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74 Cards in this Set
- Front
- Back
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Ribs 11 & 12
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"Floating ribs"; have free palpable tips
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Sternal angle
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"Angle of Louis"; articulation of manubrium & body of sternum; continuous w/2nd rib
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Costal margins
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Cartilage where ribs 8-10 attach; R & L costal margins form costal angle where they meet at xiphoid process
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Costal angle
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Where the costal margins meet at the xiphoid process; usu. 90 degrees or less
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Vertebra prominens
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Spinous process of C7
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Midclavicular line
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Bisects the center of ea. clavicle at a point halfway b/n palpated sternoclavicular & acromioclavicular joints
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Midaxillary line
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Runs down from apex of axilla & lies b/n & parallel to anterior/posterior axillary line
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Lung borders
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Anterior: apex - 3-4 cm above inner 1/3 of clavicles, base - rests on diaphragm at 6th rib in midclavicular line; lateral: apex of axilla to 7th/8th rib; posterior: apex at C7, base at T10 (T12 after deep inspiration)
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R lung - differences
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Shorter than L lung b/c of underlying liver; 3 lobes
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L lung - differences
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Narrower than R lung b/c heart bulges to the left; 2 lobes
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RUL - lateral view
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Apex of axilla down to horizontal fissure at 5th rib
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RML - lateral view
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Extends from horizontal fissure (at 5th rib) down & forward to 6th rib at midclavicular line
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RLL - lateral view
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From 5th rib to 8th rib in midaxillary line
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LUL - lateral view
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From apex of axilla down to 5th rib at midaxillary line
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LLL - lateral view
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From 5th to 8th rib at midaxillary line
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Hypercapnia
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Increased carbon dioxide in the blood; normal stimulus to breathe
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Hypoxemia
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Decreased oxygen in the blood; also increases respirations but less effective than hypercapnia
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Hypoxia
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State of lack of oxygen
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Pregnant female - dev changes
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Diaphragm elevated 4 cm, increase in transverse diameter of chest cage by 2 cm; diaphragm moves even more --> increase in tidal volume
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Aging adult - dev changes
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Costal cartilages calcified --> less mobile thorax; resp. muscle strength declines after age 50, continues to decrease into 70s; decrease in elastic properties w/in lungs --> less distensible, lessens tendency to collapse & recoil; these changes result in decreased vital capacity; gradual loss of intra-alveolar septa & decreased number of alveoli --> less surface area for gas xchange
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Size of thoracic cavity - biocultural differences
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Chest volumes from largest to smallest: whites, blacks, Asians, American Indians
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Orthopnea
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Difficulty breathing when supine; state # of pillows needed to achieve comfort; usu. seen in L heart failure pt
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Paroxysmal nocturnal dyspnea
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Awakening from sleep with shortness of breath & needing to be upright to achieve comfort
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Symmetric chest expansion - posterior
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Place hands on posterolateral chest wall w/thumbs at level of T9/T10; slide hands medially to pinch small fold of skin b/n thumbs; ask person to take deep breath; normal = thumbs move apart symmetrically
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Tactile fremitus
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Palpable vibration; use palmar base of fingers of 1 hand & touch person's chest while he repeates "99" (resonant phrase that generates strong vibrations); start at apices & palpate from 1 side to another; normal = symmetry
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Decreased fremitus
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When anything obstructs transmission of vibrations (e.g. obstructed bronchus, pleural effusion/thickening, penumothorax, emphysema)
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Increased fremitus
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Compression/consolidation of lung tissue (e.g. lobar pneumonia); present only when bronchus patent & where consolidation extends to lung surface
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Crepitus
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Coarse crackling sensation palpable over skin surface; occurs in subcutaneous emphysema when air escapes from lung & enters sub-q tissue (e.g. after open thoracic injury/surgery)
