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198 Cards in this Set
- Front
- Back
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What are 2 major functions of the lungs?
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1. gas exchange
2. acid/base balance |
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In order to function properly, which system must the respiratory system work with?
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CNS
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What is costochondritis (Tietze Syndrome)?
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a connective tissue disorder that causes inflammation of the costal cartilage
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How do you distinguish costochondritis from a heart attack?
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Pain results if you press the costosternal joint
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What are 3 parts of the sternum?
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1. manubrium
2. body 3. xiphoid process |
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How do you name intercostal spaces?
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Intercostal spaces are always named for the rib above it
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How may pairs of ribs form the thoracic cage?
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12
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Which ribs hook to the sternum directly via costal cartilage?
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the first 7 pairs
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Which ribs hook onto the first 7 pairs of ribs?
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Pairs 8, 9, 10
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Which ribs are considered free floating?
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11, 12
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What 2 areas does the 2nd rib landmark?
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1. bifurcation of the trachea
2. where the right atrium of the heart is located |
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What are the 12 thoracic pairs of ribs attached to?
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the 12 thoracic vertebrae
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Which organ marks the bottom of the thoracic cage?
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diaphragm
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What are 4 features associated with the anterior thoracic cage?
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1. suprasternal notch
2. sternum 3. manubriosternal angle (Angle of Louis) 4. costal angle |
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What is the manubriosternal angle?
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aka the Angle of Louis
where the manubrium hooks with the body of the sternum at the 2nd rib |
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How large should the costal angle be?
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90 degrees or less
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What does it mean if the costal angle is over 90 degrees?
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overinflated lungs
(may be barrel chested, indicating emphysema) |
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If you breathe deeply, in which direction does your diaphragm move?
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down
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Where should you perform CPR?
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over the sternum
avoid the xiphoid process!! |
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Why is it difficult to count the ribs of the back?
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due to musculature
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How is the C7 vertebral prominens significant to the posterior thoracic cage?
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the first pair of ribs is attached to it
*when you flex your neck, C7 is the spinous process that sticks out the most |
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What vertebral component serves as a useful anatomical landmark for the posterior thoracic cage?
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spinous processes
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Where is the inferior border of the scapula usually located?
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7th or 8th rib
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How do you find the 12th rib?
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palpate midway between the spine and side to find the location free tip
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Name 3 anterior reference lines.
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1. midsternal line
2. midclavicular line 3. anterior axillary line *p. 244 |
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Name 3 posterior reference lines.
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1. scapular line
2. vertebral line 3. posterior axillary line |
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Name 3 lateral reference lines.
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1. anterior axillary line
2. posterior axillary line 3. midaxillary line *important to know when you listen to lung |
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What is the apex of the lung? Where is it located?
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The apex is at the top of lung tissue
3-4 cm above the clavicle |
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How many lobes does the right lung have?
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3
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Why is the right lung shorter in size than the left lung?
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due to crowding by the liver
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Which lobe should you always remember to check while ascultating the right lung?
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right middle lung
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How many lobes does the right lung have?
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3
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What part of the lungs are we most interested in listening to?
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the lower lungs
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During inspiration, where should the base of the lungs be located?
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around T12
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When air is not inspired (exhaled), where should the lungs be located?
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retracted to ~T10
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Which lung has an even split in lobes?
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the left lung
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What holds lungs against the chest wall?
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negative pressure
(there is a vacuum in the lungs) |
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Name 3 segments of the thorax.
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1. mediastinum
2. right pleural cavity 3. left pleural cavity |
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Which 4 structures are a part of the manubrium?
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1. esophagus
2. trachea 3. main bronchi 4. heart |
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What are the pleurae?
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the envelope between the lungs and the chest wall
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What are 2 layers of the plurae?
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1. visceral
2. parietal |
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What does the visceral pleura line?
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directly lines the lungs
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What is the costodiaphramatic recess?
