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201 Cards in this Set
- Front
- Back
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The external intercostals increase this diamter during inspiration
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The external intercostals increase the AP diameter
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The internal intercostals decrease this diamter during expiration
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The internal intercostals decrease the transverse diameter
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What distance does the lung extend above the first rib anteriorly?
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Apex of the lung extends 4cm about the 1st rib anteriorly
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Posteriorly the apex of the lung rises to what level?
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T1
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On deep inspiration the lower border of the lung reaches what vertebral level?
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T12
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On forced expiration the lower border of the lung reaches what vertebral level?
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T9
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The trachea divides @ what vertebral level?
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T4/T5
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The trachea is ____ long & has a diameter of _____?
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10-11cm long; diameter of 2cm
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Where are the controls of the respiratory center located?
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The medulla oblongata; what does it control?
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Where is the control center for respiratory muscles?
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The pons; what does it control?
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Described the AP chest diameter in infants upto 2yrs old.
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The AP diameter approximates the transverse
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Chest circumference is almost equal to that of the head in children upto what age?
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2 yrs.
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The transverse diameter increases 2 cm and the circumference of the chest increases 5-7 cm commonly it what population?
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Pregnant Women
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Kartagener syndrome
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autosomal recessive condition characterized by: bronchiectasis, sinusitis, dextrocardia, and male infertility.
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Bronchiectasis
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chornic dilation of bronchi or bronchioles casued by repeated pulmonary infections and bronchial obstruction
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Severe chronic bronchitis may lead to what condition?
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right ventricular heart failure with dependent edema
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How do patients with chronic bronchitis typically present?
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recurrent bacterial infections, non severe dyspnea, cough w/sputum and a history of smoking.
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Alveolar gas is trapped in expiration permanently hyperinflating the lung in what condition?
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emphysema.
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A patient presents with hyperresonant lung sounds on percussion with limited expansion during inspiration, and a expiratory effort longer than 5 seconds.
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emphysema
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COPD includes what diseases of the lungs?
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Chronic bronchitis, emphysema, asthmatic bronchitis, bronchiectasis and cystic fibrosis.
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A patient with a history of coughs, sputum production, and limited tolerance for exercise may have a disease that fits into what broader group?
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COPD
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What are ways a patient with COPD will try to relieve dyspnea?
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Breathing through pursed lips, learning forward and resting arms on the knees.
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What should you suspect if a patients forced expiration time is longer than 5 seconds?
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airway obstruction
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This occurs most often in infants younger than 6 months old and its principal characteristic is hyper inflation of the lungs
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bronchiolitis.
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A infant comes in looking anxious, having trouble expiring, and tachypneic. Infant also appears cyanotic around the mouth with generalized retraction
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bronchiolitis
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In an infant with bronchiolitis how will percussion sound?
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hyperresonant
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Although tracheomalacia is benign, it may be confused with what other conditions?
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fixed lesions, tracheal stenosis, or a foreign body.
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What is the treatment for tracheomalacia?
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no treatment is necessary, it is often self-limiting.
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inspiratory stridor caused by floppiness of the trachea or airway
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a lack of rigidity called tracheomalacia
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A common cause of respiratory distress in premature infants?
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surfactant deficiency
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The risk of RDS increases with what factors?
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decreasing gestational age, maternal diabetes, acute asphyxia and family history.
Also white males and the 2nd twin. |
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How will RDS present?
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tachypnea, retractions, grunting, and cyanosis.
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what is the viral cause of bronchiolitis?
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respiratory syncytial virus
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what is the viral cause of croup?
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parainfluenza virus
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Soon after a child goes to sleep he awakens, frightened with a bark-like cough, labored breathing, retractions, hoarseness, and inspiratory stridor.
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croup
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When does croup typically appear, and what gender is it more common in?
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appears ages 1.5 - 3 yrs old. Boys more affected than girls.
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Acute, life-threatening disease caused by Haemophilus influenzae type B.
