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400 Cards in this Set
- Front
- Back
What does the thorax consist of anteriorly?
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sternum, manubrium, xiphoid process, and costal cartilages
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What does the thorax consist of laterally?
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12 pairs of ribs
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What does the thorax consist of posteriorly?
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12 thoracic vertebrae
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Function of the Diaphragm in respiration
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contracts and moves downward during inspiration, lowering the abdominal contents to increase the intrathoracic space
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Function of the external intercostal muscles in respiration
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increase the AP chest diameter during inspiration
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Function of the internal intercostals during respiration
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decrease the transverse diameter during expiration
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What are the accessory muscles for respiration?
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sternocleidomastoid and trapezius muscles
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What is the lingula of the lungs?
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left upper lobe has an inferior tonguelike projection
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Where is the horizontal fissure of the right lung?
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divides the upper portion of the right lung into the upper and middle lobes at the level of the fifth rib in the axilla and the fourth rib anteriorly
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How high do the lung apex extends?
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apex is rounded and extends anteriorly about 4 cm above the first rib into the base of the neck in adults
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Posteriorly, what V-lvl are the apexes of the lungs at?
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T1
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What V-lvl are the lower borders of the lungs at during forced expiration?
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T9
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What V-lvl are the lower borders of the lungs at during deep inspiration?
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T12
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How long is the trachea? What is the diameter?
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10-11cm long, 2cm diameter
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What V-lvl does the trachea divide into the left and right bronchi?
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T4 or T5 and just below the manubriosternal joint
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What is the difference between the right and left bronchus?
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Right bronchus is wider, shorter, and more vertically placed than the left bronchus (and therefore more susceptible to aspiration of foreign bodies)
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What are the bronchial arteries from?
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anterior thoracic aorta and the intercostal arteries, supplying blood to the lung parenchyma and stroma
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Where is the bronchial vein formed at?
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hilum of the lung
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What vein drains most of the bronchial arteries blood?
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pulmonary veins
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What chemoreceptors response to H+ concentration?
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Chemoreceptors in the medulla oblongata
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What chemoreceptors response to changes in aterial oxygen and CO2?
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chemoreceptors in the carotid body at the bifurcation of the common carotid arteries
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Where do the chemoreceptors of respiration send their signal too? Then what does that send it signal to?
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Both types of chemoreceptors respond by sending signals to the respiratory center in the medulla oblongata. Nerve impulses from here are transmitted to two subcenters in the pons, which regulate the respiratory muscles
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Why does the right lung ride higher then the left?
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fullness of the dome of the liver
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Where is the right oblique fissure?
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stretching from the fifth rib at the axilla to the sixth at the midclavicular line
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In a posterior view, what V-lvl do the lower lobes of the lung extend?
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T3 to T10 or T12 during the respiratory cycle
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In a right lateral view, the upper lobe is demarcated at about what rib level?
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fifth rib in the midaxillary line and the sixth rib more anteriorly.
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In a left lateral view, the entire expanse is bisected by the oblique fissure at about what rib level?
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third rib medially to the sixth rib anteriorly
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In both the right and left lateral view, the lung underlies what area?
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the area extending from the peak of the axilla to the seventh or eighth rib
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Where is the manubriosternal junction (angle of Louis)?
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the point at which the second rib articulates with the sternum
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What and where is the suprasternal notch?
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A depression, easily palpable and most often visible at the base of the ventral aspect of the neck, just superior to the manubriosternal junction
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What is a Costal angle?
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angle formed by the blending together of the costal margins at the sternum. It is usually no more than 90 degrees, with the ribs inserted at approximately 45-degree angles
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What is the Vertebra prominens?
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spinous process of C7
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How do you find the Vertebra prominens by palpation?
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Can be more readily seen and felt with the patient's head bent forward. If two prominences are felt, the upper is that of the spinous process of C7, and the lower is that of T1
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What is the lung at 4 weeks of gestation?
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the lung is a groove on the ventral wall of the gut
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What is the function of the lungs during gestation?
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passive respiratory movements, they do not open the alveoli or move the lung fields. prepare the term infant to respond to postnatal chemical and neurologic respiratory stimuli.
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What mediates fetal gas exchange?
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Placenta
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What causes the lungs to fill with air for the first time?
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cord being cut
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What causes the closure of the ductus arteriosus?
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increased oxygen tension in the arterial blood
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What causes the closure of the foramen ovale
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relative decrease in pulmonary pressure most often leads to closure of the foramen ovale within minutes after birth; from pulmonary arteries expanding and relaxing
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What is pulmonary surfactant?
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a complex of proteins and phospholipids and a lubricant that stabilizes the alveoli by lessening surface tension at the air-liquid interface
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Why are infants so pneumonically challenged?
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The lung is not fully grown at birth
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When do the alveoli increase in number the most? When does this mostly stop?
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Most during first 2 years of life, trickle by 8 years of age
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How is the chest of a newborn different than a adults?
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newborn is generally round, the AP diameter approximating the transverse, and the circumference is roughly equal to that of the head until the child is about 2 years old, Adult lateral diameter > AP diameter
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What mechanical and biochemical factors change respiratory function in pregnant women?
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enlarged uterus and an increased level of circulating progesterone
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In Pregnant women, what is the change to the transverse diameter and circumference?
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Transverse increase by 2cm and circumference increase by 5-7cm
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In Pregnant women, how do the subcostal angle change?
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progressively increases from about 68.5 degrees to approximately 103.5 degrees in later pregnancy
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In Pregnant women, how does the diaphragm change?
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at rest rises as much as 4 cm above its usual resting position, yet diaphragmatic movement increases so that the major work of breathing is done by the diaphragm
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In Pregnant women, how does minute ventilation and alveolar ventilation change?
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Minute ventilation increases 30% to 50% with a corresponding 50% to 70% increase in alveolar ventilation
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In Pregnant women, what causes the change in minute ventilation?
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Increased Tidal volume
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In Pregnant women, How does the respiratory rate change?
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RR remains UNCHANGED
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What causes the barrel chest in older adults?
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loss of muscle str in thorax and diaphragm, coupled with loss of lung resiliency, skeletal changes that emphasize dorsal curve of thoracic spine that increase AP chest diameter. Decrease and stiff expansion of chest wall
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In older adults, what causes underventilation of the alveoli in the lower lung fields and decreased tolerance for exertion?
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Alveoli less elastic and more fibrous which causes decrease surface area. Loss of tensile str in muscles of respiration
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Generally, Due to the changes in the lungs of older adults, what is increased and what is decreased in respiration?
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increased residual volume and decreased vital capacity
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In older adults, what can occur when older persons exceed their customary light or moderate exertional demands?
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Dyspnea
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In older adults, what can encourage bacterial growth and predisposes the older adult to respiratory infection
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Retained mucus from the mucus membrane becoming drier and unable to rid as much
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When does chest pain NOT originate in the heart?
