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317 Cards in this Set

  • Front
  • Back
What makes up the chest anteriorly
sternum, manubrium, xiphoid process and costal cartilages
what makes up the chest laterally
12 pairs of ribs
what makes up the chest posteriorly
12 thoracic vertebrae
which ribs are connected to the thoracic vertebrae
all of threm
which diameter is greater in adults, lateral or AP
lateral
what are the primary muscles of respiration
diaphragm and intercostals
what is the function of the external intercostals
increase the AP chest diameter during inspiration
internal intercostal function
decrease the lateral diameter during expiration
how do the sternocladomastoid and trap muscles assist with respiration
during exercise or pulmonary compromise
three interior divisions of the c
hest
left and right plural cavities and the mediasteinum
what is located in the mediasteinum
all of the thoracic viscera except the lungs
what lines the pleural cavities
visceral, parietal and serous pleura
where is the lingula located
upper left love of the lungs
what does the horizontal fissure divide
upper and middle lobes of the right lung at the 5th rib in the axilla and 4th rib anteriorly
what limits lung expansion
elastic subpleural tissue
how far does the lung extend above the first rib in adults
4 cm
posteriorly, to what level to the lungs extend anteriorly
T1
what do the borders of the lung extend to inferiorly on deep inspiration and forced expiration
t12 and t9
how long is the trachea
10 or 11 cm, 2 cm diamter
where does the trachea bifurcate
t4 t5
why is the right bronchus more prone to obstruction
wider, shorter and more vertically placed than the left
how are the main bronchi divided
3 on the right, 2 on the left
where do the bronchial arteries come from
anterior thoracic aorta and intercostal arteries
where is the bronchial vein formed
hilum of the lung
what is the main conduit of blood leaving the lungs
pulmonary veins
why is the right lung higher than the left
dome of the liver
posterior - lobe extension during inspiration and expiration
T3 to T10/t12
left lateral - lung extension
axilla to 7 or 8th rib
oblique fissue left lateral
3rd rib medially to 6th rib anteriorly
manubriosternal junction - what rib articulates with it
2nd
in intercostal spacing, which rib forms the top of each space
the number of each space corresponds to the rib above it
costal angle
angle formed by blending of the costal margins at the sternum
what are the costal angles
90 degrees with ribs at 45 degrees
what are the lungs at 4 weeks gestation
groove on the ventral wall of the gut
what is fetal gas exchange mediated by
placenta
what causes blood to flow through the lungs at birth
lesser resistance in pulmnonary circulation ass opposed to systemic
what closes when pulmnonary pressure declines
foramen ovale
what contracts with increased oxygen content in blood
ductus arteriosus
what is the diameter relationship of the newborn
AP is equal to lateral
when do alveoli proliferate
first 2 years of life
when does alveoli proliferation slow down
8 years old
what changes respiratory activity in pregnant women
expanding uterus and circulating progesterone
rib changes in pregnant women
increase in lower rib lateral diameter of 2cm and increase in circumference of 5 to 7 cm
diaphrapgm rises how much in pregnancy
4cm
what ventillatory changes happen in pregnancy
minute ventilation increased due to increased tidal volume
why does barrel chest occur
loss of muscle strength in the thorax and diaphragm
changes in dorsal curve of the thoracic spine do what
increased AP chest diameter
what happen to alveoli as you get older
get less elastic and more fibrotic, less area for gas exchange
what is the end result of the loss of elasticity and loss of tolerance for exertion in the lungs
decrease in vital capaicty and increase in residual capacity
mucous membranes as you get older
become drier and become harder to remove, increase propensity for bacterial growth
dyspnea
difficult and labored breathing with shortness of breath
what factors can cause dyspnea
pulmonary or cardiac compromise
what can cause dyspnea in an otherwise well person
being a fat fuck - sedentary lifestyle and obesity
orthopnea
shortness of breath that begins or increases when the patient lies down - ask if they have to sleep on a pillow or not
paroxymal nocturnal dyspnea
sudden shortness of breath after a period of sleep
platypnea
dyspnea that occurs in the upright posture
constant ache that lasts all day (chest pain)
chest pain that does not originate from the heart
chest pain that does not radiate
chest pain that does not originate from the heart
chest pain that is not made worse by pressing on the pecordium
chest pain that does not originate from the heart
chest pain that is a fleeting, needle like jab that only lasts for a second or two
chest pain that does not originate from the heart
chest pain that is situated between the shoulders or in between the shoulderblades in the back
chest pain that does not originate from the heart