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Epiglottitis
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A child in waiting room sitting up straight with neck extended, head held forward, unable to swallow, and drooling from an open mouth.
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Epiglottitis
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If you suspect Epiglottitis should you visualize the epiglottis?
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No, epiglottitis is a medical emergency Avoid visualization of the throat.
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Sub epiglottic inflammation caused by croup
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laryngotracheobronchitis.
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Adult male with nasal polyps, recurrent cough, and sterility
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CF
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Pulmonary hypertension and cor pulmonale often occur in what disease?
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Cystic Fibrosis
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Risk factors for pulmonary embolism
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>40 yrs old, Hx of venous thromboemolism, surgery with anesthesia > 30 min., heart disease, cancer, fracture of pelvis or leg bones, obesity and acquired or genetic thrombophilia
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Pleuritic chest pain in absence of dyspnea
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pulmonary embolism
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Cor pulmonale is a condition involving what side of the heart?
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right sided heart failure is associated with it.
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What are risk factors for lung cancer?
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tobacco smoke, asbestos, inonizing radiation, inhaled chemicals and noxious agents.
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Sx of lung cancer?
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Cough, wheezing
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Distant breath sounds with dullness to percussion and absent coin click. Post trauma.
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hemothorax
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Persistent tachycardia
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minimal pneumothorax
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air leaks continually into the plerual space, becoming trapped on expiraiton resulting in increasing pressure in the pleural space
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tension pneumothorax
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Onset of most pnemothorax occurs when patient is...?
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at rest
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Distant breath sounds with booming percussion and a positive coin click..
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pneumothorax
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chronic infectious disease caused by Mycobacterium tuberculosis
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tuberculosis
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chorinic infectious disease casued by Mycobacterium bovis
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tuberculosis
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The increasing incidence of what disease has lead to an increase in the incidence of tuberculosis?
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HIV
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Patient with cough, fever, malaise, headache, coryza, and mild sore throat may have? How will the lungs sound?
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influenza; may hear crackles or rhonchi.
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A child with nasal flaring, tachypnea, productive cough without crackles may have?
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pneumonia
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Lung consolidation resulting in dyspnea, tachypnea, and crackles with diminished breath sounds and dullness to percussion over the consolidated area.
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pneumonia
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Right lower quadrant pain can be caused by inflammation of what lung lobe?
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inflammation of right lower lobe can stimulate tenth and eleventh thoracic nerves.
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well defined, circumscribed mass defined by inflammation, suppuration, and subsequent central necrosis.
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lung abscess
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Aspiration of food or infected material from upper respiratory or dental sources of infection commonly cause what?
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lung abscess
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A dull percussion note with distant or absent breath sounds. Px also has a cough that produces a purulent foul-smelling sputum.
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lung abscess
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Purulent exudate in the pleural spaces
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Empyema
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distant/absent breath sounds, with dull percussion notes and absent vocal fremitus in a febrile tachypneic patient
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Empyema
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Excessive nonpurulent mobile fluid in the pleural space
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pleural effusion.
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What is Grocco's triangle?
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a right -angled area of dullness over the posterior chest that can sometimes be percussed opposite a large pleural effusion.
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pulmonary infections resulting in inflammation of the visceral and parietal pleurae.
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Pleurisy
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You hear and feel rubbing in a patients chest. Her respirations are rapid, shallow and she has diminished breath sounds.
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Pleurisy
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Inflammation of the mucous membranes of the bronchial tubes
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bronchitis
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Incomplete expansion of the lung at birth or collapse of lung at any age
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atelectasis
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what effect will atelectasis have on lung sound?
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dampen or mute lung sounds in involved area
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how do blacks report asthma?
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itchy throat, tight throat, voice tight (upper airway terms)
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how do whites report asthma?
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out of breath, hurts to breathe, aware of breathing (lower airway terms)
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What may aggravate asthma?
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allergens, anxiety, URI, cigarette smoke, exercise, cold air.