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constant achiness that lasts all day; stays in one position; made worse by pressing on the precordium; fleeting, needle like jab that lasts only a second or two; situated in the shoulders or between the shoulder blades in the back
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What are the symptoms of pain from Cocaine?
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Cocaine can cause tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax with severe acute chest pain being the common result
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What are the Risk Factors for respiratory disability?
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Gender: greater in men, but the difference between the genders diminishes with advancing age; Age: increases inexorably with advancing age; Family history of asthma, cystic fibrosis, tuberculosis and other contagious disease, neurofibromatosis; Smoking; Sedentary lifestyle or forced immobilization; Occupational exposure to asbestos, dust, or other pulmonary irritants and toxic inhalants; Extreme obesity; Difficulty swallowing for any reason; Weakened chest muscles for any reason; History of frequent respiratory infections
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Percussion sound in pleural effusion and lobar pneumonia
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Dullness
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Breath sounds in pleural effusion and lobar pneumonia
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absent in effusion, bronchial in lobar pneumonia
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Palpation in pleural effusion and lobar pneumonia
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tactile fremitus absent in effusion and increased in lobar pneumonia
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Which in bigger in a healthy adult, AP diameter or transverse diameter? By how much?
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AP diameter of the chest is ordinarily less than the transverse diameter, at times by as much as half
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What is most increased in a Barrel chest?
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AP diameter
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Thoracic Landmark: Midsternal line
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vertically down the midline of the sternum
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Thoracic Landmark: Right and left midclavicular lines
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parallel to the midsternal line, beginning at midclavicle; the inferior borders of the lungs generally cross the sixth rib at the midclavicular line
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Thoracic Landmark: Right and left anterior axillary lines
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parallel to the midsternal line, beginning at the anterior axillary folds
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Thoracic Landmark: Right and left midaxillary lines
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parallel to the midsternal line, beginning at the midaxilla
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Thoracic Landmark: Right and left posterior axillary lines
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parallel to the midsternal line, beginning at the posterior axillary folds
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Thoracic Landmark: Vertebral line
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vertically down the spinal processes
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Thoracic Landmark: Right and left scapular lines
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parallel to the vertebral line, through the inferior angle of the scapula when the patient is erect
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What can cause Barrel chest?
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compromised respiration as in, for example, chronic asthma, emphysema, or cystic fibrosis
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What is the thoracic ratio in barrel chest? How does it change?
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about 0.70 to 0.75. It does increase with age; however, when the AP diameter approaches or equals the transverse diameter (a ratio of 1.0 or even more), there is most often a problem.
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What are the anatomic changes in Barrel chest?
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The ribs are more horizontal, the spine at least somewhat kyphotic, and the sternal angle more prominent. The trachea may be posteriorly displaced. Ordinarily, the AP diameter should be less than the lateral diameter.
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What is pectus carinatum?
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pigeon chest (pectus carinatum), prominent sternal protrusion
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What is pectus excavatum?
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Funnel chest (pectus excavatum), indentation of the lower sternum above the xiphoid process
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What does a malodorous smell in the breath indicate?
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intrathoracic infection
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What are supernumerary nipples a clue to?
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these are often a clue to other congenital abnormalities, particularly in white patients
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superficial venous patterns over the chest are clue to?
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sign of heart disorders or vascular obstruction or disease
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What is the normal respiratory rate?
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12 to 20 respirations per minute
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What is the normal ratio of respirations to heartbeats?
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approximately 1:4
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What are the 10 Ps in Dyspnea of Rapid Onset?
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Pneumonia; Pneumothorax; Pulmonary constriction/asthma; Peanut (or other foreign body); Pulmonary embolus; Pericardial tamponade; Pump failure (heart failure); Peak seekers (high altitudes); Psychogenic; Poisons
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What is the definition of Dyspsnea?
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difficult and labored breathing with shortness of breath, is commonly observed with pulmonary or cardiac compromise
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What questions do you ask to establish the amount and kind of dyspnea?
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Is it present even when the patient is resting?; How much walking? On a level surface? Up stairs?; Is it necessary to stop and rest when climbing stairs?; With what other activities of daily life does dyspnea begin? With what level of physical demand?
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What is Orthopnea? What question to ask?
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shortness of breath that begins or increases when the patient lies down; ask whether the patient needs to sleep on more than one pillow and whether that helps.
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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 per minute.
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What commonly causes Tachypnea?
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symptom of protective splinting from pain of a broken rib or pleurisy. Massive liver enlargement or abdominal ascites may prevent descent of the diaphragm and produce a similar pattern
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What is Bradypnea?
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a rate slower than 12 respirations per minute
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What can cause Bradypnea?
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indicate neurologic or electrolyte disturbance, infection, or a sensible response to protect against the pain of pleurisy or other irritative phenomena. It may also indicate a splendid level of cardiorespiratory fitness.
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What is Hyperventilation (hyperpnea) respiration?
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Faster than 20 breaths per minute, deep breathing
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What is Signing in respiration?
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Frequently interspersed deeper breath
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What is Air trapping in respiration?
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Increased difficulty in geeting breath out
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What is Cheyne-Strokes in respiration?
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Varying periods of increasing depth interspersed with apnea
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What is Kussmal in respiration?
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Rapid, deep, labored
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What is Biot in respiration?
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Irregularly interspersed periods of apnea in a disorganized sequence of breaths
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What is Ataxic in respiration?
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Significant disorganization with irregular and varying depths of respiration
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Rate and depth of breathing in Acidosis (metabolic)
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Increases
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Rate and depth of breathing in Central nervous system lesions (pons)
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Increases
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Rate and depth of breathing in Aspirin poisoning
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Increases
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Rate and depth of breathing in Oxygen need (hypoxemia)
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Increases
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Rate and depth of breathing in Anxiety
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Increases
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Rate and depth of breathing in Pain
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Increases
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Rate and depth of breathing in Alkalosis (metabolic)
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Decreases
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Rate and depth of breathing in Central nervous system lesions (cerebrum)
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Decreases
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Rate and depth of breathing in Myasthenia gravis
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Decreases
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Rate and depth of breathing in Narcotic overdoses
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Decreases
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Rate and depth of breathing in Obesity (extreme)
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Decreases
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What can cause Hyperpnea?
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Exercise and anxiety can cause hyperpnea, but so can central nervous system and metabolic disease
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What causes Kussmaul breathing?
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always deep and most often rapid, is the eponym applied to the respiratory effort associated with metabolic acidosis
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What causes Hypopnea?
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Hypopnea, on the other hand, refers to abnormally shallow respirations (e.g., when pleuritic pain limits excursion).
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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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periodic breathing or Cheyne-Stokes respiration
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What causes Cheyne-Stokes respiration?
