Lecom Chapter 13 Chest And Lungs Questions

Front 1

What diameter of the chest do the external intercostal muscles increase and when?

Back 1

AP diameter during inspiration

Front 2

What diameter of the chest do the internal intercostal muscles increase and when?

Back 2

lateral diameter during expiration

Front 3

In the right lung, what divides the upper and middle lobes? What surface structures does it run along?

Back 3

Horizontal fissure, runs from the 5th rib in the axilla to the 4th rib anteriorly

Front 4

Where does the apex of the lung extend to anteriorly and posteriorly?

Back 4

anteriorly- 4cm above the 1st rib; posteriorly- level of T1

Front 5

Where does the lower borders of the lung extend to during deep inspiration and forces expiration?

Back 5

deep inspiration- T12; forced expiration- T9

Front 6

Where does the trachea divide into left and right main bronchi?

Back 6

at the level of T4 or T5 and just below the manubriosternal joint

Front 7

What is the difference between the right and left main bronchi?

Back 7

The right bronchi is wider, shorter, and more vertical (more susceptible to aspiration) and divides into 3 branches; the left bronchi has 2 branches

Front 8

Where do the bronchial arteries branch from and what do they supply?

Back 8

anterior thoracic aorta and the intercostal arteries to supply to lung parenchyma and stroma

Front 9

Where does most of the blood supplied by the bronchial arteries drain to?

Back 9

pulmonary veins

Front 10

Anteriorly, what lobes are seen?

Back 10

mainly upper and middle

Front 11

What surface structures does the left oblique fissure run along?

Back 11

5th rib midaxillary to the 6th rib midclavicular

Front 12

Posteriorly, what lobe is primarily seen and where does it extend?

Back 12

Lower lobe from T3 to T10 or T12

Front 13

In the lateral lungs, how far do the lungs extend?

Back 13

Peak of the axilla to the 7th or 8th rib

Front 14

In the left lateral lung view, what surface landmarks mark the oblique fissure?

Back 14

Level of the 3rd rib medially to the 6th rib anteriorly

Front 15

In adults, what proportion is the AP diameter to the lateral diameter?

Back 15

called the "thoracic ratio" expected to be about .7 to .75

Front 16

In newborns, what proportion is the AP diameter to the lateral diameter?

Back 16

they are equal

Front 17

In newborns, what is the circumference of the chest roughly equal too until about 2 yrs of age?

Back 17

head circumference

Front 18

In pregnant women, what movement is the major work of breathing?

Back 18

diaphragm

Front 19

In older adults, what causes a barrel chest?

Back 19

loss of muscle strength in the thorax and diaphragm coupled with the loss of lung resiliency

Front 20

Increased kyphosis (or dorsal curve) in older adults causes what change in chest diameter?

Back 20

increased AP chest diameter

Front 21

Older adults loose elasticity and increase fibrosis in alveoli causing what net result in breathing capacities?

Back 21

decrease in vital capacity and increase in residual volume

Front 22

When does the most rapid growth in the number of alveoli occur?

Back 22

first 2 years of life

Front 23

What is dyspnea, what is it commonly observed with?

Back 23

difficult and labored breathing with shortness of breath, observed with pulmonary and cardiac compromise

Front 24

What is shortness of breath that begins or increases when a patient lies down?

Back 24

orthopnea

Front 25

What is a sudden onset of shortness of breath after a period of sleep?

Back 25

paroxysmal nocturnal dyspnea

Front 26

What is dyspnea increasing in the upright posture?

Back 26

platypnea

Front 27

What are the 5 types of chest pains associated with not originating from the heart?

Back 27

constant achiness all day, does not radiate, made worse by pressing on the precordium, a fleeting needle-like jab that lasts only a second or two, and pain situated in the shoulders or between the shoulder blades in the back

Front 28

What regional areas of travel causes increased risk of exposure to TB?

Back 28

india, china, indonesia, south africa, and nigeria

Front 29

What regional areas of travel causes increased risk of exposure to histoplasmosis?

Back 29

southeastern and midwestern US

Front 30

What regional areas of travel causes increased risk of exposure to schistosomiasis?

Back 30

southwest asia, africa, and the caribbean

Front 31

Cocaine use causes what common symptoms?

Back 31

tachycardia, hypertension, coronary arterial spasm (with infarction), and pneumothorax with severe acute chest pain

Front 32

What happens to the ribs, spine, sternal angle and trachae in barrel chest resulting from compromised respiration?

Back 32

rib- more horizontal, spine is kyphotic, sternal angle is more prominent, and the trachae is posteriorly displaced

Front 33

The inferior borders of the lungs cross the 6th rib at what imaginary line?

Back 33

midclavicular

Front 34

What imaginary line goes through the inferior angle of the scapula?

Back 34

scapular lines

Front 35

What is a normal respiratory rate?