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describe an asthmatic episode
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Wheezing (on inhalation and exhalation), chest pain w/tightness, tachypnea, cough.
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Tachypnea w/Dyspnea. Tachycardic with diminished fremitus, prolonged expiration with wheezes.
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Asthma
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Diminished chest wall movement, with narrowed intercostal spaces on affected side. Tachypnea, with diminished fremitus, tracheal deviation ipsilaterally and dullness over affected lung.
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Atelectasis
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upper lobe bronchial breathing, egophony, whispered pectorlioquy.
If lower lobe affected -> diminished breath sounds |
Atelectasis
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Tacypnea, respiratory distress, hyperinflation. You may hear a variety of crackles, rhonchi, sometimes disappearing with cough.
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bronchiectasis
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Cyanosis, audible wheezing with distention of neck veins, peripheral edema. Limited mobility of diaphragm, hyperresonance.
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COPD
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Tachypnea, deep breathing, pursed lips, barrel chest, thin and underweight. Hyperresonance, prolonged expiration, diminished breath and voice sounds.
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Emphysema
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Liver edge displaced downward with limited descent of diaphragm on inspiration.
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Emphysema
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Diminished and delayed respiratory movement on affected side, with bronchophony, whispered pectoriloquy, and an occaisional friction rub
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pleural effusion and/or thickening
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what abnormality do you expect to hear superior to an area of effusion?
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egophony
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Trachea will shift contralaterally in what disorder associated with delayed respiratory movement?
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pleural effusion
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What is the left lung's counterpart to the middle lobe of the right lung?
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lingula
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At what rib level is the horizontal fissure that divides the upper and middle lobes of the right lung?
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axillary: fifth rib
anteriorly: fourth rib |
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Where does the trachea lie in relation to the esophagus and thyroid?
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anterior to the esophagus, posterior to isthmus of the thyroid
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Which bronchus is wider, shorter, and more vertically placed making it more susceptible to aspiration of foreign bodies?
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the right bronchus.
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Where do the bronchial arteries branch from?
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the thoracic aorta and the intercostal arteries.
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movement of air back and forth from deepest reaches of alveoli to the outside is referred to as?
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ventilation
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why is the right lung higher
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the fullness of the liver dome
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In the axilla the lungs reach inferiorly to what rib?
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8th rib
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Costal angle is how many degrees?
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90
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In pregnant women the subcostal angle increases from what to what?
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68.5 to 103.5 degrees
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What accounts for the increased minute ventilation during pregnancy?
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Increased tidal volume
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Why does the vital capacity decrease in older adults?
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decreased tensile strength in the muscles of respiration result in underventilation of the alveoli in the lower lung fields. Alveoli become less elastic and relatively more fibrous.
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Alveoli become less elastic and relatively more fibrous in what age group?
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older adults
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What changes increase the risk for respiratory infection in older adults?
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drier mucous membranes less able to rid themselves of mucus.
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Chest pain that does not originate from the heart has what characteristics?
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1. constant achiness lasting all day
2. pain stays in 1 position 3. made worse by pushing on percordium. 4. is fleeting, needle like jab lasting 1-2 seconds 5. situated between shoulder blades in the back |
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How do you calculate pack years?
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number of years smoking x number of packs smoked per day
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In pleural effusion breath sounds are?
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absent
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In lobar pneumonia breath sounds may be?
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bronchial
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In pleural effusion tactile fremitus is?
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absent
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In lobar pneumonia tactile fremitus is ?
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increased
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Compromised respiration results in barrel chest, what diseases can cause this?
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chronic asthma, emphysema, cystic fibrosis.
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What is the expected thoracic ratio?
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.70 - .75
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Prominent sternal protrusion
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pectus carinatum (pigeon chest)
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indentation of lower sternum above xiphoid process.
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pectus excavatum (funnel chest)
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supernumerary nipples may be a clue to congenital abnormalities in what type of patients?