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Children and older adults may breathe in this pattern during sleep, but otherwise it occurs in patients who are seriously ill, particularly those with brain damage at the cerebral level or with drug-caused respiratory compromise
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An occasional deep, audible sigh that punctuates an otherwise regular respiratory pattern
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associated with emotional distress or an incipient episode of more severe hyperventilation
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When are Sighs significant?
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Sighs are significant only if they exceed the infrequent and relatively inconsequential sighs of daily life.
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What is Apnea?
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absence of spontaneous respiration
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What are the common contributors for Apnea?
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seizures, central nervous system trauma or hypoperfusion, a variety of infections of the respiratory passageway, drug ingestions, and obstructive sleep disorders
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What kind of respiration is characteristic of apnea?
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Cheyne-Strokes
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universal expectation of the absence of breathing when one is swallowing
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deglutition apnea
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What is Primary apnea?
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self-limited condition, and not uncommon after a blow to the head. It is especially noted immediately after the birth of a newborn, who will breathe spontaneously when sufficient carbon dioxide accumulates in the circulation. If irritating and nausea-provoking vapors or gases are inhaled, there can be an involuntary, obviously temporary halt to respiration (reflex apnea)
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What is Secondary apnea?
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grave. The breathing stops and it will not begin spontaneously unless resuscitative measures are immediately instituted. Any event that severely limits the absorption of oxygen into the bloodstream will lead to secondary apnea
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What is sleep Apnea?
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characterized by periods of an absence of breathing effort during sleep, can be very disturbing; the respiratory muscles do not function and airflow is not maintained through the nose and mouth
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What is Selective Apnea?
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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. The neural center for control is in the pons. When it is affected, breathing can become gasping, because inspirations are prolonged and expiration constrained
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What is apnea of prematurity?
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more intense version of periodic apnea of the newborn, a normal condition characterized by an irregular pattern of rapid breathing interspersed with brief periods of apnea that one usually associates with rapid eye movement sleep
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is the result of a prolonged but inefficient expiratory effort
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Air trapping
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consists of somewhat irregular respirations varying in depth and interrupted by intervals of apnea, but lacking the repetitive pattern of periodic respiration
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Biot respiration
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associated 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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Biot respiration
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Thoracic (costal) respiration is primarily the result of the use of what muscle?
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Intercostal muscle
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Diaphragmatic respiration, on the other hand, is primarily the result of
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movement of the diaphragm responding to intrathoracic pressure
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Abdominal respiration involves contraction of what muscles?
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the diaphragm and the interplay of the abdominal muscles, resulting in the expansion and recoil of the abdominal walls
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Men are likely to use what type of respiration? What about Women?
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Men are more likely to use diaphragmatic respiration and women, particularly when they are pregnant, are more likely to use thoracic
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reaction of the ribs and interspaces to respiratory obstruction
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Unilateral or bilateral bulging
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What problem can cause prolonged expiration and bulging on expiration?
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caused by outflow obstruction or the valvelike action of compression by a tumor, aneurysm, or enlarged heart. this happens, the costal angle widens beyond 90 degrees.
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When is the upper airway obstructed but not severely?
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Inspiratory stridor (with a ratio with expiration of more than 2:1); A hoarse cough or cry; Flaring of the alae nasi; Retraction at the suprasternal notch
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When is the upper airway obstructed severely?
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Stridor is inspiratory and expiratory; Cough is barking; Retractions also involve the subcostal and intercostal spaces; Cyanosis is obvious even with blow-by oxygen
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When is the upper airway obstructed? When the obstruction is above the glottis?
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Stridor tends to be quieter; The voice is muffled, as if there is a hot potato in the mouth; Swallowing is more difficult; Cough is not a factor; The head and neck may be awkwardly positioned to preserve the airway (e.g., extended with retropharyngeal abscess; head to the affected side with peritonsillar abscess)
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When is the upper airway obstructed? When the obstruction is below the glottis?
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Stridor tends to be louder, more rasping; The voice is hoarse; Swallowing is not affected; Cough is harsh, barking; Positioning of the head is not a factor
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What do Retractions suggest?
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obstruction to inspiration at any point in the respiratory tract.
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When are the respiratory musculature pulls back in an effort to overcome blockage?
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As intrapleural pressure becomes increasingly negative
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How is obstruction is high in the respiratory tree (e.g., with tracheal or laryngeal involvement) characterized?
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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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When does Paradoxic breathing occur?
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when a negative intrathoracic pressure is transmitted to the abdomen by a weakened, poorly functioning diaphragm; obstructive airway disease; or during sleep, in the event of upper airway obstruction. Thus, on inspiration, the lower thorax is drawn in, and on expiration, the opposite occurs.
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A foreign body in one or the other of the bronchi (usually the right because of its broader bore and more vertical placement) causes what movement?
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unilateral retraction, but the suprasternal notch is not involved
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Asthma and bronchiolitis cause what kind of respiratory movement?
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Retraction of the lower chest
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What are the peripheral clues suggests pulmonary or cardiac difficulty?
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lips and nails for cyanosis, the lips for pursing, the fingers for clubbing, and the alae nasi for flaring
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Pursing of the lips is an accompaniment of ___?
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increased expiratory effort
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What does pursing of the lips reduce?
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reduces the effort of dyspnea.
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What is Clubbing?
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enlargement of the terminal phalanges of the fingers and/or toes is associated
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What can cause Clubbing?
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chronic fibrotic changes within the lung, the chronic cyanosis of congenital heart disease, or cystic fibrosis. (Note that other chronic problems involving the lungs [e.g., asthma and emphysema] are not associated with clubbing.)
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Flaring of the alae nasi during inspiration is a common sign of what?
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air hunger, particularly when the alveoli are considerably 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. It may be localized (e.g., over the suprasternal notch and base of the neck) or cover a wider area of the thorax, usually anteriorly and toward the axilla. Crepitus is always a sign requiring attention.
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What is pleural friction rub ? What causes it?
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A palpable, coarse, grating vibration, usually on inspiration, suggests a pleural friction rub caused by inflammation of the pleural surfaces. Think of it as the feel 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 tenth rib, with your palms lightly in contact with the posterolateral surfaces (Fig. 13-14). Watch your thumbs diverge during quiet and deep breathing. A loss of symmetry in the movement of the thumbs suggests a problem on one or both sides. Then face the patient and place your thumbs along the costal margin and the xiphoid process, with your palms touching the anterolateral chest. Again, watch your thumbs diverge as the patient breathes.
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How does barrel chest feel on palpation compared to a normal chest during respiration?
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no thumbs diverge; The chest is so inflated that it cannot expand further and your hands may even come together a bit.
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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 second intercostal space at the level of the bifurcation of the bronchi
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Decreased or absent fremitus may be caused by what problems?
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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, often coarser or rougher in feel, occurs in what problems?
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occurs 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 occurs with what problems?
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lung consolidations and some inflammatory and infectious processes
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What can cause the trachea to deviate?
