Hpa Thorax And Lungs

Front 1

normal air pathway

Back 1

nose-pharynx-larynx-trachea-mainstem bronchus-right and left main bronchi-lobar/secondary bronchi-tertiary/segmental bronchi-terminal bronchioles-respiratory bronchioles-alveolar ducts-alveolar sacs-alveoli

Front 2

upper respiratory tract

Back 2

nose
parynx
larynx
upper trachea

Front 3

lower respiratory tract

Back 3

lower trachea to lungs

Front 4

Composition of thorax

Back 4

bones, cartilage, muscle
anterior - 12 pairs of ribs and sternum
posterior - 12 thoracic vertebrae and spinal column

Front 5

Sections and length of sternum

Back 5

15cm
manubrium, body, xiphoid process

Front 6

Composition of ribs

Back 6

1-7 vertebrosternal or true ribs
8-10 false ribs
11-12 floating ribs

Front 7

lowest rib that can be palpated anterior, lateral, posterior

Back 7

anterior 10
lateral 11
posterior 12

Front 8

# ICS

Back 8

11

Front 9

Shape of lungs

Back 9

cone shaped
lower outer surface is concave where meets diaphragm
medial aspect concave for heart (more left lung = cardiac notch)

Front 10

Thoracic Landmarks

Back 10

ANTERIOR
sternum
clavicles
nipples
suprasternal notch
angle of louis
costal angle
POSTERIOR
vertebra prominens
Inferior angle of scapula
Spine
12th rib

Front 11

Where is suprasternal notch?

Back 11

midsternal line, above manubrium

Front 12

Where is angle of louis?

Back 12

feel suprasternal notch and move down sternum to a horizontal ridge - articulates with second rib

Front 13

Where is costal angle?

Back 13

place fingers at bottom of anterior rib cage, move horizontally toward sternum until they meet in midsternal line

Front 14

Where are vertebra prominens?

Back 14

flex neck forward
superior process palpable is C7 - can count ribs till T4

Front 15

Where is inferior angle of scapula?

Back 15

inferior border of scapula = 7th rib or 7th ICS

Front 16

Which lung is longer? By how much?

Back 16

left, 2.5cm

Front 17

Lobes of lungs

Back 17

R - upper, middle, lower
L - upper, lower

Front 18

What are apex and base of lung?

Back 18

apex - top
base - bottom

Front 19

Where are lung apices located anteriorly and posteriorly?

Back 19

anterior - 2.5-4cm superior to inner third of clavicles
posterior - near T1

Front 20

Where does lower lung border extend to posteriorly during deep inspiration and expiration?

Back 20

inspiration T12
expiration T10

Front 21

Where is the anterior inferior border of lungs?

Back 21

6th rib at midclavicular line
8th rib at midaxillary line

Front 22

What divides lobes of lungs?

Back 22

fissures

Front 23

What are the fissures in the left and right lungs anteriorly?

Back 23

Left - left oblique fissure
Right - horizontal fissure, right oblique fissure

Front 24

What are the fissures in the left and right lungs posteriorly?

Back 24

right and left oblique fissures

Front 25

What are the different imaginary lines?

Back 25

R&L midclavicular lines
R&L scapular lines
R&L, anterior and posterior axillary lines
midaxillary lines
midsternal line
midspinal line (or vertebral)

Front 26

What are the lobes of the different lungs? Where are they divided (anterior)?

Back 26

Right
-Right upper lobe
-Right middle lobe (borders above at 4th rib at right sternal border)
-Right lower lobe (borders above at 5th rib at midaxillary line, borders lower at 6th rib at midclavicular line)

Left
-Left upper lobe
-left lower lobe
-border at 5th rib at midaxillary line and 6th rib at midclavicular line

*borders called oblique fissures

Front 27

Where are the lungs (and lobes) located posteriorly?

Back 27

Upper border lower at T3
lungs sit at T10 on expiration and T12 on inspiration
right and left oblique fissures

Front 28

Where are the lungs (and lobes) located laterally?

Back 28

RU/RL border: T3 and 5th rib at midaxillary line
RL/RM border: 5th rib at midaxillary line and 6th rib at midclavicular line right oblique fissure
RU/RM border: 4th rib - right horizontal fissure

LU/LL - T3 and 6th rib at midclavicular line - left oblique fissure

Front 29

What is the mediastinum?