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white patients
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superficial venous patterns over the chest may indicate?
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heart disorders or vascular obstruction
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Expected rate of respiration in an adult
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12-20
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Platypnea
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dyspnea increase in the upright posture
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Paroxysmal nocturnal dyspnea (PND)
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sudden onset of shortness of breath after a period of sleep; sitting upright is helpful
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Orthopnea
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S.O.B. that begins or increases when the patient lies down.
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Tachypnea
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respiratory rate approaching 25 resp/min
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Acidosis, lesions to the pons, anxiety, aspirin poisoning, hypoxemia and pain have what effect on respirations?
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Increase
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Alkalosis, lesions the cerebrum, myasthenia gravis, narcotic overdoses and extreme obesity have what effecct on respirations?
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Decrease
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Frequently interspersed deeper breaths
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sighing
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faster than 20 breaths per minute, deep breathing
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hyperventilation
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increasing difficulty in getting breath out
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air trapping
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varying periods of increase depth interspersed with apnea
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Cheyne-Stokes
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Rapid, deep, labored breathing
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Kussmaul
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irregularly interspersed periods of apnea in a disorganized sequence of breaths, seen in patients with severe intra-cranial pressure
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biot
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significant disorganization with irregular and and varying depths of respiration
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ataxic
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Abnormally shallow breaths, in a person with pleuritic pain
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hypopnea
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a blow to the head may cause?
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primary apnea
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breathing stops and it will not begin spontaneously unless resuscitative measures are instituted
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secondary apnea
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Long inspiration, expiration apnea
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apneustic breathing
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Expiratory obstruction caused by tumor, aneurysm, or enlarged heart does what to the costal angle?
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widens it beyond 90 degrees
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What do retractions suggest?
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obstruction to inspiration
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Retraction of the lower chest occurs in what pathologies?
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asthma and bronchiolitis
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unilateral retraction can be caused by
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foreign body obstruction
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Diseases associated with clubbing include?
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chronic fibrotic lung changes, congenital heart disease (chronic) cystic fibrosis
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When obstruction is above the glottis:
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quieter stridor, muffled voice, difficult swallowing, cough not a factor, awkward head position
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When obstruction is below the glottis:
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loud stridor, hoarse voice, harsh, barking cough, and swallowing is not affected
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Crepitus in the chest indicates
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air in the subcutaneous tissue from a rupture somewhere in the respiratory system or infection by a gas producing organism
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Palpable, coarse, grating vibration, usually on inspiration suggests:
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pleural friction rub
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Why will your thumbs not diverge when examining chest of a patient that has COPD?
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barrel chested patients lungs are so inflated they cannot expand further. your fingers may even come together a bit.
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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 maybe caused by?
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excess air in the lungs, pleural thickening, pleural effusion, pulmonary edema, or bronchial obstruction.
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increased fremitus maybe caused by?
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presence of fluids or solid mass within lungs, lung consolidation, heavy bronchial secretions, compressed lung, or tumor.
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slight deviation of the trachea to which side is normal
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to the right
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Hyperresonance with hyperinflation may indicate what?
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emphysema, pneumothorax or asthma
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Dullness or flatness suggests what?
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atelectasis, pleural effusion, pneumothorax, or asthma.
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Tympani is the sound usually associated with percussion where?
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over the abdomen
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When percussing the lower border of the diaphragm the note should change from what to what?
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resonance to dullness
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When percussing the upper border of the diaphragm the note should change from what to what?
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dullness to resonance.
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normal diaphragmatic excursion?
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3 - 6 cm
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Fishy stale breath
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uremia caused by trimethylamines
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Ammonia-like smell on breath
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uremia caused by ammonia
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musty fish/clover smell on breath
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fetor hepaticus: hepatic failure, portal vein thrombosis, portacaval shunts
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foul, feculent smell on breath
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intestinal obstruction/diverticulum
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foul, putrid smell on breath
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nasal/sinus pathology, or respiratory infection: empyema, lung abscess, bronchiectasis
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halitosis smell on breath
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tonsillitis, gingivitis, respiratory infections, Vincent angina, GERD
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cinnamon smell on breath
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pulmonary TB
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where should you start auscultating on an older adult?