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problems within the chest and may, on occasion, seem to pulsate. It may be displaced by atelectasis, thyroid enlargement, significant parenchymal and/or pleural fibrosis, or pleural effusion; it may be pushed to one side by tension pneumothorax, a tumor, or nodal enlargements on the contralateral side; or it may be pulled by a tumor on the side to which it deviates
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How does the trachea move in a Anterior mediastinal tumors? In mediastinitis?
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Anterior mediastinal tumors may push it posteriorly; with mediastinitis, the trachea may be pushed forward
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Trachea: A palpable pull out of midline with respiration is called
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"tug"
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Percussion to the chest producing hyperresonance is caused by what problems?
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associated with hyperinflation may indicate emphysema, pneumothorax, or asthma; *Hyperresonance is an abnormal sound, the result of air trapping (e.g., in obstructive lung disease).
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Percussion to the chest producing Dullness or flatness suggest what conditions?
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atelectasis, pleural effusion, pneumothorax, or asthma.
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Tympany is the sound usually associated with __?
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percussion over the abdomen.
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What is the Intensity, Pitch, Duration, and quality for Resonant sound from Percussion to the chest
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Loud, Low, Long, Hollow
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What is the Intensity, Pitch, Duration, and quality for Flat sound from Percussion to the chest
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Soft, High, Short, Very dull
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What is the Intensity, Pitch, Duration, and quality for Dull sound from Percussion to the chest
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Medium, Medium to high, Medium, Dyll thud
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What is the Intensity, Pitch, Duration, and quality for Tympanic sound from Percussion to the chest
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Loud, High, Medium, Drumlike
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What is the Intensity, Pitch, Duration, and quality for Hyperresonant sound from Percussion to the chest
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Very loud, Very low, Longer, Booming
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What can cause the following bad breath smell: Sweet, fruity
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Diabetic ketoacidosis; starvation ketosis
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What can cause the following bad breath smell: Fishy, stale
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Uremia (trimethylamines)
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What can cause the following bad breath smell: Ammonia-like
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Uremia (ammonia)
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What can cause the following bad breath smell: Musty fish, clover
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Fetor hepaticus: hepatic failure, portal vein thrombosis, portacaval shunts
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What can cause the following bad breath smell: Foul, feculent
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Intestinal obstruction/diverticulum
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What can cause the following bad breath smell: Foul, putrid
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Nasal/sinus pathology: infection, foreign body, cancer; respiratory infections: empyema, lung abscess, bronchiectasis
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What can cause the following bad breath smell: Halitosis
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Tonsillitis, gingivitis, respiratory infections, Vincent angina, gastroesophageal reflux
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What can cause the following bad breath smell: Cinnamon
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Pulmonary tuberculosis
|
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Where do most pulmonary pathologic conditions in older patients occur?
|
Lung base
|
|
Which breath sound is Heard over most of lung fields; low pitch; soft and short expirations (see Figs. 13-22 and 13-23); more prominent in a thin person or a child, diminished in the overweight or very muscular patient
|
Vesicular
|
|
Which breath sound is Heard over main bronchus area and over upper right posterior lung field; medium pitch; expiration equals inspiration?
|
Bronchovesicular
|
|
Which breath sound is Heard only over trachea; high pitch; loud and long expirations, sometimes a bit longer than inspiration?
|
Bronchial/tracheal (tubular)
|
|
Why is the diaphragm of the stethoscope usually preferable to the bell for listening to the lungs?
|
because it transmits the ordinarily high-pitched sounds better and because it provides a broader area of sound
|
|
In CHF, why do you begin auscultation at the base of the lungs?
|
to detect crackles that may disappear with continued exaggerated respiration
|
|
Where are the sounds of the middle lobe of the right lung and the lingula on the left are best heard?
|
in the respective axillae
|
|
What are Vesicular breath sounds?
|
low-pitched, low-intensity sounds heard over healthy lung tissue
|
|
What are Bronchovesicular sounds?
|
heard over the major bronchi and are typically moderate in pitch and intensity
|
|
What are bronchial breath sounds?
|
The sounds highest in pitch and intensity are the bronchial breath sounds, which are ordinarily heard only over the trachea
|
|
When are bronchovesicular and bronchial breath sounds abnormal?
|
if they are heard over the peripheral lung tissue.
|
|
What is and when do you hear amphoric breathing?
|
Breathing that resembles the noise made by blowing across the mouth of a bottle is defined as amphoric and is most often heard with a large, relatively stiff-walled pulmonary cavity or a tension pneumothorax with bronchopleural fistula
|
|
What is Cavernous breathing and when do you hear it?
|
sounding as if coming from a cavern, is commonly heard over a pulmonary cavity in which the wall is rigid.
|
|
What causes breath sounds to be hard to hear?
|
more difficult to hear or are absent if fluid or pus has accumulated in the pleural space, if secretions or a foreign body obstructs the bronchi, if the lungs are hyperinflated, or if breathing is shallow from splinting because of pain
|
|
When are Breath sounds are easier to hear?
|
When the lungs are consolidated; the mass surrounding the tube of the respiratory tree promotes sound transmission better than do air-filled alveoli.
|
|
What is a crackle sound?
|
an abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds, each lasting just a few milliseconds. The individual noise tends to be brief and the interval to the next one similarly brief.
|
|
What is white noise breath sound in patients?
|
expiratory wheezing without the stethoscope or, on inspiration in patients with chronic bronchitis or asthma, a radio static-like sound lacking a musical pitch. This, perhaps without a common understanding, is termed white noise and is caused by a narrowed central airway.
|
|
What causes crackles?
|
disruptive passage of air through the small airways in the respiratory tree
|
|
What is sibilant?
|
High-pitched crackles
|
|
What is sonorous?
|
Low-pitched crackles
|
|
What do Crackles with a dry quality sound like and where do they tend to occur?
|
more crisp than gurgling, are apt to occur higher in the respiratory tree.
|
|
What are fine crackles?
|
high-pitched, discrete, discontinuous crackling sounds heard during the end of inspiration; not cleared by a cough
|
|
What are medium crackles?
|
Lower, more moist sound heard during the midstage of inspiration; not cleared by a cough
|
|
What are Coarse crackles?
|
loud, bubbly noise heard during inspiration; not cleared by a cough
|
|
What are Rhonchi (sonorous wheeze)?
|
loud, low, coarse sounds like a snore most often heard continuously during inspiration or expiration; coughing may clear sound (usually means mucus accumulation in trachea or large bronchi)
|
|
What are Wheeze (sibilant wheeze)?
|
musical noise sounding like a squeak(or whistle); most often heard continuously during inspiration or expiration; usually louder during expiration
|
|
What does Pleural friction rub sound like? what causes it? And where is it best heard?
|
dry, rubbing, or grating sound, usually caused by inflammation of pleural surfaces; heard during inspiration or expiration; loudest over lower lateral anterior surface
|
|
What causes Rhonchi (sonorous wheezes)?