chest pain associated with what symptoms can indicate a problem
(5)
trauma, coughing, lower respiratory infections, recent anesthesia, history of thrombophlebitis
chest pain that occurs simultaneously with what can indicate some fucked up shit happening (6)
shallow breathing, fever, coughing, anxiety about getting air, radiation of pain to neck or arms
what can happen when you snort too many lines of coke
severe, acute chest pain, tachycardia, hypertension, coronary artery spasm, and pneumothorax
what is the order of the exam for lungs
inspection, palpation, percussion and ascultation
dullness on percussion is present with what
pleural effusion and lobar pneumonia
breath sounds are absent in what
pleural effusion
bronchial breath sounds in what
lobar pneumonia
tactile fremitus is absent in what
effusion
tactile fremitus is increased in what
pneumonia
chest pain that is situated between the shoulders or in between the shoulderblades in the back
chest pain that does not originate from the heart
chest pain associated with what symptoms can indicate a problem
(5)
trauma, coughing, lower respiratory infections, recent anesthesia, history of thrombophlebitis
chest pain that occurs simultaneously with what can indicate some fucked up shit happening (6)
shallow breathing, fever, coughing, anxiety about getting air, radiation of pain to neck or arms
what can happen when you snort too many lines of coke
severe, acute chest pain, tachycardia, hypertension, coronary artery spasm, and pneumothorax
what is the order of the exam for lungs
inspection, palpation, percussion and ascultation
dullness on percussion is present with what
pleural effusion and lobar pneumonia
breath sounds are absent in what
pleural effusion
bronchial breath sounds in what
lobar pneumonia
tactile fremitus is absent in what
effusion
tactile fremitus is increased in what
pneumonia
bronchopulmonary dysplasia and transient tachypnea of the newborn can lead to low birth weight
that shit cray
what kind of light is needed to highlight chest movement
bright tangental
what defects can be noticed with tangental light situations
minimial pulsations or retractions or presence of deformities
what is the difference in the AP diameter as opposed t o the lateral
AP is about half lateral
what does barrel chest arise from
compromised respiration (chronic asthma, emphysema, cystic fibrosis)
what are the physiological changes that occur in barrel chest
ribs are more horizontal, and somewhat kyphotic, sternal angle is more prominent, posterior trachea
thoracic ratio in barrel chest
normally .70-.75, can approach 1.0 in chronic conditions
where is the midsternal line
vertically down the midline of the sternum
where are the right and left midclavicular lines
parallel to the midsternal line, at midclavicular, inferior borders of the lung go to 6th rib at MCL
right and left midaxillary lines
parallel to midsternal, begin at midaxilla
right and left posterior axillary lines
parallel to midsternal lines, beginning at posterior axillay folds
vertebral line
vertically down spinal processes
right and left scapular lines
parallel to vertebral line, though inferior angle of scapula
posterior spine deviation
kyphosis
lateral spine deviation
scoliosis
pidgeon chest
pectus carnaitum
funnel chest
pectus excavatum - indentation lower sternum above the xyphoid process
what happens to someones breath when they have an intrathoracic infection
it becomes malodorous
supernumary nipples
sign of congenital anomalies
superficial venous patterns
sign of heart disorders or vascular obstruction
normal respiratory range
12 to 20
respirations to heart beat ratio
1:4
what factors can affect the rate of respiration
age of the individual and degree of exertion
how should the chest expand normally during inspitation
bilaterally symmetric
normal respiration
regular and comfortable 12 to 20 PM
air trapping
increasing difficulty in getting breath out
bradypnea
slower than 12 breaths per minute
cheyne stokes breathing
varying periods of increasing depth with interspesed apnea
tachypnea
breathing more than 20 per minute
kussmaul breathing
rapid deep labored
hyperventilation - hyperpnea
greater than 20 deep breaths per minute
biot
irregular interspersed periods of apnea in a disorganized sequence of breaths
sighing
frequently interspersed deeper breath
ataxic
significant disorganization with irregular and varying depths of respiration
gender effects on respiratory disability
greater differences in men, but differences between sexes gets less as age increases
what happens as a result of protective splinting from a broken rib or pleurisy
increased shallow rapid breathing
pleurisy
infection of lung plerura
liver enlargement or ascities can also cause what
shallow rapid breathing
what causes bradypnea
neurologic or electrolyte disturbance, infection or a response to proetect against pain of pleurisy
when does cheyene stokes come about
seriously ill or breathing associated with damage to respiratory area in brainstem
what type of breathing is associated with emotional distress
sighing - just like making these goddamn flash cards is making me do