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at the lung base
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Vesicular sounds are heard longest during which phase of breathing?
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expiration
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Why do you start auscultating at the base of the lung in someone with congestive heart failure?
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to detect crackles that may disappear with continued exaggerated respiration.
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What sounds are highest in pitch?
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bronchial sounds
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What causes amphoric breath sounds?
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stiff walled pulmonary cavity, or a tension pneumothorax with bronchopleural fistula
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What causes cavernous breathing?
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a rigid wall of the pulmonary cavity
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when are breath sounds diminished?
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when fluid or pus has accumulated in the pleural space, if secretions or foreign body has obstructed the bronchi, if lungs are hyperinflated, or if breathing is shallow.
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Breath sounds are easier to hear in what conditions?
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when the lungs are consolidated. (pneumonia)
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Discontinous brief sounds heard more often during inspiration that do not disappear with a cough
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crackles
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loud, low, coarse sounds like a snore heard continuously, coughing may clear sound. caused by airway obstructed by thick mucus, muscular spasm, new growth or external pressure.
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rhonchi
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musical noise sounding like a squeak, heard continuously, usually louder during expiration
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wheeze
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the worst obstructions are characterized by what kind of wheezes?
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long, high pitched
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bilateral wheezes are heard in?
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asthmatics, or acute or chronic bronchitis
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If the infection site is the source of wheeze suspect?
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virus
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Unilateral wheezing may occur with?
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a foreign body obstruction
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a dry, crackly, grating, low pitched sound heard on expiration and inspiration heard over the lungs
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friction rub
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what is Hamman sign?
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mediastinal crunch, loud crackles and clicking and gurgling sounds.
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What is Hamman sign associated with?
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mediastinal emphysema
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Patient sits up and leans forward to breath easier, where is the mass?
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anterior mediatsinum
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when would you hear a succussion splash?
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when air and fluid are present in the pleural cavity
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whispered pectoriloquy and egophony can be heard loudly in patients with?
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lung consolidation (pneumonia)
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Cough with fever
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infection
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amount of air expelled after a maximal inspiration followed by a maximal expiration
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vital capacity
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Peak expiratory flow rate
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maximum flow of air that can be achieved during forced expiration. useful surrogate for vc in kids.
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How would you estimate forced vital capacity?
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Have patient exhale to limit, then hold breath. Count the seconds until a breath is needed, multiply by fifty
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mucoid and viscid sputum
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viral infection
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slight, persistent blood streaking sputum
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carcinoma
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blood clotted, large amounts of blood in sputum
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infarction
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large amounts of blood in sputum
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tuberculous cavity
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sputum abundant in the early morning, with slight, intermittent blood streaking
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sputum of chronic infectious disease
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yellow, green, or rust colored sputum. often purulent. may be clear, and mucoid/viscid.
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bacterial infection
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a difference of greater than 3 cm of the head and chest circumference in a newborn suggests what?
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prematurity
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how do babies prefer to breathe?
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through the nose
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periodic breathing is common in what age group?
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infants
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frequent hiccups in newborn suggests?
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seizures, drug withdrawal, or encephalopathy
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newborns rely primarily on what for respiratory effort?
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diaphragm
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What may cause an asymmetric chest rise in newborns?
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diaphragmatic hernia or pneumothorax
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GI sounds in the chest of an infant think?
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diaphragmatic hernia
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Child older than 5 with barrel chest
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cystic fibrosis
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newborn resp rate
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30 - 80
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1 year resp rate
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20 - 40
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3 years resp rate
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20 - 30
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6 years resp rate
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16 - 22
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10 years resp rate
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16 - 20
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an infant may do this when it tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
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respiratory grunting
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