Back 29

area between the 2 lungs

Front 30

Anterior skeletal anatomy of thorax and lungs

Back 30

ribs
clavicles
angle of louis
trachea
bronchi
costal angle

Front 31

Posterior skeletal anatomy of thorax and lungs

Back 31

vertebra prominens
spine
scapula

Front 32

Organs of thorax

Back 32

lungs
breast
liver
spleen
heart

Front 33

Layers of pleura

Back 33

parietal - outer
visceral - inner

Front 34

Muscles of thorax and lungs

Back 34

diaphragmm
internal intercostal muscles
external intercostal muscles
accessory muscles

Front 35

Respiratory structures in the mediastinum

Back 35

trachea
pulmonary vasculature

Front 36

length and width of trachea

Back 36

11-13cm length
2-3cm width

Front 37

Purpose of bronchi

Back 37

transport gases
trap foreign particles

Front 38

observable signs of respiratory distress

Back 38

anxious look
nasal flaring
SCM muscles prominent and working hard
intercostal and supraclavicular retractions
circumoral cyanosis

Front 39

Location of diaphragm

Back 39

R: 5th rib 5th ICS at MCL
L:6th rib-6th ICS at MCL

posteriorly: 10th vertebrae on expiration, T12 on inspiration

laterally - 8th rib at midclavicular line

Front 40

Function of External intercostal muscles

Back 40

elevate ribs during inspiration

Front 41

function of internal intercostal muscles

Back 41

draw ribs together during expiration

Front 42

function of accessory muscles

Back 42

accomodate increased oxygen demane

Front 43

accessory muscles of respiration

Back 43

scalene
sternocleidomastoid
trapezius
abdominal rectus

Front 44

what is external respiration?

Back 44

process by which gases are exchanged between lungs and pulmonary vasculature

Front 45

what is internal respiration?

Back 45

process by which gases are exchanged between the pulmonary vasculature and body's tissues

Front 46

stimuli for breathing

Back 46

increased CO2 level
decreased O2 level
increased blood pH level

Front 47

what controls involuntary breathing?

Back 47

pons and medulla

Front 48

Gerontological thorax and lung changes

Back 48

anatomic
-ligaments stiffen and cartilage calcifies
-muscle atrophy - diaphragm flattens - more effort to breathe, less neural stimulation to muscles
-lung - decrease in elastic recoil, loss of tissue and alveolar capillaries - surface for diffusion less and thicker
-thoracic cage more rigid and shape changes - barrel chest and kyphosis

poorer gas exchange
-medulla less sensitive to changes in O2 and CO2
-Hgb less affinity for O2, less perfusion, more tired, less energy, slower

defense mechanisms less efficient
-decreased ciliary action
-diminished cough reflex

more susceptible to respiratory infections

Front 49

Common respiratory symptoms

Back 49

dsypnea
cough
sputum
chest pain

Front 50

Dyspnea P/T/A

Back 50

provoke - lying flat, emotional event, exertion
palliate - rest, rebreathing
Timing - slow or sudden onset

Associated symptoms
-cough - worse with inhaled irritants, allergens, exertion, URI, better at rest, expectoration
-wheezing, chest tightness
-pleuritic pain, cough, sputum, fever - onset sudden
-anxiety, sighing, lightheadedness, palpitations, CP

Front 51

PND

Back 51

paroxysmal nocturnal dyspnea
-night time onset
-frequent
-episodic
-orthopnea

Front 52

Characteristics of COPD

Back 52

Chronic obstructive pulmonary disease
-increased resistance to airflow-airway obstruction or narrowing
-may be due to inflammation, secretions, spasms, destruction of lung tissue
-difficult to breathe, use pursed-lip breathing
-most commonly caused by cigarette smoking
-can also be caused by lung irritants over a long period of time
-most common types: asthma, bronchitis, emphysema

Front 53

Characteristics of angina-type chest pain

Back 53

pressing retrosternal, radiating to jaw, arm
transient 1-3 mins, up to 20
triggered by exertion
relieved with rest
associated symptoms: dyspnea, sometimes nausea and sweating

Front 54

Characteristics of pericarditis

Back 54

sharp, knife-like, severe precordium or retrosternal pain
may radiate to shoulder and neck
persistent, worse with breathing, coughing, lying, swallowing
relieved with sitting forward

Front 55

Characteristics of bronchitis

Back 55

burning upper sternum, either side
mild to moderate
worth with coughing
associated symptoms: cough, fever

Front 56

Characteristics of pleurisy, pneumonia

Back 56

sharp, knife-like
chest wall over pathological area
persistent, worse with breathing, coughing, trunk movements
relieved by lying on involved side

Front 57

Characteristics of anxiety chest pain

Back 57

precordium or across anterior chest
stabbing or dull
transient
follow emotional event/stress
associated symptoms: breathless, palpitations, weakness

Front 58

What happens anatomically in COPD?

