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177 Cards in this Set
- Front
- Back
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primary muscles of respiration (2)
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diaphragm and intercostals
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which intercostals are important to inspiration?
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external
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which of the lobes on the left lobe contains the lingula?
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left upper lobe
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at what rib levels (axilla and anterior) is the oblique fissure on the right? on the left?
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5th rib in axilla and 6th rib at midclavicular; 6th rib at midclavicular
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posteriorly the apexes of the lungs rise to what vertebral level?
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T1
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upon deep inspiration the lower borders of the lungs descend to which vertebral level?
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T12
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upon forced expiration the lower borders of the lungs ascend to which vertebral level?
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T9
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at what vertebral level does the trachea bifurcate?
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T4/5
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main bronchi are divided into ____ branches on the right and ____ on the left
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3; 2
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acini consists of these 4 parts:
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respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli
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bronchial arteries branch from where? (2)
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anterior thoracic aorta and intercostal arteries
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most of the blood from the lungs is drained via the:
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pulmonary veins
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chemoreceptors are found in these 2 places and each is stimulated by what
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medulla oblongota (H+) and carotid body (low O2 and high CO2)
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chemoreceptors send signals to the respiratory center in this part of the brain
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medulla oblongota
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nerve impulses from the medulla send signals to this part of the brain that controls respiratory muscles
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pons
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anterior right lung consists mainly of which 2 lobes?
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upper and middle
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posterior lung is mainly which lobe(s)?
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lower lobe
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lower lobe extends between which vertebral levels?
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T3-T10/12
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at what rib levels is the horizontal fissure at axilla and anteriorly?
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axilla at 5th rib and anteriorly at 4th rib
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the lateral lung extends between which landmarks?
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peak of axilla to 7th or 8th rib
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the number of each intercostal space corresponds to that rib immediately below/above it?
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above
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is the resistance in the pulmonary circulation less than or greater than that in systemic circulation?
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less than
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what stimulates the closure of the foramen ovale?
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decrease in pulmonary pressure
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what stimulates the closure of the ductus arteriosus?
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increase in O2 tension in arterial blood
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barrel chest seen in older adults is the result of what?
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loss of muscle strength in thorax and diaphragm
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underventilation of alveoli in lower lung fields and decreased tolerance for exertion in older age are result of what? (3)
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alveoli become less elastic and more fibrous, interalveolar folds decrease which decreases alveolar surface area, and loss of strength of resp muscles
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what predisposes older adults to respiratory infections?
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aging mucous membranes become drier and can't get rid of mucous
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what 5 sx associated with chest pain signals a circumstance not involving the heart?
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constant achiness, stays in 1 position, made worse by pressing on precordium, fleeting needle-like jab and location in shoulders or between shoulder blades
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possible cause of severe, acute chest pain in adults and adolescents
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cocaine use
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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
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pectus excavatum
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superficial venous patterns over the chest may indicate what?
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heart disorders or vascular obstruction
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the scapular lines go through which part of the scapula?
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inferior angle
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normal RR
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12-20
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normal RR:HR
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1:4
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these 2 conditions can cause dyspnea in an otherwise normal person
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obesity and sedentary lifestyle
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difficult and labored breathing with SOB
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dyspnea
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SOB that begins or increases when the patient lies down
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orthopnea
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sudden onset of SOB after a period of sleep
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paroxysmal nocturnal dyspnea
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dyspnea that increases in upright posture
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platypnea
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these 4 non-resp conditions can cause hyperventilation
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protective splinting from broken rib or pleurisy or massive liver enlargement or abd ascites
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these 4 conditions can cause bradypnea
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neuro or electrolyte disturbance, infection or protection against pain
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10 Ps of rapid onset dyspnea
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pneumonia, pneumothorax, pulm constriction/asthma, peanut (foreign body), pulm embolus, pericardial tamponade, pump failure, peak seekers, psychogenic, poision
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these 6 conditions cause increased resp rate and depth
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metabolic acidosis, CNS (pons) lesion, anxiety, ASA poisoning, hypoxia, pain
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these 5 conditions cause decreased resp rate and depth
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metabolic alkalosis, CNS (cerebrum) lesion, MG, narcotic overdose, obesity
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regular period of breathing with intervals of apnea followed by crescendo/decrescendo sequence of respr
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Cheyne-Stokes (periodic) breathing
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Cheyne-Stokes breathing occurs in those with these 2 probs
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cerebral brain damage or drug-caused resp compromise
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irregular resp varying in depth and interrupted by intervals of apnea, but lacking the repetitive pattern of periodic respiration
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biot resp
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biot respiration is associated with what 3 conditions?