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a potential space (~3cm) at the posteriormost ends of the pleural cavities
the lungs expand into this recess during forced inspiration, but the recess is never fully filled |
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What is pleural effusion?
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when too much fluid between the visceral and parietal plurae collect in the costodiaphragmatic recess
(this impairs breathing because it limits the expansion of the lungs) |
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Which airways are associated with the structure of the lungs?
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1. trachea
2. bronchial tree |
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Describe the mechanics of inspiration.
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the diaphragm descends and pushes down on the liver, while the thoracic cavity and the lungs inflate
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Describe the mechanics of expiration.
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The diaphragm returns to the upper dome shape and positive pressure enables the air to flow out
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Describe 4 purposes of ventilation.
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1. supply O2 to the body for energy production
2. remove CO2 as a waste product 3. maintain acid-base balances of arterial blood supply 4. maintain heat exchange |
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How often should you take breaths while talking?
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Normally, you are 10-12 words between breaths
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What are 8 forms of subjective data that you should ask your patient during the health history?
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1. cough
2. dyspnea 3. orthopnea 4. chest pain with breathing 5. hemoptysis 6. past history of respiratory infections 7. smoking history 8. environmental exposure |
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If your patient says he has a cough, what are 2 questions you should ask?
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1. Is there any sputum? (if yes, what color?)
2. What type of cough is it? |
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Name 5 types of coughs.
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1. afternoon-->irritant exposure
2. morning-->smoking 3. dry-->cardiac 4. hacking-->pneumonia 5. congested-->bronchitis |
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What is dyspnea?
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conscious difficulty breathing
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What is orthopnea?
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increased dyspnea with lying down
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If you suspect that a patient has orthopnea, what should you ask?
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how many pillows do you need to sleep on?
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Which conditions could be characterized by orthopnea?
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1. left sided heart failure
2. COPD 3. hypertension 4. obesity |
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What might burning or stabbing breathing indicate?
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bronchitis or pneumonia
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What is hemoptysis?
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coughing up blood
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Where might the blood in hemoptysis come from?
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nose, stomach, or throat
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If a patient has hemoptysis, what are 2 possible conditions that they have?
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1. TB
2. pulmonary embolism |
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How should you assess a patient's smoking history?
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in pack years
pack years= packs/day x #years |
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What are 7 phases in thorax physical assessment?
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1. inspection
2. respiratory excursion 3. palpate for tactile fremitus 4. percuss for symmetry 5. diaphragmatic escursion 6. ascultate posterior chest 7. repeat inspection, palpation, percussion and ascultation on the anterior chest |
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What 4 types of information should you acquire during inspection?
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1. shape and configuration of chest wall
2. facial expression and breathing effort 3. rate, rhythm, and quality of respirations 4. skin abnormalities and color |
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Why might someone be sitting in the tripod position?
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to make their chest bigger for gas exchange
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Why might someone have a scared facial expression?
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shortness of breath
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Is it important to note whether or not a patient is using their intercostals for breathing?
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yes
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If a patient has jaundice or purple lips, what might that indicate?
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not enough oxygen
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What are 9 respiration patterns?
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1. normal
2. tachypnea 3. bradypnea 4. cheyne-stokes 5. chronic obstructive breathing 6. sign 7. hyperventilation 8. hypoventilation 9. biot's |
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What is tachypnea?
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more than 24 breaths/minute
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What is bradypnea?
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less than 10 breaths/minute
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What might cause bradypnea?
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1. morphine
2. increased intracranial pressure |
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Describe Cheyne-Stokes respiration patterns.
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Waxing/waning in regular periods of apnea
normal breathing lasts for about 20-30 seconds, then followed by apnea |
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What conditions might cause Cheyne-Stokes patterns of respiration?
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1. intracranial pressure
2. renal failure 3. congestive heart failure |
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What conditions might cause tachypnea?
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1. fever
2. pneumonia 3. bronchitis |
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Describe the breathing in a patient with COPD.