Back 58

-airways and air sacs lose elasticity
-walls between many alveoli destroyed
-walls of airways become thick and inflamed
-cells in the airways make more mucous than usual - clogs airways
-develops slowly

Front 59

Emphysema
-characteristics of lung expansion
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 59

-characteristics of lung expansion (do not expand normally and are smooth instead of balloon structure)
-shape of thorax (1:1)
-tracheal position (midline)
-percussion (hyperresonance)
-adventitious sounds (wheezes)

Front 60

#deaths/year from asthma in US

Back 60

5000

Front 61

Characteristics of asthma
-physiology
-symptoms
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 61

-extra sensitive airways that narrow when they become irritated
-symptoms:
wheezing
coughing
SOB
chest tightness
-shape of thorax (1:2)
-tracheal position (midline)
-percussion (hyperresonance)
-adventitious sounds (wheezes)

Front 62

What causes airway narrowing in asthma?

Back 62

airway inflammation
bronchoconstriction

Front 63

Pneumonia
-cause
-symptoms
-risk factors

Back 63

caused by acute inflammation of lung tissue due to microbial infection

Sx: CP, fever, tachypnea

risk factors
-immuno-compromised or upper airway muco-ciliary defense system weakened
-highly virulent organism

Front 64

Health history: Age related

Back 64

children and young adults
-bronchiectasis (dilates bronchi and destroys muscle and elastic structures in bronchus)
-cystic fibrosis
Adults and older adults
-lung cancer
-chronic bronchitis
-pneumonia
-emphysema, sarcoidosis

Front 65

Health history: female

Back 65

sarcoidosis

(chronic multi-system disease that affects lungs, alveoli more fibrous)

Front 66

Health history: male

Back 66

mesothelioma
idiopathic pulmonary fibrosis
pneumothorax

Front 67

Health history: caucasian

Back 67

CF

Front 68

Health history: african american

Back 68

sarcoidosis

Front 69

Health history: medical, respiratory specific

Back 69

asthma
bronchitis
emphysema
pneumonia
TB
croup
CF
pneumothorax
pulmonary edema
pulmonary embolus
lung cancer
frequent coryza
epiglottitis
pleurisy

Front 70

Health history: non-resp. specific medical

Back 70

cardiovascular (because of SOB)

Front 71

Health history: medications

Back 71

antibiotics
bronchodilators
cough expectorant
cough supressant
O2

Front 72

Health history: allergies

Back 72

asthma
hypersensitivity to any drugs, food, pet, dust, smoke, perfume, pollen

Front 73

Health history: childhood illnesses

Back 73

pertussis
measles

Front 74

Health history: special needs

Back 74

O2 dependent
phrenic pacer dependent
ventilator dependent

Front 75

Health history: accidents and injuries

Back 75

chest trauma
near drowning

Front 76

Health history: family history

Back 76

allergies
asthma
bronchiectasis
cancer
cystic fibrosis
emphysema
TB

Front 77

Health history: travel history

Back 77

airplane - prolonged exposure to confined space and recirculated air
TB - haiti, SE asia
pneumonic plague - india

Front 78

Questions to ask about smoking

Back 78

-have you ever smoked?
-for how long?
-how much?
-have you ever tried quitting?

Front 79

Health history: sleep

Back 79

-ask about difficulty breathing when lying flat
-ask about # pillows
-ask about snoring

Front 80

Health history: diet

Back 80

foods that affected breathing?

Front 81

Health history: exercise

Back 81

SOBOE?

Front 82

Inspection components

Back 82

shape of thorax
symmetry of chest wall
presence of superficial veins
costal angle
angle of ribs
ICS
muscles of respiration
respirations
sputum

Front 83

Normal thorax shape/diameter

Back 83

AP: transverse 1:2 or 5:7
slightly elliptical in shape

Front 84

When is a barrel chest normal?

Back 84

infants, older adults

Front 85

Shapes of thorax and AP to transverse diameter

Back 85

normal 1:2
barrel chest 1:1 (COPD)
pectus carinatum: protrusion (rickets)
pectus excavatum: depression

Front 86

What else should be assessed? (o2)

Back 86

nail clubbing
cap refill

Front 87

normal costal angle

Back 87

90 degrees during exhalation and rest, widens slightly during inhalation

Front 88

angle of ribs - normal

Back 88

45 degrees with sternum

Front 89

what are you looking for when inspecting ICS

Back 89

bulging
retractions

Front 90

what are you looking for when inspecting muscles of respiration

Back 90

use of accessory muscles

Front 91

Characteristics of respiration

Back 91

rate
depth
rhythm
symmetry
audibility
mode

Front 92

eupnea
tachypnea
bradypnea
apnea

Back 92

eupnea - 12-20 breaths/min
tachypnea >20
bradypnea<12
apnea - no respiration for 10 or more seconds

Front 93

What are Cheyne-Stokes respirations? When are they normal?