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increased ICP, drug poisoning, and medulla brain damage
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axtaxic resp is a more severe form of what other resp?
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biot
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what causes secondary apnea?
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anything that limits O2 from getting into the blood
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what 3 things can cause primary apnea?
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blow to the head, newborn (needs more CO2 build up) and inhalation of irritating vapor or gases
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this is characterized by long inspiration and what amounts to expiration apnea
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apneustic breathing
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Dx: chest asymmetry
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collapsed lung or limitation of expansion by extrapleural air, fluid or mass
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Dx: unilateral or bilateral bulging
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resp obstruction
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Dx: retractions
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inspiratory obstruction
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Dx: stridor
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obstruction high in resp tree
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Dx: unilateral retraction without suprasternal notch involvement
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foreign body in bronchi
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Dx: retraction of lower chest
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asthma and bronchiolitis
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sx of upper airway obstruction
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inspiratory stridor, hoarse cough, nasal flaring and suprasternal notch retraction
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sx of severe upper airway obstruction
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inspiratory and expiratory stridor, barking cough, retractions also involve subcostal and intercostal spaces, cyanosis
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sx of obstruction above glottis
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quieter stridor, muffled voice, difficult swallowing, no cough, awkwardly positioned head
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sx of obstruction below glottis
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louder stridor, hoarse voice, swallowing ok, harsh cough
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this is done during increased expiratory effort and reduces the effort of dyspnea
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lip pursing
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3 diseases associated with clubbing
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lung fibrosis, CHD and CF
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Dx: crepitus
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air in subcut tissue from ruptured resp tract or infection by gas-producing org
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palpable, coarse, grating vibration during inspiration
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pleural friction rub
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Dx: pleural friction rub
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inflam of pleural surfaces
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posteriorly at what vertebral level do you place your hands to eval thoracic expansion?
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T10
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where is tactile fremitus best felt?
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parasternally at the 2nd intercostal space at the level of the bifurcation of the bronchi
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Dx: decreased fremitus (5)
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emphysema, pleural thickening or effusion, pulm edema, bronchial obstruction
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Dx: increased fremitus (2)
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fluids or solid mass in the lungs
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Dx: displacement of trachea (7)
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atelectasis, thyroid enlargement, fibrosis, pleural effusion, tension pneumothorax, tumor, nodal enlargement
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Dx: hyperresonance upon percussion
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emphysema, pneumothorax, asthma
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Dx: dullness or flatness over lung fields
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atelectasis, pleural effusion, pneumothorax or asthma
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normal diaphragmatic excursion
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3-6 cm
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sweet/fruity breath
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DKA
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fishy/stale breath
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uremia (trimethylamines)
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ammonia-like breath
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uremia (ammonia)
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musty fish/clover breath
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fetor hepaticus, hepatic failure, portal vein thrombosis, portacaval shunts
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foul, feculent breath
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intestinal obstruction/diverticulum
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foul/putrid breath
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nasal/sinus pathology, resp infections
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halitosis breath
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tonsillitis, gingivitis, resp infection, angina, GERD
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cinnamon breath
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pulm TB
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where do pulm pathologic conditions generally occur in older adults?