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prolonged expiration (blowing out air) before that person can take another breath
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Describe Biot's respiration pattern.
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Characterized by irregular periods of apnea
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What conditions might cause Biot's respiration patterns?
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1. head trauma
2. heat stroke |
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What is hyperventilation?
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increased rate and depth of breathing
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What conditions might cause hyperventilation?
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1. fearful
2. anxious 3. diabetic with ketoacidosis |
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What is a normal anteroposterior: transverse diameter ratio?
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1:2
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What is a normal costal angle?
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less than 90 degrees
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What type of chest might someone with COPD appear to have?
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barrel chest
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What is the anteroposterior: transverse diameter ratio in a patient with a barrel chest?
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1:1
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What are 7 configurations of the thorax?
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1. normal (adult)
2. barrel chest 3. pectus excavatum 4. pectus carinatum 5. scoliosis 6. kyphosis 7. normal ROUND thorax (infant) |
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What is pectus excavatum?
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sternum depressed in
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What is pectus carinatum?
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sternum protruding
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If a patient has mild pectus excavatum or pectus carinatum, is it serious?
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not usually
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What is kyphosis?
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When lumbar areas collapse on each other
(partially due to posture) |
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Would one describe a healthy infant's chest as barrel or round?
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round
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How do you palpate for symmetric expansion?
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1. place both hands on posterior chest with thumbs at T9 or T10
2. pinch up a small fold of skin 3. ask the person to take a deep breath 4. your thumbs should move apart symmetrically |
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When might symmetric expansion palpation yield abnormal results?
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1. sig pneuonia
2. atalectasis (lack of gas exchange in alveoli) |
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What is tactile fremitus?
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palpable vibration
(when you talk, sounds transmit from the bronchial tree to the chest wall) |
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If something increases lung density (such as fluid), does it increase or decrease tactile fremitus?
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increases fremitus
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Does sound travel faster in non-fluid or fluid?
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fluid
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How do you palpate for tactile fremitus?
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1. Use the palmar base of finger or ulnar edge to touch the chest while the patient says 99
2. start over apices and palpate from side to side or compare sides |
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What substances conduct sound best?
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dense or solid structures transmit sound better than porous structures
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Do you have more or less fremitus with a deep voice?
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more fremitus
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In abnormal tactile fremitus, what might an increase in tactile fremitus indicate?
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consolidation of WBCs, RBCs, and/or pus in the lungs
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In abnormal tactile fremitus, what might a decrease in tactile fremitus indicate?
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lung collapse
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How do you percuss the posterior chest?
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hyperextend the middle finger and tap with the other middle finger in the intercostal spaces
*see slide for ladder pattern |
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Is percussion easier or harder to hear in the front chest?
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harder
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What sound do you want to hear when you percuss the chest?
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resonance
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When you hear resonance, what does this tell you about the structure?
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-it has more air
-it has a louder/deeper sound because it vibrates more freely |
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Why does the liver have a dull sound?
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it has less air
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Name and describe 5 predominant notes over lung fields.
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1. resonant
2. hyperresonant (in lung with lots of air) 3. tympany (none) 4. dull (pneumonia, liver) 5. flat (over bone) |
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See slide 24 for expected percussion notes in the posterior chest!
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1. resonence at apex and posterior midclavicular line
2. flatness over scapula 3. dullness over viscera and liver |
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How do you percuss for diaphragmatic excursion?
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measure the area of dullness by comparing the base of the lungs at an exhaled state to an inhaled state
the areas should be the same, but the right might be a little lower due to the liver |
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What is normal diaphragmatic excursion?
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3-5 cm
(if the patient is an avid runner, he might have a larger change between inflated and deflated lungs) |
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Where do you normally hear vesicular breath sounds?
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in the periphery
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What is the duration of inspiration:expiration for vesicular sounds?
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25:1
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Where do you normally hear bronchovesicular breath sounds?