|
passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure
|
|
Where do more sibilant, higher-pitched rhonchi arise from?
|
the smaller bronchi, as in asthma
|
|
Where do more sonorous, lower-pitched rhonchi arise from?
|
larger bronchi, as in tracheobronchitis
|
|
How do you distinguish between crackles and rhonchi?
|
rhonchi tend to disappear after coughing, whereas crackles do not
|
|
What causes a wheeze (sibilant wheeze)?
|
relatively high-velocity air flow through a narrowed or obstructed airway. The longer the wheeze and the higher the pitch, the worse the obstruction
|
|
What may cause a wheeze heard bilaterally?
|
bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis
|
|
What may cause a Unilateral or more sharply localized wheezing or stridor?
|
foreign body
|
|
What may cause a consistent wheeze or whistle of single pitch at the site of compression?
|
tumor compressing a part of the bronchial tree
|
|
If a infection is the cause of a wheeze? What is the usual organism type?
|
Viral instead of bacterium
|
|
Where are fiction rub sounds?
|
outside the respiratory tree
|
|
Describe a friction rub sound and when best heard
|
dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration. It may have a machine-like quality
|
|
When does a friction rub sound have no significance?
|
if heard over the liver or spleen
|
|
What can cause a friction rub heard over the heart or lungs?
|
inflamed, roughened surfaces rubbing together. Over the pericardium, this sound suggests pericarditis; over the lungs, pleurisy
|
|
What is the difference between a respiratory friciton rub and a cardiac rub?
|
The respiratory rub disappears when the breath is held; the cardiac rub does not.
|
|
What can compress the trachea and compromise breathing, making it noisier and more difficult and make a patient sit up and lean forward to relieve the compression?
|
anterior mediastinal mass
|
|
What is found with a Mediastinal crunch (Hamman sign)?
|
mediastinal emphysema
|
|
great variety of noise-loud crackles and clicking and gurgling sounds. These are synchronous with the heartbeat and not particularly so with respiration, but the sounds can be more pronounced toward the end of expiration. They are easiest to hear when the patient leans to the left or lies down on the left side
|
Mediastinal crunch (Hamman sign) is found with mediastinal emphysema
|
|
How can you hear for Air and fluid simultaneously present in the pleural cavity or in large cavities within the lungs? What type of sound are you looking for?
|
can be heard if one listens over the possibly involved area while gently shaking the patient. With the patient sitting, place a hand on the patient's shoulder and then move the patient from side to side, not brusquely but with a bit of vigor. The fluid will splash, and in the presence of air, a succussion splash will be heard.
|
|
What is bronchophony?
|
Greater clarity and increased loudness of spoken sounds
|
|
What is whispered pectoriloquy? When can you hear it?
|
bronchophony is extreme (e.g., in the presence of consolidation of the lungs), even a whisper can be heard clearly and intelligibly through the stethoscope
|
|
What is egophony? When can you hear it?
|
When the intensity of the spoken voice is increased and there is a nasal quality (e.g., e's become stuffy broad a's), the auditory quality is called egophony.
|
|
How does vocal resonance change with emphysema?
|
vocal resonance diminishes and loses intensity when there is blockage of the respiratory tree for any reason
|
|
How does Anthrax present?
|
Your patients might come in with flu-like fever, achiness, sniffles, and little else; this is how the disease process starts when spores of Bacillus anthracis are inhaled.
|
|
What causes smallpox?
|
variola virus
|
|
How does Smallpox present?
|
prodrome lasting 3 to 4 days characterized by nonspecific headache, chills, fever, and generalized aches and pains. Temperature drops and then skin lesions begin to appear, at first primarily on the face and upper extremities
|
|
What is the cause of the Plaque?
|
Yersinia pestis
|
|
How does The Plaque present?
|
nonspecific fever and malaise, and even mental confusion and a possible staggering gait; Buboes. Pulmonary might not show buboes, can have respiratory distress with enlarged nodes
|
|
What can cause a moist cough? What is it accompanied by?
|
infection, sputum production
|
|
What can cause a dry cough?
|
A dry cough can have a variety of causes (e.g., cardiac problems, allergies, HIV infection), which may be indicated by the quality of its sound.
|
|
What does a acute onset of cough suggest?
|
An acute onset, particularly with fever, suggests infection; in the absence of fever, a foreign body or inhaled irritants are additional possible causes.
|
|
What can cause a infrequent cough?
|
allergens or environmental insults
|
|
What kind of cough is heard in pertussis?
|
A regular, paroxysmal cough
|
|
What can cause a irregularly occurring cough?
|
variety of causes (e.g., smoking, early congestive heart failure, an inspired foreign body or irritant, or a tumor within or compressing the bronchial tree
|
|
What kind of Postural Influences can cause a cough?
|
after a person has reclined or assumed an erect position (e.g., with a nasal drip or pooling of secretions in the upper airway).
|
|
What can cause a dry cough may sound brassy?
|
compression of the respiratory tree (as by a tumor) or hoarse if it is caused by croup.
|
|
inspiratory whoop at the end of a paroxysm of coughing.
|
Pertussis
|
|
What is vital capacity (VC)?
|
amount of air that is expelled after the patient takes a maximal inspiration and follows that with a maximal expiration
|
|
What is peak expiratory flow rate (PEFR)?
|
a measure of the maximum flow of air that can be achieved during forced expiration, is a useful surrogate for the VC in children as well as adults
|
|
How you can measure forced vital capacity (FVC)?
|
roughly estimated by asking the patient to exhale to the limit and then to hold the breath. Count the seconds until a breath must be taken and multiply that number by 50 to get the number of cc's of FVC
|
|
What does acute onset of Sputum suggest?
|
Infection
|
|
What does chronic Sputum suggest?
|
Possibility of a significant anatomic change (e.g., tumor, cavitation, or bronchiectasis) becomes apparent
|
|
Cause of Sputum? Yellow, green, rust (blood mixed with yellow sputum), clear, or transparent; purulent; blood streaked; mucoid, viscid
|
Bacterial infection
|
|
Cause of Sputum? Mucoid, viscid; blood streaked (not common)
|
Viral infection
|
|
Cause of Sputum? All of the above; particularly abundant in the early morning; slight, intermittent blood streaking; occasionally, large amounts of blood*
|
Chronic infectious disease
|
|
Cause of Sputum? Slight, persistent blood streaking
|
Carcinoma
|
|
Cause of Sputum? Blood clotted; large amounts of blood
|
Infarction
|
|
Cause of Sputum? Large amounts of blood*
|
Tuberculous cavity
|
|
What is normal chest circumference for a full term infant?
|
30 to 36 cm, sometimes 2 to 3 cm smaller than the head circumference
|
|
How is the chest circumference different between a intrauterine growth retardation and a diabetic mother baby?