what is biot respiration associated with
elevated intracrania pressure, respiratory compromise
rate and depth of breathing will increase with ( 6)
acidosis, CNS lesions (pons) , ANxiety, aspirin overdose, hypoxemia, pain
rate and depth of breathing will decrease with ( 5)
alkalosis, CNS lesions (cerebrum) , myasthenia gravis, narcotic overdose, extreme obesity
apnea
absence of spontaneous respiration
primary apnea
self limited condition that occurs after a blow to the head, noted after the birth of a newborn
secondary apnea
breathing stopping and will not resume unless resusicative measures are taken, anything that limits oxygen absorption into the blood will cause this
reflex apnea
when irritating or nausea provoking vapors are inhaled, can temporarily halt respiration
sleep apnea
periods of absence of breathing during sleep, airflow is obstructed during sleep
apneustic breathing
long inspiration and expiration apnea - affection of respiration center in pons
periodic apnea of newborn
irregular pattern of rapid breathing interspersed with brief periods of apnea that are associated with REM sleep
what is normal respiration
symmetric without use of accessory muscles
what can unequal chest rise be associated with
collapsed lung, limitation of expansion by extrapleural air, fluid or a mass
what is prolonged expiration and bulging on expiration caused by
outflow obstruction or the valvelike compression by a tumor, anyurism, or enlarged heart
what happens when something compresses the lungs inside the chest
the costal angle opens up beyond 90 degrees
retractions
chest wall caves in at the sternum
what does retractions indicate
obstruction to inspiration at any point in the respiratory tract
when are retractions seen
inspiration
what happens when you have restrictions higher up in the laryngeal tree
stridor
what is seen with paradoxic breathing
when the lower thorax is drawn in on inspiration and vice versa
what causes paradoxic breathing
poorly functioning diaphragm, obstructive airway disease, upper airway obstruction during sleep
what causes unilateral retraction
foreign body in the bronchus
what happens with retraction of the lower chest
asthma and bronchiolitis
2 causes of clubbing
pulmonary/cardiac disease or congenital
pursing of the lips is a sign of
respiratory difficulty
what changes are associated with clubbing
emphysema, lung cancer, cyanosis of congenital heart disease, cystic fibrosis
flaring of the nasal alai
air hunger
Capritta hates it when mollie does what?
cleans herself
inspiratory stridor with what I:E ratio is consistent with
upper airway constriction
Memorize the table on 348
No way to put that into questions, just stare at it
crepitus
crackling sensation that can be heard and felt
what does crepitus indicate
air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas producing organism
what is suggested by a coarse grating vibration on inspiration
pleural friction rub
tactile fremitus
palpable vibration of the chest wall that results from speech or other verbilizations
where is tactile fremitus best felt
parasternally at the second intercostal space at the level of the bifurcation of the bronchii
what obscures fremitus
scapulae
what are the two most common findings of pleural effusion
dullness on percussion and tactile fremitus
what is indicated by decreased or absent fremitus
excess air int he lungs, emphysema, pleural thickening, effusion, massive pulmonary edema, bronchial obstruction
increased fremitus
fluids, solid mass in the lungs, lung consolidation, bronchial obstructions, compressed lungs or tumors
gentle tremulous fremitus occurs
with some lung consolidation, some inflammatory and infectious processes
where should the trachea be midline
area above the suprasternal notch
what deviation of the trachea is normal
slight to the right
what happens with volume lung disorders
trachea deviates to the affected side
thyroid enlargement or pleural effusion
trachea deviates away from the affected side
pneumotorax on trachea
either side depending on if there is tension or not
tension pneumotorax deviation
away from the affected side
collapsed lung
towards the affected side
anterior mediasteinal tumor
pushes it posteriorly
mediasteinitis
pushes it anteriorly
pull out of midline with respiration
tug
what does a patient do to ease breathing when they have an anterior mediasteinal mass
lean forward (not like a cholo)
what to do when you are examining a womans chest
ask her to move her breasts out of the way (well what the fuck else are you supposed to do)
table on 350
just memorize it, its not worth typing out
where can resonance usually be heard over the lungs
over all areas of the lungs
hyperresonance with hyperinflation
emphysema, pneumothorax, asthma
dullness or flatness
pneumonis, atelecastasis, pleural effusion, pneumothorax or asthma
tympany is heard where
percussion over abdomen
what pathologic processes limit diaphragmatic excursions
pulmonary, abdominal, fractured ribs
why is the diaphragm higher on the right than the left