Back 93

crescendo and decrescendo patterns with periods of apnea that last 15-30 seconds
-can be normal in elderly and young children
-may occur during sleep
-regularly irregular pattern

Front 94

What are ataxic (Biot's) respirations?

Back 94

irregularly irregular
no crescendo/decrescendo pattern
deep and shallow breaths with periods of apnea at random intervals

indicates medulla damage

Front 95

apneustic respirations

Back 95

prolonged gasping during inspiration followed by short, inefficient expiration

Front 96

agonal respirations

Back 96

irregularly irregular
varying depths and patterns
-impending death

Front 97

hyperpnea

Back 97

breath greater in volume then resting tidal volume, rate is normal and pattern even

Front 98

shallow respirations

Back 98

seen when lung pathology exists and breathing is painful, recent chest surgery, obesity

Front 99

air trapping

Back 99

rapid, shallow respirations and forced expirations occuring in patients with COPD

Front 100

Kussmaul's respirations

Back 100

extreme increased depth and rate of respirations
-diabetic ketoacidosis

Front 101

sighing

Back 101

normal respirations interrupted by deep inspiration followed by deep expiration
-can occur in CNS lesions

Front 102

orthopnea

Back 102

difficulty breathing in positions other than upright

Front 103

characteristics of sputum to look for

Back 103

colour
odor
amount
consistency

Front 104

normal sputum

Back 104

light in colour
odourless
can be thick or thin depending on hydration

Front 105

pathologies associated with mucoid sputum

Back 105

tracheobronchitis
asthma
coryza

Front 106

pathologies associated with yellow or green sputum

Back 106

bacterial infection

Front 107

pathologies associated with rust or blood tinged sputum

Back 107

pneumococcal pneumonia
pulmonary infarction
TB
lung cancer

Front 108

pathologies associated with black sputum

Back 108

black lung disease

Front 109

pathologies associated with pink sputum

Back 109

pulmonary edema

Front 110

General palpation - looking for

Back 110

pulsations
masses
thoracic tenderness
crepitus

Front 111

Palpation components

Back 111

general: anterior, posterior, lateral
thoracic expansion
thoracic fremitus
Tracheal position

Front 112

thoracic expansion - normal

Back 112

thumbs separate an equal amount and remain in same plane
3-5cm

Front 113

aspects of hand used to perform tactile fremitus

Back 113

palmar
ulnar - back of hand
ulnar - closed fist

Front 114

where is tactile fremitus performed?

Back 114

anterior
posterior
lateral

Front 115

Normal tactile fremitus findings

Back 115

more pronounced near major bronchi (second ICS anteriorly, T1 and T2 posteriorly), trachea

less palpable in periphery of lung

Front 116

Percussion components

Back 116

general - anterior, posterior, lateral
diaphragmatic excursion

Front 117

How deep does percussion reverberate sounds?

Back 117

5cm deep

Front 118

Normal percussion findings

Back 118

normal lung tissue - resonant
diaphragm and cardiac sillouette - dull
rib - flat

Front 119

When is hyperresonance in percussion normal?

Back 119

thin adults
patients with decreased musculature

Front 120

What does diaphragmatic excursion provide information about?

Back 120

depth of ventilation

Front 121

Normal diaphragmatic excursion findings

Back 121

3-5cm

insp. T12
exp. T10

Front 122

Auscultation components

Back 122

General - anterior, posterior, lateral
Breath sounds
Voice sounds

Front 123

Types of breath sounds

Back 123

bronchial
bronchovesicular
vesicular

Front 124

Where are bronchovesicular breath sounds heard?