|
An infant with intrauterine growth retardation will have a relatively smaller chest circumference compared to the head, whereas the infant of a poorly controlled diabetic mother will have a relatively larger chest circumference
|
|
What are supernumerary nipples? Where are they? What do they suggest?
|
ordinarily not fully developed, along a line drawn caudad from the primary nipple. In white children, but not as often in blacks, they may be associated with a variety of congenital abnormalities.
|
|
acrocyanosis in a newborn for several days only may suggest what?
|
nothing
|
|
What is the expected respiratory rate in a newborn?
|
The expected rate varies from 40 to 60 respirations per minute, although a rate of 80 is not uncommon
|
|
What is Periodic breathing in a newborn?
|
a sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10 to 15 seconds, is common
|
|
When is periodic breathing a concern for a newborn?
|
cause for concern if the apneic episodes tend to be prolonged and the baby becomes centrally cyanotic (i.e., cyanotic about the mouth, face, and torso)
|
|
What is a diaphragmatic hernia? What are the concerns?
|
result of an imperfectly structured diaphragm, occurs once in slightly more than 2000 live births; heart move to the right, respiratory distress, defects in one or both lungs
|
|
What does Frequent hiccupping in a infant suggest?
|
seizures, drug withdrawal, or encephalopathy, among other possibilities.
|
|
When is it common for a infant to have Paradoxic breathing?
|
Paradoxic breathing (the chest wall collapses as the abdomen distends on inspiration) is common, particularly during sleep.
|
|
What can occur in a difficult forceps delivery?
|
Crepitus around a fractured clavicle (with no evidence of pain) is common
|
|
Why is it common to hear to hear crackles and rhonchi immediately after birth?
|
fetal fluid has not been completely cleared
|
|
Stridor accompanied by a cough, hoarseness, and retraction, signifies what problem?
|
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)
|
|
How does Stridor sound in a infant? Cause?
|
high-pitched, piercing sound most often heard during inspiration. It is the result of an obstruction high in the respiratory tree
|
|
What is the I/E ratio to be concern at?
|
inspiration (I) may be three to four times longer than expiration (E), giving an I/E ratio of 3:1 or 4:1
|
|
What can make a baby head bob in the supine position?
|
Retraction at the supraclavicular notch and contraction of the sternocleidomastoid muscles
|
|
Infants who have a narrow tracheal lumen readily respond with stridor because of what problem?
|
compression by a tumor, abscess, or double aortic arch.
|
|
What is Respiratory grunting in an infant?
|
mechanism by which the infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
|
|
Flaring of the alae nasi is another indicator for?
|
respiratory distress at this, or any, age.
|
|
What musculature for respiration do children use by age 6 or 7?
|
thoracic (intercostal) musculature for respiration
|
|
In young children, obvious intercostal exertion (retractions) on breathing suggests….
|
airway problem (e.g., asthma).
|
|
If the roundness of the young child's chest persists past the second year of life, be concerned about the possibility of ….
|
chronic obstructive pulmonary problem such as cystic fibrosis
|
|
What change in lung volume can a pregnant women have?
|
decrease in functional residual capacity (FRC), which is the volume of air in the lungs at the end of quiet exhalation
|
|
How is vital capacity in a pregnant women changed?
|
There is an increase of 100 to 200 mL in vital capacity, the amount of air that can be expelled at the normal rate of exhalation after a maximum inspiration
|
|
How is tidal volume changed in a pregnant women?
|
the amount of air inhaled and exhaled during normal breathing, increases 40% along with minute ventilation
|
|
How is ventilation changed in a pregnant women?
|
increases her ventilation by breathing more deeply, not more frequently.
|
|
What causes hyperresonance in older adults?
|
increased distensibility of the lungs
|
|
How does the diameter of the chest in older adults change?
|
The AP diameter of the chest is increased in relation to the lateral diameter
|
|
How does the spine change in older adults?
|
The dorsal curve of the thoracic spine is prominent (kyphosis) with flattening of the lumbar curve
|
|
What does Calcification of rib articulations cause in older adults?
|
interfere with chest expansion, requiring use of accessory muscles
|
|
What is Asthma?
|
chronic obstructive pulmonary disease (COPD) characterized by airway inflammation
|
|
What can cause asthma?
|
airway hyperreactivity triggered by allergens, anxiety, upper respiratory infections, cigarette smoke or other environmental poisons, or exercise. Cold air aggravates asthma. The result is mucosal edema, increased secretions, and bronchoconstriction. Airway resistance increases and respiratory flow is impeded.
|
|
a youngster, presents with wheezing for the first time
|
Foreign Object
|
|
Describe a asthma attack
|
Episodes are characterized by paroxysmal dyspnea; tachypnea; cough; wheezing on expiration and inspiration; and, as airway resistance increases, more prolonged expiration. Chest pain is common and, with it, a feeling of tightness.
|
|
What is Atelectasis?
|
incomplete expansion of the lung at birth or the collapse of the lung at any age
|
|
What can cause Collapse in Atelectasis?
|
compression from outside (e.g., exudates, tumors) or resorption of gas from the alveoli in the presence of complete internal obstruction (the loss of elastic recoil of the lung for any reason [e.g., thoracic or abdominal surgery, plugging, exudates, foreign body]). The affected area of the lung is airless. The overall effect is to dampen or mute the sounds in the involved area.
|
|
What is Bronchitis?
|
inflammation of the mucous membranes of the bronchial tubes
|
|
Which bronchitis is accompanied by chest pain and fever?
|
Acute
|
|
Which bronchitis has excessive secretion of mucus in the bronchial tree?
|
Chronic
|
|
What is Pleurisy?
|
inflammatory process involving the visceral and parietal pleura, often the result of pulmonary infections, bacterial or viral, and sometimes associated with neoplasm or asbestosis
|
|
What symptoms can occur if Pleurisy is near the diaphragm?
|
pain can be referred to the ipsilateral shoulder
|
|
What symptoms can occur if Pleuristy is becoming pleural effusion?
|
the pain and rub may disappear; but the fever, tachypnea, and malaise will not.
|
|
What is a pleural effusion?
|
Excessive nonpurulent fluid in the pleural space can result in permanent fibrotic thickening. The sources of fluid vary: infection, neoplasm, and trauma are all possible causes
|
|
What is Grocco's triangle?
|
in Pleural effusion, a right-angled area of dullness over the posterior chest, which can sometimes be percussed opposite a large pleural effusion, the diaphragm on the horizontal of the triangle, the spinous processes, the vertical.
|
|
How are breath sounds and percussion in an area of pleural effusion sound?
|
breath sounds are muted; percussion note is often hyperresonant (Skodaic resonance) in the area above the perfusion
|
|
What is Empyema?
|
said to occur when fluid collected in the pleural spaces is a purulent exudate, arising most commonly from adjacent infected, sometimes traumatized, tissues
|
|
What other problems are associated with Empyema?
|
It may be complicated by pneumonia, a penetrating injury, simultaneous pneumothorax, or bronchopleural fistulae.