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Resonance
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Low-pitched, clear, hollow sound; predominates in healthy lung tissue of adult
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Hyperresonance
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Lower-pitched, booming sound found when too much air present (e.g. emphysema, pneumothorax)
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Dullness
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Soft, muffled thud signals abnormal density in lungs (e.g. pneumonia, pleural effusion, ateletasis, tumor)
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Bronchial breath sounds
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Trachea & larynx; high pitched, loud, inspiration < expiration; harsh, hollow tubular sound
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Bronchovesicular sounds
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Over major bronchi: posterior - b/n scapulae, anterior - around upper sternum in 1st/2nd ICS; moderate pitch & loudness, inspiration = expiration; mixed quality
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Vesicular sounds
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Over peripheral lung fields where air flows through smaller bronchioles & alveoli; low-pitched, soft, inspiration > expiration; rustling
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Adventitious sounds
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Added sounds that are not normally heard in the lungs
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Symmetric chest expansion - anterior
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Place hands on anterolateral wall w/thumbs along costal margins & pointing toward xiphoid process; ask person to take deep breath; thumbs move apart symmetrically & smoothly
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Tactile fremitus - # of stops
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Posterior: minimum of 5 stops on ea. side; anterior: minimum of 4 stops on ea. side (avoid palpating over female breast tissue b/c it normally damps the sound)
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Palpate anterior & posterior chest wall
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Notes any tenderness; normal = none present
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Percuss anterior & posterior chest - # of stops
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Posterior: minimum of 8 stops on ea. side; anterior: minimum of 5 stops on ea. side
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Auscultate anterior & posterior chest - # of stops
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Posterior: minimum of 9 stops on ea. side; anterior: minimum of 5 stops on ea. side
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Aging adult - normal findings
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Chest cage commonly shows increased anteropostioer diameter, giving round barrel shape, & kyphosis (outward curvature of thoracic spine)
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Normal adult thorax configuration
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Elliptical shape w/anteroposterior-to-transverse diameter of 1:2 or 5:7
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Barrel chest
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Equal anteroposterior-to-transverse diameter; ribs horizontal instead of normal downward slope; associated w/normaly aging & chronic emphysema & asthma as a result of hyperinflation of lungs
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Pectus excavatum
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Markedly sunken sternum & adjacent cartilages; depression begins at 2nd intercostal space & most depressed at junction of xiphoid w/sternal body; congenital, not symptomatic
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Pectus carinatum
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Forward protrusion of sternumb w/ribs sloping back at either side & vertical depressions along costochondral junctions (pigeon breast); less common than pectus excavatum; requires no treatment
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Scoliosis
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S-shaped curvature of thoracic & lumbar spine; unequal shoulder & scapular height & unequal hip levels; mild deformities asymptomatic; if severe (> 45 degrees) devation present, may reduce lung volume --> at risk for impaired cardiopulmonary function.
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Kyphosis
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Exaggerated posterior curvature of thoracic spine (humpback) causing significant back pain & limited mobility; severe deformities impair cardiopulmonary function
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Tachypnea
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Rapid shallow breathing; increased rate > 24 breaths/min; normal response to fever/fear/exercise; also occurs w/resp. insufficiency, pneumonia, alkalosis, pleurisy, lesions of pons
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Hyperventilation
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Increase in both rate & depth; normally occurs w/extreme exertion/fear/anxiety; also occurs w/DKA, hepatic coma, salicylate overdose, lesions of midbrain, blood gas concentrations
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Bradypnea
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Decreased but regular rate (less than 10 breaths/min); ex: drug-induced depression of resp. center in medulla, increased ICP, diabetic coma
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Hypoventilation
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Irregular shallow pattern caused by overdose of narcotics/anesthetics; may also occur w/prolonged bed rest or conscious splingint of chest to avoid resp. pain
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Cheyne-Stokes resp.
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Cycle in which resp. gradually wax & wane in regular pattern, increasing in rate & depth & then decreasing; alternating breathing periods (30-45 sec) & apnea (20 sec); most common cause: severe heart failure
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Biot's resp.