Back 124

1st and 2nd ICS (anterior) close to sternum and ICS 1-4 posteriorly next to spinal column

Front 125

Adventitious breath sounds

Back 125

fine crackle
coarse crackle
sonorous wheeze
sibilant wheeze
pleural friction rub
stridor

Front 126

Bronchial breath sounds
-pitch
-intensity
-quality
-relative duration
-location

Back 126

-pitch (high)
-intensity (loud)
-quality (blowing or hollow)
-relative duration (I<E)
-location (trachea)

Front 127

Bronchovesicular breath sounds
-pitch
-intensity
-quality
-relative duration
-location

Back 127

-pitch (moderate)
-intensity (moderate)
-quality (combo of other 2)
-relative duration (I=E)
-location (between scapulae, 1st and 2nd ICS lateral to sternum)

Front 128

Vesicular breath sounds
-pitch
-intensity
-quality
-relative duration
-location

Back 128

-pitch (low)
-intensity (soft)
-quality (gentle rustling or breezy)
-relative duration (I>E)
-location (peripheral lung)

Front 129

Purpose of voice sounds

Back 129

reveal if lungs are filled with air, fluid, or are solid

Front 130

Types of voice sound assessment

Back 130

bronchophony
egophony
whispered petroiloquy

Front 131

Fine Crackle
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 131

-respiratory phase (I)
-timing (discontinuous)
-description (dry, high pitched crackling, popping)
-clear with cough? (no)
-etiology (air passing through moisture in small airways that suddenly reinflate)
-conditions (COPD, CHF, pneumonia, pulmonary fibrosis, atelectasis)

Front 132

Coarse Crackle
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 132

-respiratory phase (I)
-timing (discontinuous)
-description (moist, low-pitched crackling, gurgling - long duration)
-clear with cough? (possibly)
-etiology (air passing through airways that suddenly reinflate)
-conditions (pneumonia, pulmonary edema, bronchitis, atelectasis)

Front 133

Sonorous wheeze (rhonchi)
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 133

-respiratory phase (E)
-timing (continuous)
-description (low-pitched, snoring)
-clear with cough? (possibly)
-etiology (narrowing of large airways or obstruction of bronchus)
-conditions (asthma, bronchitis, airway edema, tumor, bronchiolar spasm, foreign body obstruction

Front 134

Sibilant Wheeze
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 134

-respiratory phase (E)
-timing (cont)
-description (high-pitched, musical)
-clear with cough? (possibly)
-etiology (narrowing of large airways or obstruction of bronchus)
-conditions (asthma, chronic bronchitis, emphysema, tumor, foreign body obstruction_

Front 135

Pleural friction rub
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 135

-respiratory phase (I+E)
-timing (cont)
-description (creaking, grating)
-clear with cough? (no)
-etiology (inflamed parietal and visceral pleura - can occasionally be felt on thoracic wall as 2 pieces of dry leather rubbing against each other)
-conditions (pleurisy, TB, pulmonary infarction, pneumonia, lung abscess

Front 136

Stridor
-respiratory phase
-timing
-description
-clear with cough?
-etiology
-conditions

Back 136

-respiratory phase I)
-timing (cont)
-description (crowing)
-clear with cough? (no)
-etiology (partial obstruction of larynx, trachea)
-conditions (croup, foreign body obstruction, large airway tumor)

Front 137

Asthma
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 137

-shape of thorax (normal, may have barrel in chronic)
-tracheal position (midline)
-percussion (hyperresonant)
-adventitious sounds (wheezes)

Front 138

Atelectasis (patent bronchus)
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 138

-shape of thorax (normal)
-tracheal position (shifts to affected side)
-percussion (dull)
-adventitious sounds (crackles or wheezes)

Front 139

Atelectasis (obstructed bronchus)
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 139

-shape of thorax (normal)
-tracheal position (shifted to affected side)
-percussion (dull)
-adventitious sounds (absent)

Front 140

Bronchiectasis
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 140

-shape of thorax (1:1)
-tracheal position (midline or deviated toward affected side)
-percussion (resonant to dull)
-adventitious sounds (crackles or wheezes)

Front 141

Bronchitis
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 141

-shape of thorax (normal)
-tracheal position (midline)
-percussion (resonant)
-adventitious sounds (crackles or wheezes)

Front 142

CHF
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 142

-shape of thorax (normal)
-tracheal position (midline)
-percussion (resonant)
-adventitious sounds (crackles)

Front 143

Pleural Effusion
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 143

-shape of thorax (normal)
-tracheal position (shifts to unaffected side)
-percussion (dull)
-adventitious sounds (possible friction rub)

Front 144

Pneumonia with lobar consolidation
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 144

-shape of thorax (normal)
-tracheal position (shifts to affected side)
-percussion (dull)
-adventitious sounds (crackles or occasional friction rub)

Front 145

Pneumothorax
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 145

-shape of thorax (normal)
-tracheal position (shifts to unaffected side)
-percussion (hyperresonant)
-adventitious sounds (absent)

Front 146

Pulmonary edema
-shape of thorax
-tracheal position
-percussion
-adventitious sounds

Back 146

-shape of thorax (normal)
-tracheal position (midline)
-percussion (dull)
-adventitious sounds (crackles)