|
|
How are breath sounds, percussion, vocal fremitus and patient status in Empyema?
|
Breath sounds are distant or absent in the affected area, the percussion note is dull, vocal fremitus is absent, and the patient is often febrile and tachypneic and appears ill.
|
|
What is a lung abscess?
|
well-defined, circumscribed mass defined by inflammation, suppuration, and subsequent central necrosis
|
|
Most common cause of lung abscess?
|
Aspiration of food or infected material from upper respiratory or dental sources of infection
|
|
Percussion sound, breath note, accompanied symptoms in Lung abscess?
|
The percussion note is dull and the breath sounds distant or absent over the affected area. There may be a pleural friction rub, and cough may produce a purulent, foul-smelling sputum. The patient is usually obviously ill and febrile, sometimes tachypneic. The breath commonly has a foul odor.
|
|
What is Pneumonia?
|
inflammatory response of the bronchioles and alveolar spaces to an infective agent (bacterial, fungal, or viral). Exudates lead to lung consolidation, resulting in dyspnea, tachypnea, and crackles.
|
|
Percussion sound, breath note, accompanied symptoms in Pneumonia?
|
Diminished breath sounds and dullness to percussion occur over the area of consolidation. Involvement of the right lower lobe can stimulate the tenth and eleventh thoracic nerves to cause right lower quadrant pain and simulate an abdominal process.
|
|
In children, what other symptoms then audible crackles should a doctor note that suggest 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
|
|
characterized by cough, fever, malaise, headache, and the coryza and mild sore throat typical of the common cold
|
Influenza
|
|
The entire respiratory tract may be overwhelmed by interstitial inflammation and necrosis extending throughout the bronchiolar and alveolar tissue (Fig. 13-33). There may be a variety of respiratory findings: crackles, rhonchi, and tachypnea, as well as cough (generally nonproductive) and substernal pain.
|
Influenza
|
|
What is Tuberculosis?
|
chronic infectious disease that most often begins in the lung but may then have widespread manifestations in many organs and systems
|
|
How does Tuberculosis start?
|
tubercle bacillus (usually Mycobacterium tuberculosis; occasionally Mycobacterium bovis or an atypical mycobacterium) is inhaled from the airborne moisture of the coughs and sneezes of infected persons and given the opportunity to settle in the furthest reaches of the lung. Latent period not sick
|
|
What group of people have increasing incidence of tuberculosis and of mycobacteria that are resistant to treatment?
|
HIV population
|
|
What is PNEUMOTHORAX and what can cause it?
|
The presence of air or gas in the pleural cavity may be the result of trauma or may occur spontaneously, perhaps because of rupture of a congenital bleb
|
|
What is tension pneumothorax?
|
air leaks continually into the pleural space, becoming trapped on expiration and resulting in increasing pressure in the pleural space
|
|
What can be a clue to a minimal pneumothorax ?
|
An unexplained but persistent tachycardia may be a clue to a minimal pneumothorax that will not otherwise be detected on physical examination.
|
|
Breath sounds and percussion in pneumothorax?
|
breath sounds are distant but the percussion note may boom.
|
|
What is a positive coin click test sound like and what is it looking for?
|
Place a coin over the suspicious area in the chest (e.g., posteriorly) and, while listening to the opposite side (anteriorly), have someone strike the coin with the edge of another. A clear click will be heard only in the event of a pronounced pneumothorax.
|
|
What is hemothorax and what is the cause?
|
The presence of blood in the pleural cavity,may be the result of trauma or invasive medical procedures (e.g., thoracentesis, pleural biopsy)
|
|
Breath sounds and percussion in hemothorax with predominantly blood?
|
If there is no air, or if blood predominates, the breath sounds will be distant or absent, the percussion note will be dull, and the coin click will be absent
|
|
What can cause lung cancer?
|
Etiologic agents include tobacco smoke, asbestos, ionizing radiation, and other inhaled chemicals and noxious agents
|
|
What symptoms can lung cancer cause?
|
It may cause cough, wheezing, a variety of patterns of emphysema and atelectasis, pneumonitis, and hemoptysis
|
|
What is Cor pulmonale?
|
acute or chronic condition involving right-sided heart failure
|
|
What is acute cor pulmonale?
|
In the acute phase, the right side of the heart is dilated and fails, most often as a direct result of pulmonary embolism
|
|
What is chronic phase cor pulmonale?
|
In chronic cor pulmonale, a chronic, 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 Pulmonary embolism?
|
Risk factors include, among others, age older than 40 years, 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 may be a clue to a Pulmonary embolism?
|
Pleuritic chest pain in the absence of dyspnea is a major clue to embolism. There may be a low-grade fever.
|
|
What is Cystic fibrosis (CF)?
|
autosomal recessive disorder of exocrine glands involving the lungs, pancreas, and sweat glands
|
|
What is the hallmark of CF in children younger than 5?
|
Cough with sputum
|
|
How does CF present?
|
distinctive Salt in sweat, Abnormally thick mucus may cause progressive clogging of the bronchi and bronchioles, and subsequent pulmonary infections; Initially, areas of hyperinflation and atelectasis are evident. As pulmonary dysfunction progresses, the tolerance for exercise diminishes and pulmonary hypertension and cor pulmonale often occur.
|
|
What is Epiglottitis?
|
acute, life-threatening disease almost always caused by Haemophilus influenzae type B. It begins suddenly and progresses rapidly, often to full obstruction of the airway (Fig. 13-40, A) and resulting in death.
|
|
child sits straight up with neck extended and head held forward, appears very anxious and ill, is unable to swallow, and is drooling from an open mouth; cough is not common. The fever may be high. The epiglottis appears beefy red
|
Epiglottitis
|
|
What is Croup?
|
syndrome that generally results from infection with a variety of viral agents, particularly the parainfluenza viruses. It occurs most often in very young children, generally from about 1½ to 3 years of age.
|
|
The child awakens suddenly, often very frightened, with a harsh, bark-like cough. Labored breathing, retraction, hoarseness, and inspiratory stridor are characteristic. No fever, laryngotracheobronchitis, no drooling of face
|
Croup
|
|
What are risk factors for respiratory distress syndrome (RDS)?
|
premature, decreasing gestational age, maternal diabetes, acute asphyxia, and with a family history of the problem. White males and the second of twins are also at greater risk
|
|
What are the symptoms of RDS?
|
Tachypnea, retractions, grunting, and cyanosis are all part of the clinical picture
|
|
What is ARDS and the cause?
|
Full-term infants have on occasion suffered adult respiratory distress syndrome (ARDS), a harrowing problem because of the complications of shock, asphyxia, and aspiration.
|
|
What is tracheomalacia?
|
Noisy breathing in infancy, sometimes described as wheezing, is often inspiratory stridor. It can often be attributed to a floppiness of the trachea or airway, a lack of rigidity termed tracheomalacia. This condition causes the trachea to change in response to the varying pressures of inspiration and expiration
|
|
What problems can acommpanied by tracheomalacia?