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major bronchi
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What is the duration of inspiration and expiration for bronchovesicular sounds?
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1:1
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Where do you normally hear bronchial (tubular) breath sounds?
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only hear over the trachea
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What is the duration of inspiration and expiration for bronchial sounds?
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1:2
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How should you ascultate the lung fields?
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side to side and down (ladder)
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Where are posterior bronchovesicular breath sounds located?
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in the posterior area where the trachea bifurcates
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Where are posterior vesicular breath sounds located?
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breath sounds heard over the lung tissue
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Name 4 adventitious breath sounds?
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1. Crackles, rales, crepitations (fine to medium)
2. crackles, rales, crepitations (medium to course) 3. wheezes (sonorous) 4. wheezes (sibilant) *see slide 28 for diagram |
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What are 3 types of transmitted voice sounds?
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1. bronchophony
2. egophony 3. whispered pectoriloquy |
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What is bronchophony?
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"99" is clear, rather than muffled
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What is egophony?
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"e" to "a" changes (ie e is heard as a)
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What is whispered pectoriloquy?
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louder clear whispered "99" rather than faint or absent sound
(normal=whispered voice is heard faintly and indistinctly, if at all) |
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What are 3 areas that you should inspect during the thoracic exam?
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1. shape and configuration of chest wall
2. rib interspaces 3. accessory muscles |
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What are 4 assessments that you should do on the anterior chest?
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1. check for symmetric chest expansion
2. palpate for tactile fremitus 3. percuss the anterior chest 4. ascultate the anterior chest |
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Where is the trachea located in a normal lung?
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midline
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How should you describe tactile fremitus in a normal lung?
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normal
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What should the percussion be like in a normal lung?
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resonant
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What breath sounds should you hear in a normal lung?
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vesicular, except perhaps over large bronchi or trachea
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Should you hear adventitious sounds in a normal lung?
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no
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What is atelectasis?
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lobar obstruction
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How might the trachea appear in atelectasis?
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may be shifted towards the involved side
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Describe tactile fremitus during atelectasis.
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absent
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What should you percuss during atelectasis?
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dullness over airless areas
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What are the breath sounds in atelectasis?
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usually absent with bronchial plug
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Should you hear adventitious sounds during atelectasis?
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no
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A bronchial obstruction might lead to a collapsed area in the lung (for example, in the base). What might the diaphragm do in this event?
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diaphragm elevates to fill in space left by shrunken section
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Where is the trachea located in consolidation-pneumonia?
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midline
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In consolidation-pneumonia, how should you expect tactile fremitus to be?
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increased over involved area with bronchophony, egophony, whispered pectoriloquy
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In consolidation-pneumonia, what should you percuss?
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dullness over airless area
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What should the breath sounds be like in consolidation-pneumonia?
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bronchial over involved area
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Should you hear adventitious sounds in consolidation-pneumonia?
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yes: late inspiratory crackles over involved area
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In consolidation-pneumonia, what might the alveoli be consolidated with?
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1. fluid
2. bacteria 3. RBCs 4. WBCs |
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Where is the trachea located in bronchitis?
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midline
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What is tactile fremitus like in bronchitis?
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normal
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What should percussion be like in bronchitis?
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vesicular, except perhaps over large bronchi or trachea
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Should there be adventitious sounds in bronchitis?
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none or scattered coarse crackles in early inspiration and perhaps expiration
or wheezes and rhonchi |
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In bronchitis, what happens to alveoli located beyond an obstruction?
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deflation
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What might occur in the bronchi during bronchitis?
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1. bronchial inflammation
2. copious secretions |
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Where is the trachea located in emphysema?
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midline
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Describe tactile fremitus in emphysema.
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decreased
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Describe percussion in emphysema.
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hyperresonant
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Describe breath sounds in emphysema.
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decreased to absent
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Are there adventitious sounds in emphysema?