liver be all up in the diaphragms shit
what is the usual excursion distance
3 to 5 or 6 cm
ribs on ribs on ribs
sweet fruity breath
diabetic or starvation ketoacidosis
fishy stale breath
uremia (trimethylamines)
ammonia like breath
uremia (ammonia)
musty fish, clover breath
hepatic involvement, hepatic failure, portal vein thrombosis, portacaval shunts
foul, feculent breath
intestinal obstruction
foul putrid breath
nasal, sinus pathology, infection, foreign body, respiratoy infections, empyema, lung abscess, bronchiesctasis
halitosis
tonsilitis, gingivitis, respiratory infections, vincent angina, GI reflux
cinnamon breath (this sound good actually)
pulmonary TB (Oh shit nevermind)
how can you characterize the sounds of ascultation
intensity, pitch, quality and duration
what can be caused by hyperventilation
faintness
where do most pathologic lung conditions occur
base of the lungs
why do you use the diaphragm of the stethomoscope
transmits higher pitched sounds better
CHF lung sounds
base will have crackles
where are the sounds of the middle lobe of the right lung and linguila on the left best heard
respective axillae
three types of breath sounds
vesicular, bronchovesicular, tubular
vesicular
low pitched, low intensity heard over healthy lung tissue
bronchovesicular
med pitch and intensity heard in major bronchi
bronchial
highest in pitch and intensity, trachea only
amorphic breathing
sound heard by blowing across a bottle, heard with large stiff walled pulmonary cavity, tension pneumothorax
cavernous breathing
cavern sounding, pulmonary cavity in which wall is ridgid
what make it more difficult ot hear breath sounds
pus or fluid in the pleural space
what makes breath sounds easier to hear
consolidation of lung tissue
mass surrounding the bronchial tree does what to sounds
make it easier to transmit than air filled alveoli
back hair causes what
extraneous breath sounds (ha ha ha) #brownpeopleproblems
sickle cell does what to pulmonary
frequent pulmonary problems, arching of the back to make breathing easier
memorize table on 356
living in a gangstas paradise
crackle
heard more often in inspiration, disruptve passage of air through the respiratory tree
high pitched crackles
sibilant
low pitched crackles
sonorous
dry non gurging pitched crackles heard where
higher in the respiratory tree
rhonchi
deeper more pronounced, during expiration, passage of air through airway constricted by thick secretions, muscular spasm or external pressure
higher pitched rionchi from where
smaller bronchi
lower pitched rionchi
larger bronchi
tracheobronchitis
larger bronchi infection
when do rhonchi dissapear and crackles do now
after coughing
wheeze (wheezy?)
continuous high pitched musical sound, heard during inspiration of expiration
what causes wheezing
high velocity air flow through a narrowed or obstructed airway
bilateral wheeze
bronchospasm of asthma, acute or chronic bronchitis
unilateral or sharp wheezing or stridor
foreign body
tumor compressing part of the bronchial tree can create
consistent wheeze or whistel of single pitch at site of compression
friction rub ourside of the respiratory tree
dry crackling, low pitched sound, inspiration and expiration
friction rub heard over what doesnt mean anything
liver spleen
friction rub over heart indicates what
inflammed, roughened surfaces rubbing together
what does frinction rub over the pericardium indicate
pericarditis
friction rub over the lungs
pleurisy
respiratory rub vs cardiac rub
respiratory dissapears when breath is held
mediasteinal crunch (hamman sign)
mediasteinal emphysema, more pronounced with expiration, easier to hear when pt leans to left or lies down ont he left side
lower pitched voices od men do what to vocal resonance
more fremitus than of women
vocal sounds through the lungs usually are
muffled and indistinct, best heard medially
factors that influence vocal resonance also infleunce what
tactile fremitus
greater clarity and increased loudness of spoken sounds
bronchophony
whispered pectoriloquy
when you can hear a whisper clearly
egophony
when nasal quality has been attributed to speech
what can the above conditions all arise from
consolidation of lung tissue,
what can decrease vocal resonance
loss of tissue in respiratory tree (barrel chesting)
coughs
usually reflexive response to irritants such as foreign bodies, infectious agents or masses compressing the respiratory tree
COPD
4th largest cause of death in USA, 20% who die never smoked,
dry or moist cough
infection and can accompanied by sputum production
onset
acute with fever means infection, absense of fever is foreign body or inhaled irritants
frequency of occurence
infrequent is allergens
regularity
paroxymal cough heard in peritussis
pitch and loudness cough
high pitch and loud or low and quiet
postural influences cough
soon after reclines or erect position, (nasal drip or pooling of secretions)
dry couggh brassy
if it is caused by compression of the respiratory tree
horse cough
croup
pertussis
inspiration whoop at the end of paroxysm in older children and adults
tables on page 359
lean with it?