|
At times, the larynx may also have the same yielding characteristic (laryngomalacia; if the entire large airway is involved, the condition is called laryngotracheomalacia).
|
|
Who gets Bronchiolitis the most?
|
infants younger than 6 months old
|
|
principal characteristic of Bronchiolitis? Cause?
|
hyperinflation of the lungs. The cause is viral, usually the respiratory syncytial virus
|
|
Expiration becomes difficult, and the infant appears anxious and tachypneic. Generalized retraction and perioral cyanosis are common. AP diameter of the thoracic cage may be increased and percussion hyperresonant.Wheezing may or may not be apparent. In the presence of severe tachypnea, air exchange is poor and the breaths are rapid and short, with the expiratory phase prolonged. Crackles may or may not be heard. The abdomen appears distended from swallowed air.
|
Bronchiolitis
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group of respiratory problems in which coughs, chronic and often excessive sputum production, and dyspnea are prominent features. Ultimately, an irreversible expiratory airflow obstruction occurs.
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
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eased by leaning forward and resting the arms on the knees
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Dyspnea
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forced expiration time is longer than 4 to 5 seconds
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suspect airway obstruction.
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What is Emphysema?
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most severe chronic obstructive pulmonary disorder, is a condition in which air may take over and dominate a space in a way that disrupts function. The air spaces beyond the terminal bronchioles dilate, rupturing alveolar walls, permanently destroying them, reducing their number, and permanently hyperinflating the lung
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Alveolar gas is trapped, essentially in expiration, and gas exchange is seriously compromised. Chronic bronchitis is a common precursor. Involutionary changes as the lungs lose elasticity because of aging, smoking, or impairment of the defenses mediated by α-antitrypsin are also contributors
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Emphysema
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The overinflated lungs tend to be hyperresonant on percussion. Further expansion on inspiration is limited; occasionally there is a prolonged expiratory effort (i.e., longer than 4 or 5 seconds) to expel air. Dyspnea is common even at rest. Cough is infrequent without much production of sputum. The patient is often thin and barrel-chested, even cachectic
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Emphysema
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What is BRONCHIECTASIS and what is the cause?
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Chronic dilation of the bronchi or bronchioles is caused by repeated pulmonary infections and bronchial obstruction
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What can Bronchiectasis lead to?
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malfunction of bronchial muscle tone and loss of elasticity
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Findings of Bronchiectasis?
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The extent of findings on physical examination is governed by the degree of wetness. The cough and expectoration are most often the major clues; Kartagener syndrome (sometimes)
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What is Kartagener syndrome?
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autosomal recessive condition, is characterized by bronchiectasis, sinusitis, dextrocardia, and male infertility.
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Who gets CHRONIC BRONCHITIS? Symptoms and common risk factor?
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patients older than 40. The mucus of the bronchi is chronically inflamed, recurrent bacterial infections are common, dyspnea may be present although not severe, and cough and sputum are impressive. Smoking is prominent in the history
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absence of spontaneous respiration
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Apnea
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irregular breaths varying in depth and interrupted by intervals of apnea but lacking repetitive pattern, associated with increased intracranial pressure
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Biot respiration
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greater clarity and increased loudness of spoken words
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Bronchophony
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typically moderate in intensity; heard over major bronchi
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Bronchovesicular
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intervals of apnea followed by crescendo/decrescendo squence of breathing; often accociated with dying
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Cheyne-Stokes
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sudden spasmodic expiration, forcing a sudden opening of the glottis
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Cough
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abnormal sound, more often heard on inspiration; characterized by discrete discontinuous sounds; rales
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Crackles
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increase of intensity of spoken sound with accompanying nasal sound
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Egophony
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occurs outside the respiratory tree; dry, crackly, grating, low-pitched sound
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Friction rub
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mediastinal crunch; variety of sound including loud crackles and clicking or gurgling sounds; associated with mediastinal emphysema
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Hamman sign
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deep and usually rapid; associated with metabolic acidosis
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Kussmaul
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whisper can be clearly heard through stethoscope; associated with consolidation of lungs
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Pectoriloquy
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sonorous wheezes
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Rhonchi
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high-pitched piercing sound heard during inspiration
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Stridor
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low pitched, low-intensity sounds heard over healthy lung tissue
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Vesicular
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spoken word transmitted through lung fields; usually muffled and indistinct
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Vocal Resonance
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continuous, high-pitched musical sound; almost whistle; heard on inspiration or expiration
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Wheeze
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Airway reactivity triggered by allergens, anxiety, or URI
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Asthma
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Excessive nonpurulent fluid in the pleural space
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Pleural effusion
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Inflammation of the mucous membranes of the bronchial tubes
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Bronchitis
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Inflammatory process involving the viseral and parietal pleura
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Pleurisy
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Purulent exudate collected in the pleural spaces
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Empyema
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Inflammatory response of the bronchioles and alveolar spaces
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Pneumonia
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Chronic Infectious disease beginning in the lung with the tubercle bacillus
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Tuberculosis
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Acute or chronic infection involving the right-sided heart failure
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Cor Pulmonale
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Autosomal recessive disorder of exocrine glands in children younger than 5 years of age
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Cystic fibrosis
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Chronic dilation of the bronchi or bronchioles caused by repeated pulmonary infections
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Bronchiectasis
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What examination method will elicit the clinical finding: Biot's respiration
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Inspection
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What examination method will elicit the clinical finding: Tactile fremitus
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Palpation
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What examination method will elicit the clinical finding: Chyne-stokes
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Inspection
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What examination method will elicit the clinical finding: Dullness
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Percussion
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What examination method will elicit the clinical finding: Vesicular
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Auscultation
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What examination method will elicit the clinical finding: Tympany
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Percussion
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What examination method will elicit the clinical finding: Dyspnea
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Inspection
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What examination method will elicit the clinical finding: Bronchophony
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Auscultation
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What examination method will elicit the clinical finding: Vibration
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Palpation
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What examination method will elicit the clinical finding: Kussmaul breathing
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Inspection
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What examination method will elicit the clinical finding: Bronchial
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Auscultation
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What examination method will elicit the clinical finding: Rhonchi
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Auscultation
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What examination method will elicit the clinical finding: Barrel chest
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Inspection
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What examination method will elicit the clinical finding: Hyperresonance
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Percussion
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What examination method will elicit the clinical finding: Wheeze
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Auscultation
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What examination method will elicit the clinical finding: Tug
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Palpation
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What examination method will elicit the clinical finding: Crackles
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Auscultation
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What examination method will elicit the clinical finding: Diaphragmatic excursion
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Percussion
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What examination method will elicit the clinical finding: Bronchovesicular
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Auscultation
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What examination method will elicit the clinical finding: Crepitus
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Palpation
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