Back 35

12 to 20 per minute

Front 36

What is the ratio of respirations to heartbeats?

Back 36

1:04:00

Front 37

What is the respiratory rate in bradypnea and what does it indicate?

Back 37

less than 12 per minute, indicates neurologic or electrolyte disturbances, infection, or a sensible response to protect against the pain of pleurosity or other irritative phemonena

Front 38

Hyperventilation due to breathing rapidly is called?

Back 38

tachypnea

Front 39

Hyperventilation due to breathing deeply is called?

Back 39

hyperpnea

Front 40

What is the respiratory rate in hyperventilation?

Back 40

over 20 per minute

Front 41

What is tachypnea a symptom of?

Back 41

protective splinting from pain of a broken rib or pleurosity, massive enlargement of the liver or abdominal ascitis preventing descent of the diaphragm

Front 42

What 6 influences cause increased rate and depth of breathing?

Back 42

metabolic acidosis, CNS lesions of the pons, anxiety, aspirin poisoning, oxygen need, and pain

Front 43

What 5 influences cause decreased rate and depth of breathing?

Back 43

metabolic alkalosis, CNS lesions of the cerebrum, myasthenia gravis, narcotic overdoses, and extreme obesity

Front 44

What is primary apnea and what commonly causes it?

Back 44

breathing spontaneously after sufficient carbon dioxide accumulates in the circulation; common after a blow to the head

Front 45

What is secondary apnea and what causes it?

Back 45

breathing stops and it will not begin spontaneously unless resuscitative measures are immediately taken; caused by any event that severely limits the absorption of oxygen into the bloodstream

Front 46

What is reflex apnea?

Back 46

involuntary temporary halt in respiration from irritiating and nausea-provoking vapors or gases are inhaled

Front 47

What is apneustic breathing and what causes it?

Back 47

a long inspiration and what amounts to expiration apnea (gasping) from neuronal lesion affecting the pons

Front 48

What is periodic apnea of the newborn and what is it associated with?

Back 48

An irregular pattern of rapid breathing interspersed with brief periods of apnea that is usually associated with rapid eye movement sleep

Front 49

What type of breathing is applied to the respiratory effect associated with metabolic acidosis?

Back 49

Kussmaul breathing

Front 50

What is hypopnea?

Back 50

abnormally shallow breathing

Front 51

What is Cheyne-Stokes respiration and what is it associated with?

Back 51

also called periodic breathing; a cresendo/decresendo sequence of breathing associated with cerebral level brain damage or drug-associated respiratory compromise

Front 52

What is biot respiration, what is it associated with, and what is it called when it is extreme?

Back 52

irregular respirations varying in depth and interrupted by intervals of apnea; associated with severe and persistent increased intracranial pressure, respiratory compromise resulting form drug poisoning, or brain damage at the level of the medulla; extreme expression is called ataxic

Front 53

What causes a prolonged expirations and bulging on expiration?

Back 53

outflow obstruction or valvelike action of compression by a tumor, aneurysm, or enlarged heart; costal angle widens beyond 90 degrees

Front 54

What condition causes stridor?

Back 54

obstruction high in the respiratory tree

Front 55

What occurs with paradoxic breathing and what causes it?

Back 55

on inspiration the lower thorax is drawn in; develops when negative intrathoracic pressure is transmitted to the abdomen by a weakened poorly functioning diaphragm, obstructive airway disease, or during sleep from an upper airway obstruction

Front 56

What does pursing of the lips accompany?

Back 56

increased expiratory effort

Front 57

What is crepitis and what does it indicate?

Back 57

a crackly or crinkly sensation that can be both palpated and heard; indicated air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas-producing organism

Front 58

What is a palpable coarse grating vibration on inspiration? What is it caused by?

Back 58

pleural friction rub caused by inflammation fo the pleural surfaces

Front 59

What is the palpable vibration of the chest wall that results from speech or other verbalizations?

Back 59

tactile fremitus

Front 60

Where is tactile fremitus best felt?

Back 60

parasternally at the 2nd intercostal space at the level of the bifurcation of the bronchi

Front 61

What characterizes stridor in obstruction above the glottis? Below the glottis?

Back 61

above- quieter; below-louder and more rasping

Front 62

What characterizes the voice in obstruction above the glottis? Below the glottis?

Back 62

above- muffled; below- hoarse

Front 63

What level (above or below the glottis) causes difficulty swallowing but not affecting cough?

Back 63

above the glottis

Front 64

What level (above or below the glottis) causes a harsh barking cough without affecting the swallowing?

Back 64

below the glottis

Front 65

What two factors must both happen to diagnose pleural effusion?

Back 65

dullness to percussion and tactile fremitus

Front 66

What causes decreased or absent fremitus?

Back 66

excess air in the lungs, emphysema, pleural thickening or effusion, massive pulmonary edema, or bronchial obstruction

Front 67

What causes increased fremitus?