production of sputum associated with what
cough
if actue onset of sputum
infection
chronic sputum
significant anatomical change
bacterial infection sputum
yellow, green , rust (blood with yellow), clear or transparent, purulent, blood streaked, mucoid, viscid
viral infection sputum
mucoid, viscid, blood streaked
chronic infectious disease sputum
everything mentioned, abundant in the early morning
carcinoma
slight perisstent, intermittent blood streaking
infarction
blood clotted, lots of blood
tuberculous cavity
occasional large amounts of blood
what at 1 and 5 minutes tells you a lot about birth
apgar scores
where does depressed respirations in the newborn come from
origins in the maternal environment
APgar score table page 360
I cant see how you hating from outside the club, you cant even get in
chest circumfurence of a newborn
30 to 36 cm, 2 to 3 smaller than head
IUGR infant chest circumference
smaller compared to head
diabetic mother chest circumference
larger than normal
differencebetween chest and head circumference increases with
prematurity
newborn lung function
susceptable to envionmental factors
pattern of respirations
vary with feeding and sleep
how much will the respiratory rate vary in the first minute
40 to 60 RPM, 80 not uncommon
C section babies respiratory rate vs vaginak birth
more rapid c section
babies breath through mouth or nose
obligate nose breathers
inceased prematureity means what with breathing
increased irregularity in breathing
periodic breathing
relatively vigorous respiration followed by apnea as long as 10 to 15 seconds
presistance of preterm breathing in infants is relative to the
gestational age of the baby
apnetic period of breathing diminishes in frequency as
baby approaches term status
when should periodic breathing wane in a term infant
few hours after birth
coughing in newborn
rare is a problem
sneezing in newborn
frequent and is expected
purpose of sneezing in newborn
clears nose
when are hiccups found in newborn
frequent after meals
frequent hiccuping says what
seizures, drug withdrawl or encephalopathy
what muscle do newborns rely on for inspiration
diaphragm (mostly) and abdominals
is paradoxic breathing common in newborns
yes in sleep
if normal chest expansion is asymmetric then
expect compromise to fill lungs
when is crepitus common in babies
around a fractured clavicle - common after difficult forceps delivery
newborn xyphoid process
mobile, moves back and forth under finger
breath sounds from one area to another
travel easily from one to another, localization difficult
crackles and ronchi common when in newborn
right after birth, fluid clearing
ascultory findings asymmetric
problem - aspiration of meconium
GI gurgling in chest
diaphragmatic hernia
stridor with inspiration length
3 to 4x longer than expiration
stridor with I/E ratio
3:1 or 4:!
stridor accimanies with cough, hoarseness orretractions
serious problem with trachea or larynx
narrow tracheal lumen from tumor compression, abcess, or double aortic arch
develop stridor
respiratory grunting
infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
flaring of nasal alai
respiratory distresss
when do children use intercostal muscles for respitation
6,7 years old
newborn resp rate
30-80
1 year old resp rate
20-40
3 year old resp rate
20-30
6 year
16 to 22
10 year old
16 to 20
17 year old
12 to 20
increasing roundness of chest with age leads to what diagnosis
cystic fibrosis/COPD (by 5 or 6 is ominous)
when is it easier to hear breath sounds in a child
after they breathe more deeply after running up and down hallway
childs chest sounds vs adult
thinner and more resonant than adult
hyperresonance is more common in
young child
where may bronchovesivular sounds be heard in a child
throughout the chest
wheezing ina child for first time
suspect foreign body
audible crackles is not enough evidence for what
pneumonia
minimal pneumothorax causes what
unexplained persistent tachycardia
chest expansion is what in adults compared to children
decreased
respiratory muscle use in adults
less able to use
what can happen as a result of calcifications of rib articulations
interfere with chest expansion, use of accessory muscles
breathing pathology common in pregnancy
dyspnea
how can pregnant woman increase ventilation
breathing more deeply, not quickly
what curve of the spine is prominent in older adults
dorsal curve - thoracic spine, also flattening of lumbar curve
diameter changes in chest with older adults
AP is increased in relation to lateral
hyperresonance in older adults
increased distensibility of lungs
Table on 365, yeah it sucks
your girlfriend a freak like cirq du solei (lil wayne always messes it up)