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lung bases
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breathing that resembles the noise made by blowing over bottle mouth
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amphoric
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amphoric breathing is usually heard with what conditions? (2)
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stiff walled pulm cavity or tension pneumothorax with bronchopulm fistula
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Dx: decreased or absent breath sounds (4)
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fluid or pus in pleural space, secretions or foreign body in bronchi, hyperinflation of lungs, splinting due to pain
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Dx: increased breath sounds
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consolidated lungs
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discontinuous adventitious resp sound heard more often during inspiration
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crackle
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crackles are caused by
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disruptive passage of air through the small airways of resp tract
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sibilant crackles are ___ pitched while sonorous are ___ pitchced
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high; low
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prolonged or continuous adventitious resp sounds heard more often during expiration
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rhonchi
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rhonchi are caused by
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passage of air through an airway obstructed by thick secretion, muscular spasm, new growth or external pressure
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continuous high pitched musical adventitious resp sound heard during inspiration or expiration
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wheeze
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wheeze is caused by
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high velocity air through narrowed or obstructed airway
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dry crackly low pitched sound heard in expiration and inspriation
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friction rub
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sound heard with mediastinal emphysema, synchronous with heartbeat and more pronounced at end of expiration
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Hamman sign (mediastinal crunch)
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Dx: moist cough
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infection
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Dx: dry cough
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cardiac probs, allergies, HIV etc
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Dx: acute onset cough with/without fever
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infection; foreign body, inhaled irritant
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Dx: regular, paroxysmal cough
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pertussis
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amount of air that is expelled after max inspiration and max expiration
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vital capacity
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max amount of air that can be forcefully expired
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peak expiratory flow rate
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Dx: yellow, green, rust colored, clear/transparent, purulent, blood streaked, mucoid or viscid sputum
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bacterial infection
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Dx: mucoid, viscid, blood streaked sputum
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viral infection
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Dx: all colors particularly abundant in morning, occasionally large amounts of blood
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chronic infectious disease
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Dx: slight, persistent blood streaked sputum
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carcinoma
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Dx: blood clotted, large amounts of blood in sputum
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infarction
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Dx: large amounts of blood
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TB
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expected infant RR
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40-60
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Dx: frequent hiccups in infants (3)
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seizures, drug withdrawl or encephalopathy
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Dx: persistent GI gurgling heard in chest
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diaphragmatic hernia
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volume of air in lungs at end of quiet expiration
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functional residual capacity
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amount of air inhaled and exhaled during normal breathing
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tidal volume
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Dx: tachypnea, dyspnea, decreased fremitus, occasional hyperresonance, prolonged expiration, wheezes, decreased lung sounds
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asthma
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Dx: delayed chest wall movement, narrowed intercostal spaces, tachypnea, decreased fremitus, deviated trachea ipsilaterally, dullness over affected lung, wheezes/rhonchi/crackles, decreased breath sounds in lower lobe
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atelectasis
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Dx: tachypnea, hyperinflation, crackles, rhonchi
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bronchiectasis
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Dx: occasional tachypnea and shallow breathing, prolonged breath sounds, occasional crackles and expiratory wheezes
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bronchitis
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Dx: wheezing, cyanosis, distention of neck veins and peripheral edema, decreased vocal fremitus, occasional hyperresonance, inspirational crackles, decreased breath sounds
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COPD
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Dx: tachypnea, deep breathing, pursed lips, barrel chest, decreased fremitus, hyperresonance, decreased breath sounds, prolonged expiration
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emphysema
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Dx: decreased and delayed resp movement, trachea shifted contralaterally, decreased fremitus, dull to flat percussion, decreased breath sounds, bronchophony and whispered pectoriloquy, occasional friction rub
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pleural effusion/thickening
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Dx: tachypnea, shallow breathing, nasal flaring, occasional cyanosis, increased fremitus, dullness on percussion, crackles with rhonchi, bronchial breath sounds, egophony, bronchophony and whispered pectoriloquy
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pneumonia consolidation
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cyanosis, bulging intercostal spaces, resp lag on affected side, tracheal deviation contralateral, decreased fremitus, hyperresonance, decreased breath sounds, Hamman sign or succussion splash, decreased breath sounds
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pneumothorax
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3 organisms that cause cough with sinus infection
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H. influenzae, M. catarrhalis, Strep pneumoniae
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mucosal edema and bronchoconstriction caused by airway hyperreactivity triggered by environmental factors
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asthma
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Dx: paroxysmal dyspnea, tachypnea, cough, wheezing on expiration and inspiration, prolonged expiration
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asthma
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does cold or warm air aggravate asthma?
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cold
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what may coexist in a person with asthma?
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allergic skin conditions
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incomplete expansion of lungs at birth or collapse at any age
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atelectasis
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affect of atelectasis on lung sounds
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to dampen or mute the sounds
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a high birthweight (4.5 kg) predisposes a newborn to ____ in childhood?