Back 67

in the presence of fluids or a solid mass within the lungs, lung consolidation, heave but nonobstructive bronchial secretions, compressed lung, or tumor

Front 68

What causes the trachea to pull toward the affected lung?

Back 68

volume loss such as fibrosis or atelectasis due to tumor or adenopathy; collapsed lung

Front 69

What causes the trachea to pull away from the affected lung?

Back 69

thyroid enlargement, pleural effusion, tension pneumothorax

Front 70

What pushes the trachea anteriorly? Posteriorly?

Back 70

anteriorly- mediastinitis; posteriorly- anterior mediastinal tumors

Front 71

What is the intensity, pitch, duration, and quality of a resonant tone?

Back 71

intensity loud, pitch low, duration long, and quality hollow

Front 72

What is the intensity, pitch, duration, and quality of a flat tone?

Back 72

intensity soft, pitch high, duration short, and quality very dull

Front 73

What is the intensity, pitch, duration, and quality of a dull tone?

Back 73

intensity medium, pitch medium to high, duration medium, and quality dull thud

Front 74

What is the intensity, pitch, duration, and quality of a tympanic tone?

Back 74

intensity loud, pitch high, duration medium, and quality drumlike

Front 75

What is the intensity, pitch, duration, and quality of a hyperresonant tone?

Back 75

intensity very loud, pitch very low, duration longer, and quality booming

Front 76

What causes a hyperresonant tone?

Back 76

air trapping, as in obstructive lung disease emphysema, pneumothorax, or asthma

Front 77

Where is tympany percussion heard?

Back 77

abdomen

Front 78

What causes dullness or flatness?

Back 78

pneumonia, atelectasis, pleural effusion, pneumothorax, or asthma

Front 79

During diaphragmatic excursion, what tone change are you noting for to mark the border?

Back 79

resonance (lung) to dullness (diaphragm)

Front 80

What does a sweet fruity breath smell indicate?

Back 80

diabetic ketoacidosis; starvation

Front 81

What does a fishy, stale breath smell indicate?

Back 81

trimethylamine uremia

Front 82

What does a musty fish, cloverbreath smell indicate?

Back 82

fetor hepaticus; hepatic failure, portal vein thrombosis, portacaval shunts

Front 83

What does a foul feculent breath smell indicate?

Back 83

intestinal obstruction

Front 84

What does a foul putrid breath smell indicate?

Back 84

nasal/sinus pathology: infection, foreign body, cancer; respiratory infections: empyema, lung abscess, bronchiectasis

Front 85

What does a halitosis breath smell indicate?

Back 85

tonsilitis, gingivitis, respiratory infections, Vincent angina, gastroesophageal reflux

Front 86

What does a cinnamon breath smell indicate?

Back 86

pulmonary TB

Front 87

Should you use the diaphragm or bell to listen to the lungs, why?

Back 87

diaphragm, transmits ordinarily high-pitched sounds better and provides a broader area of sound

Front 88

What should you do differently when ausculating a person with congestive heart failure?

Back 88

begin at the base of the lungs to detect crackles that may disappear with continued exaggerated respiration

Front 89

Where is vesicular breath sounds heard, what pitch, what intensity?

Back 89

heard over most of lung fields, low pitch, low intensity

Front 90

Where is bronchovesicular breath sounds heard, what pitch, what intensity?

Back 90

heard over main bronchus area and over upper right posterior lung field; medium pitch and intensity

Front 91

Where is bronchial/tracheal (tubular) breath sounds heard, what pitch, what intensity?

Back 91

only over the trachea, high pitch and intensity

Front 92

What does amphoric breathing sound like and what causes it?

Back 92

resembles noise made by blowing across the mouth of an open bottle; heard with large still walled pulmonary cavity or tension pneumothorax with bronchopleural fistula

Front 93

What causes cavernous breathing sound?

Back 93

over a pulmonary cavity with a rigid wall

Front 94

When are lungs sound easier to hear?

Back 94

when they are consolidated as in a mass (solid object)

Front 95

Which adventisous sound is continuous? Which is discontinuous?

Back 95

continuous- crackles; discontinuous-rhonchi and wheezes

Front 96

What are high-pitched breathing sounds called?

Back 96

sibilant

Front 97

What are low-pitched breathing sounds called?

Back 97

sonorous

Front 98

When and where are crackles heard?

Back 98

during inspiration in the small airways of the respiratory tree

Front 99

What causes rhonchi breath sounds, when are they heard, what do they sound like?

Back 99

caused by the passage of air through an airway obstructed by thich secretions, muscular spasm, new growth, or external pressure; heard during expiration; loud low course sound

Front 100

Are crackles are rhonchi cleared by coughing?

Back 100

rhonchi

Front 101

Higher pitched rhonchi are caused by what? Located where?

