularly occurring cough?
|
Smoking, early congestive heart failure, an inspired foreign body or irritant, or a tumor within or compressing the bronchial tree
|
|
|
What would cause a dry cough to sound brassy?
|
If it is caused by compression of the respiratory tree
|
|
|
What would cause a dry cough to sound hoarse?
|
If it is caused by croup
|
|
|
What produces an inspiratory whoop at the end of a paroxysm of coughing?
|
Pertussis
|
|
|
On inspection what should a healthy lung look like?
|
Symmetry of movement on expansion, absence of retractions
|
|
|
On palpation, what should a healthy lung feel like?
|
Midline trachea without a tug, symmetric, unaccentuated tactile fremitus
|
|
|
On percussion, what should a healthy lungs sound like?
|
Range of 3-5cm in the descent of diaphragm, resonant and symmetric percussion notes
|
|
|
On auscultation, what should a healthy lungs sound like?
|
Absence of adventitious sounds, vesicular breath sounds, except for bronchovesicular sounds beside the sternum and the more prominent bronchial components in the area of the larger bronchi
|
|
|
What is vital capacity?
|
Is a valuable indicator of the amount of air that is expelled after the patient takes a maximal inspiration and follows that with a maximal expiration.
|
|
|
What variables can influence the vital capacity?
|
The physical dimensions of the chest cage, posture, gender, age, height, and the degree of physical fitness
|
|
|
What vital capacity is impaired, what disease processes can be suspected?
|
loss of lung tissue, airway obstruction, loss of muscle strength, chest deformity, pneumothorax
|
|
|
What is the peak expiratory flow rate?
|
A measure of the maximum flow of air that can be achieved during forced expiration
|
|
|
What is the reliability of the PEFR limited by?
|
The patient's ability to cooperate
|
|
|
What is the PEFR useful to as a measure for?
|
Large airway function
|
|
|
If a patient has a chronic sputum problem, what becomes apparent?
|
The possibility of a significant anatomic changes i.e. tumor, cavitation, or bonchiectasis
|
|
|
Yellow, green, rust, clear, or transparent; purulent; blood streaked; mucoid; viscid sputum. What is the cause?
|
Bacterial infection
|
|
|
Mucoid, viscid; blood streak (not common) sputum. What is the cause?
|
Viral infection
|
|
|
Yellow, green, rust, clear, or transparent; purulent; blood streaked; mucoid; viscid sputum. particularly abundant in the early morning; slight intermittent blood streaking; occasionally, large amounts of blood. What is the cause?
|
Chronic infectious disease
|
|
|
Slight, persistent blood streaking sputum. What is the cause?
|
Carcinoma
|
|
|
Blood clotted; large amounts of blood in sputum. What is the cause?
|
Infarction
|
|
|
Large amounts of blood in sputum?
|
tuberculous cavity
|
|
|
What causes depressed respiration in a newborn?
|
Origins in the maternal environment during labor, such as sedatives or compromised blood supply to the child; or it may result from mechanical obstruction by mucus
|
|
|
What should the chest circumference measure in a healthy full-term infant?
|
30-36cm
|
|
|
How much smaller is the chest circumference compare to that of the head?
|
2-3 cm smaller
|
|
|
If an infant had a relatively smaller chest circumference compared to the head, what could be the cause?
|
Intrauterine growth retardation
|
|
|
If an infant had a relatively larger chest circumference compared to the head, what could be the cause?
|
It is the infant of a poorly controlled diabetic mother
|
|
|
What is the distance between the nipples of an infant?
|
one-fourth the circumference of the chest
|
|
|
In white children what is supernumerary nipples associated with?
|
A variety of congenital abnormalities
|
|
|
The pattern of respiration seen in a newborn can be affected by?
|
The room temperature, feeding, and sleep
|
|
|
Is cyanosis of the hands and feet (acrocyanosis) a cause for concern?
|
No
|
|
|
What is periodic breathing?
|
a sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10-15 seconds
|
|
|
What is periodic breathing a cause for concern?