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none or scattered coarse crackles in early inspiration and perhaps expiration
or wheezes and rhonchi associated with chronic bronchitis |
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Describe the alveoli in emphysema.
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overdistended alveoli with destruction of septa
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Where is the trachea located in asthma?
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midline
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Describe tactile fremitus in asthma.
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decreased
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Describe percussion in asthma.
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resonant to hyperresonant
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Describe breath sounds in asthma.
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often obscured by wheezes
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Are there adventitious sounds in asthma?
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Yes, wheezes, possibly crackles
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What occurs in the bronchi during asthma?
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bronchospasm
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What occurs in the bronchial mucosa during asthma?
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edema, thick mucus
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Where is the trachea located in pleural effusion?
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shifted toward opposite side in large effusion
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Describe tactile fremitus in pleural effusion.
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decreased to absent
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Describe percussion in pleural effusion.
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dull to flat over fluid
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Describe breath sounds in pleural effusion.
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decreased to absent, but bronchial sounds may be heard near the top of large effusion
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Do you hear adventitious sounds in pleural effusion?
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none, except a possible rub
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What does build up of excessive fluid at the base of the lung do to the alveoli in pleural effusion?
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compresses alveoli
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Where is the trachea located in pneumothorax?
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shifted toward the opposite side if much air
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What is pneumothorax?
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Air in the pleural space due to:
1. rupture in lung wall 2. leak in chest wall 3. lung collapse |
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Describe tactile fremitus in pneumothorax.
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decreased to absent over pleural air
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Describe percussion in pneumothorax.
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hyperresonant to tympanic over pleural air
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Describe breath sounds in pneumothorax.
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decreased to absent over pleural air
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Describe adventitious sounds in pneumothorax.
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none, except a possible pleural rub
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Where is the trachea located in congestive heart failure?
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midline
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Describe tactile fremitus in congestive heart failure.
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decreased
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Describe percussion in congestive heart failure.
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resonant
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Describe breath sounds in congestive heart failure.
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vesicular
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Are there adventitious sounds in congestive heart failure?
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late inspiratory crackles in the dependent portions of the lungs; possibly wheezes
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What anatomical abnormalities occur as a result of congestive heart failure?
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1. dependent airways deflated
2. engorged capillaries 3. bronchial mucosa may be swollen |
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What causes crackles (fine-med)?
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high-pitched fluid in the lungs from:
-pneumonia -CHF |
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What do crackles (fine-med) sound like?
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rolled hbair
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When do crackles (fine-med) occur?
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at the end of inspiration; caused by air colliding with secretions
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What do medium to course crackles sound like?
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"velcro" at the beginning of inspiration
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What are atalectic crackles?
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after the patient sleeps, you hear them right after he wakes up, but they go away a few minutes after letting him breathe
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What are rhonchi?
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sonorous wheezes that mostly occur at exhalation
sound like snoring |
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What condition causes rhonchi?
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bronchitis due to blocked airflow
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What do sibilant wheezes sound like?
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musical
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What condition causes sibilant wheezes?
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asthma
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What is a strider?
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A very loud, high-pitched crowing sound
A medical emergency in kids |
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How does a pleural friction rub sound?
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Grating sound during inspiration and expiration
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What does pneumonia do to transmitted voice sounds?
|
pneumonia brings density .:. better conduction
-bronchophony -egophony -whispered pectoriloquy |
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Where might atelectasis occur?
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anywhere in the lung
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What might a chest x-ray show in atalectasis?
|
change in diaphragm
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Describe the 4 types of bronchitis.
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copious secretions characterized by
1. chronic 2. acute 3. bacterial 4. viral |
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If you sense a lot of fluid in the pleura, what should you order?
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throrocentesis
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What causes wheezes in asthma?
|
1. mucus
2. bronchospasm |
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In pneumothorax, why does percussion indicate hyperresonant to tympanic over pleural air?
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no lung in tissue site
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What do you need in the event of pneumothorax?
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a chest tube
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