Back 101

asthma, smaller bronchi

Front 102

Lower pitched rhonchi are caused by what? Located where?

Back 102

tracheobronchitis, larger bronchi

Front 103

Rhonchi are also called what?

Back 103

sonorous wheezing

Front 104

A wheeze is also called what?

Back 104

sibilant wheeze

Front 105

What does a wheeze sound like? When is it heard? What causes it?

Back 105

continuous high pitched musical sound; during inspiration and expiration; caused by a relatively high-velocity air flow through a narrowed or obstructed airway

Front 106

What does a friction rub sound like? When is it heard?

Back 106

dry crackly grating low-pitched sound heard during inspiration and expiration (machine-like)

Front 107

What causes a friction rub over the heart? Over the lungs?

Back 107

heart- pericarditis; lungs-pleurisy

Front 108

What is another name for mediastinal crunch? What causes it?

Back 108

Hamman sign; found with mediastinal emphysema

Front 109

When are mediastnal crunch sounds more pronounced? When are they easiest to hear?

Back 109

more pronounced at the end of expiration; easiest to hear when the patient leans to the left or lies down on the left side

Front 110

What is bronchophony?

Back 110

greater clarity and increased loudness of spoken sounds

Front 111

What is egophony?

Back 111

the intensity of the spoken voice is increased and there is a nasal quality (e's become a's)

Front 112

What is the 4th leading cause of death in the US?

Back 112

chronic obstructive pulmonary disease

Front 113

What usually causes an infrequent cough?

Back 113

allergen or environmental insult

Front 114

What causes a regular paroxysmal cough? What is it characterized by at the end?

Back 114

pertussis, whoop at the end

Front 115

A dry cough sounds brassy if it is caused by?

Back 115

compression of the respiratory tree

Front 116

A dry cough sounds hoarse if it is caused by?

Back 116

croup

Front 117

Where does snoring and gurgling arise from?

Back 117

nasopharynx

Front 118

Where does stridor arise from?

Back 118

glottis

Front 119

What causes yellow, gree, rust, clear, or transparent sputum?

Back 119

bacterial infection

Front 120

What characterizes viral infection sputum?

Back 120

mucoid, viscid, and uncommonly blood streaked

Front 121

Chronic infectious disease sputum is particularly abundant when? What also is seen with it?

Back 121

abundant in the morning; intermittent blood streaking

Front 122

In an infant, what do the 0,1,and2 Apgar scores mean for heart rate?

Back 122

0 absent, 1 slow below 100, 2 over 100 beats/min

Front 123

In an infant, what do the 0,1,and2 Apgar scores mean for respiratory effort?

Back 123

0 absent, 1 slow or irregular, 2 good crying

Front 124

In an infant, what do the 0,1,and2 Apgar scores mean for muscle tone?

Back 124

0 limp, 1 some flexion of extremities, 2 active motion

Front 125

In an infant, what do the 0,1,and2 Apgar scores mean for response to catheter in nostril?

Back 125

0 no response, 1 grimace, 2 cough or sneeze

Front 126

In an infant, what do the 0,1,and2 Apgar scores mean for color?

Back 126

0 blur or pale, 1 body pink extremities blue, 2 completely pink

Front 127

What is the chest circumference of a healthy infant?

Back 127

30 to 36 cm

Front 128

A smaller chest circumference compared to head circumference of an infant indicates?

Back 128

intrauterine growth retardation

Front 129

A larger chest circumference compared to head circumference of a infant indicated?

Back 129

poorly controlled diabetic mother

Front 130

What is periodic breathing? Is it common in infants?

Back 130

a sequence of relatively vigorous respiratory effort followed by apnea for as long as 10 to 15 seconds; it is common in infants

Front 131

What is the I/E ratio for stridor in infants?

Back 131

3:1 or 4:1

Front 132

What causes respiratory grunting in infants?

Back 132

infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels

Front 133

What should be considered in children with loss of synchrony between the left and right during respiration or a lag of movement of the chest on one side?

Back 133

atelectasis or diaphragmatic hernia

Front 134

What should be considered in stridor heard in children?

Back 134

croup or epiglottitis

Front 135

What is the normal respiration rate for a newborn?

Back 135

30 to 80 /min

Front 136

What is the normal respiration rate for a 1 year old?

Back 136

20 to 40 /min

Front 137

What is the normal respiration rate for a 3 year old?

Back 137

20 to 30 /min

Front 138

What is the normal respiration rate for a 6 year old?

Back 138

16 to 22 /min

Front 139

What is the normal respiration rate for a 10 year old?

Back 139

16 to 20 /min

Front 140

What is the normal respiration rate for a 17 year old?

Back 140

12 to 20 /min

Front 141

An unexplained persistent tachycardia may be a clue for what condition?

Back 141

minimal pneumothorax