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obesity
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inflammation of mucous membranes of bronchial tubes
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bronchitis
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Dx: excessive secretion of mucous in bronchial tree
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chronic bronchitis
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inflammatory process involving visceral and parietal pleura
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pleurisy
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what happens to the pleura in pleurisy?
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becomes edematous and fibrinous
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Dx: acute pain, difficulty breathing, pleural rub heard and felt, rapid and shallow respirations, decreased breath sounds
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pleurisy
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excessive non-purulent fluid in the pleural space can cause this:
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permanent fibrotic thickening
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right angled area of dullness over posterior chest that can be percussed opposite a large pleural effusion
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Grocco's triangle
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what makes up the horiz and vertical parts of Grocco's triangle?
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diaphragm and SPs
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purulent exudate collects in pleural space
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empyema
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Dx: decreased breath sounds, dull percussion, no vocal fremitus, fever, tachypnea
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empyema
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well defined, circumscribed mass defined by inflammation, suppuration and central necrosis
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lung abscess
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Dx: dull percussion, decreased breath sounds, pleural friction rub, cough, fever, tachypnea, foul smelling breath
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lung abscess
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common causes of lung abscess
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aspiration of food or infected matter from upper resp or dental source
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inflammatory response of bronchioles and alveolar spaces to infective agent
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pneumonia
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involvement of R lower lobe in pneumonia can cause this
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stimulation of 10th and 11th thoracic nerves and cause RLQ pain
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Dx: (in immunocompromised) interstitial inflammation and necrosis throughout bronchiolar and alveolar tissue
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influenza
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air leaks continually into pleural space, becoming trapped on expiration and resulting in increasing pressure in pleural space
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tension pneumothorax
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Dx: unexplained but persistent tachycardia
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minimal pneumothorax
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Dx: decreased breath sounds, dull percussion and absent coin click
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hemothorax
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most common type of lung CA
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bronchogenic carcinoma
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Dx: cough, wheezing, patterns of emphysema and atelectasis, pneumonitis, hemptysis
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lung CA
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acute or chronic condition involving R sided heart failure
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cor pulmonale
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most common cause of acute cor pulmonale
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PE
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risk factors for PE (8)
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> 40 yo, hx of venous thromboembolism, anesthesia > 30 min, heart disease, CA, pelvic or leg fracture, obesity, throbophilia
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Dx: pleuritic chest pain without dyspnea
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PE
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autosomal recessive disease of exocrine glands involving lungs, pancreas and sweat glands
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CF
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Dx: salt loss, pulm infections, areas of hyperinflation and atelectasis
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CF
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hallmark sx of CF in those under 5 yo
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cough with sputum
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sx of mild CF in adults
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nasal polyps, cough and male sterility
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most common cause of epiglottitis
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haemophilus influenzae type B (HiB)
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in what age group does epiglottitis occur most often?
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3-7
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Dx: sitting up straight, neck extended, head forward, anxious, ill, unable to swallow, drooling, cough, fever
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epigottitis
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what should never be done if one suspects epiglottitis?
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direct exam of throat
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laryngotracheobronchitis is also known as
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croup syndrome
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most common cause of croup
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parainfluenza viruses
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Dx: bark-like cough in child, labored breathing, retractions, hoarseness, inspiratory stridor
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croup
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what mimics croup?
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aspirated foreign body
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4 risk factors for RDS
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decreasing gestational age, maternal DM, acute asphyxia and fam hx
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floppiness of trachea or airway
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tracheomalacia
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Dx: noisy breathing in infant (inspir stridor)
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tracheomalacia
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Dx: hyperinflation, difficult expiration, generalized retractions, perioral cyanosis, hyperresonant percussion, distended abdomen (in infant)
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bronchiolitis
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5 diseases that can be included in the COPD group
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chronic bronchitis, emphysema, asthmatic bronchitis, bronchiectasis and CF
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Dx: cough, sputum production, dyspnea with pursed lips, leaning forward, barrel chest, scattered crackles and wheezes
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COPD
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chronic dilation of bronchi or bronchioles caused by repeated pulm infections and bronchial obstruction
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bronchiectasis
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autosomal recessive condition characterized by bronchiectasis, sinusitis, dextrocardia and male infertility
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Kartagener syndrome
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