|
If the apneic episodes tend to be prolonged and the baby becomes centrally cyanotic
|
|
|
Is coughing a problem in newborns?
|
Yes, coughing is rare and should be considered a problem
|
|
|
Is sneezing and hiccuping also a cause for concern?
|
No
|
|
|
What might frequent hiccuping suggest?
|
Seizures, drug withdrawal, or encephalopathy among other possibilities
|
|
|
What do newborns rely on primarily for their respiratory efforts?
|
The diaphragm
|
|
|
What muscles do infants use for their respiratory efforts?
|
The abdominal muscles
|
|
|
What is paradoxic breathing? and what is it common?
|
The chest wall collapses as the abdomen distends on inspiration. It is common during sleep
|
|
|
If the chest expansion is asymmetric in a newborn, what do you suspect?
|
Some compromise of the baby's ability to fill on e of the lungs e.g. pneumothorax or diaphragmatic hernia
|
|
|
What is a diaphragmatic hernia a result of?
|
It is the result of an imperfectly structered diaphragm
|
|
|
What are some symptoms of a diaphragmatic hernia?
|
Bowel sounds heard in the chest and a flat or scaphoid abdomen are significant clues. The heart is usually displaced to the right.
|
|
|
Why is not not uncommon to hear crackles and rhonchi immediately after birth?
|
Because fetal fluid has not been completely cleared
|
|
|
What is stridor?
|
It is a high-pitched, piercing sound most often heard during inspiration.
|
|
|
What is stridor a result of?
|
An obstruction high in the respiratory tree
|
|
|
If it is accompanied by a cough, hoarseness, and retraction, stridor signifies what?
|
A serious problem in the trachea or larynx e.g. a floppy epiglottis; congenital defects; croup; or an edematous response to an infection, allergen, smoke, chemicals or aspirated foreign body
|
|
|
Infants who have a narrow tracheal lumen readily respond with stridor to its compression by what?
|
A tumor, abscess, or double aortic arch
|
|
|
Retraction at the 1.____________________ and contraction of the 2.________________ should be considred significant
|
1. supraclavicular notch
2. Sternocleidomastoid muscles |
|
|
What is respiratory grunting?
|
It is a mechanism by which the infant tries to expel trapped air of fetal lung fluid while trying to retain air and increase oxygen levels
|
|
|
Flaring of the alae nasi is an indicator of?
|
respiratory distress
|
|
|
By the age of 6 or 7, children use what muscles for respiration?
|
thoracic (intercostal) muscles
|
|
|
In young children, obvious intercostal exertion (retractions) on breathing suggest what?
|
An airway problem e.g. asthma
|
|
|
If the roundness of the young child's chest persists past the second year what should you be concerned about?
|
About the possibility of a chronic obstructive pulmonary problem such as cystic fibrosis
|
|
|
Is dyspnea common in pregnancy?
|
Yes
|
|
|
In pregnancy, what is dyspnea a result of?
|
Normal physiologic changes
|
|
|
What is the most apparent change in lung volume in pregnancy?
|
A decrease in functional residual capacity, which is the volume of air in the lungs at the end of quiet exhalation
|
|
|
What happens to the vital capacity during pregnancy?
|
There is an increase of 100 to 200mL in vital capacity, the amount of air that can be expelled at the normal rate of exhalation after a maximum inspiration
|
|
|
What happens to the tidal volume during pregnancy?
|
The tidal volume, the amount of air inhaled and exhaled during normal breathing, increases 40% along with minute ventilation
|
|
|
How does a pregnant woman increase her ventilation?
|
By breathing more deeply, not more frequently.
|
|
|
In late pregnancy the supine position does what to pO2?
|
It can further decrease pO2
|
|
|
Patient is tachypnea, dyspnea, tachycardic, has diminished fremitus, has occasional hyperresonance, limited diaphragmatic descent, dullness over affected lung, prolonged expiration, wheezes and diminished lung sounds. What is the condition?
|
Asthma
|
|
|
See Table 13-5
|
See Table 13-5
|