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Similar to Cheyne-Stokes resp., except pattern is irregular; series of normal resp. (3-4) followed by period of apnea; cycle length varies from 10 sec to 1 min; seen w/head trauma, brain abscess, heat stroke, spinal meningitis, encephalitis
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Fine crackles (rales)
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Sounds "wet"; discontinuous, high-pitched, short crackling, popping sounds heard during inspiration; inhaled air collides w/previously deflated airways; in the lung bases; not cleared w/coughing/suctioning, cleared w/Furosemide (Lasix); ex: heart failure
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Coarse crackles (rhonchi)
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Sound like "snot"; discontinuous, loud, low-pitched, bubbling, gurgling sounds starting in early inspiration & may be present in expiration; inhaled air collides w/secretions in trachea & large bronchi; cleared w/coughing/suctioning; ex: pneumonia
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Atelectatic crackles
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Discontinuous, sounds like fine crackles but do not last & are not pathologic; disappear after first few breaths; heard in axillae, bases of lungs
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High-pitched wheeze
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Continuous, high-pitched, musical squeaking sounds that sound polyphonic; predominate in expiration but may occur in both expiration & inspiration; air squeezed/compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, tumors
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Low-pitched wheeze
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Continuous, low-pitched, monophonic single note, musical snoring, moaning sounds; heard throughout cycle though more prominent on expiration; airflow obstruction
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Stridor
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Continuous, high-pitched, monophonic, inspiratory, crowing sound, louder in neck; originating in larynx/trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body
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Bronchophony
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Ask person to repeat "99" while you listen w/steth; normal = soft, muffled, indistinct voice transmission; abnormal = clear "99" heard due to increased lung density
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Egophony
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Listen to chest while person says long "ee-ee-ee" sound; normal = hear "eeee" through steth; abnormal = over area of consolidation, "eeee" sounds like long "aaaa"
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Whispered pectoriloquy
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Ask person to whisper "1-2-3" as you listen; normal = faint, muffled, almost inaudible; abnormal = w/small amts of consolidation, whispered voice is very clear & distinct, somewhat faint
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Atelectasis
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Collapsed, shrunken, deflated section of alveoli as result of 1) airway obstruction, alveolar air beyond it is gradually absorbed by pulm. capillaries, & alveolar wall caves in; 2) compression on the lung; 3) lack of surfactant
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Lobar pneumonia
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Infection in lung parenchyma leaves alveolar membrane edematous & porous, so RBCs & WBCs pass from blood to alveoli; alveoli become consolidated w/bacteria, solid cell debris, fluid, blood cells --> decreased surface area of resp. membrane --> hypoxemia
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Bronchitis
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Proliferation of mucous glands in passageways --> excessive mucous secretion; inflammation of bronchi w/partial obstruction of bronchi by secretions/constrictions; sections of lung distal to obstruction may be deflated
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Emphysema
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Caused by destruction of pulm. connective tissue; characterized by permanent enlargement of air sacs distal to terminal bronchioles & rupture of interalveolar walls --> increases airway resistance, esp. on expiration --> hyperinflated lung & increase in lung volume; 80-90% of cases are from cigarette smoking
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Asthma
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Allergic hypersensitivity to certain inhaled allergens, irritants, Mos, stress, or exercise that produces a complex response characterized by bronchospasm, & inflammation, edema in walls of bronchioles, & seccretion of highly viscous mucus into airways --> increase airway resisitance, esp. during expiration & produce symptoms of wheezing, dyspnea, chest tightness
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Pleural effusion
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Collection of excess fluid in intrapleural space, w/compression of overlying lung tissue; may contain watery capillary fliud, protein, purulent matter, blood, or milky lymphatic fluid; gravity settles fliud in dependent areas of thorax; presence of fluid subdues all lung sounds
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Heart failure
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Pump failure w/increasing pressure of cardiac overload --> pulm. congestion or increased amt of blood present in pulm. capillaries; dependent air sacs deflated, pulm. capillaries engorged; bronchial mucosa may be swollen
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Pneumothorax
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Free air in pleural space neutralizes usual neg. pressure --> causes partial/complete lung collapse; usu. unilateral; can be 1) spontaneous (air enters through rupture in lung wall); 2) traumatic (air enters through opening/injury in chest wall); 3) tension (trapped air in pleural space increases, compressing lung & shifting mediastinum to unaffected side)
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Pneumocystis jiroveci pneumonia
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Protozoal infection associated w/AIDS; cysts containing P. jiroveci & macrophages form in alveolar spaces, alveolar walls thicken, & disease spreads to bilateral interstitial infiltrates of foamy, protein-rich fluid
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Tuberculosis
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Inhalation of tubercle bacilli into alveolar wall starts: 1) initial complex is acute inflammatory response--macrophages engulf but do not kill bacilli, tubercle forms around bacilli; 2) scar tissue forms, lesion calcifies & shows on x-ray; 3) reactivation of previously healed lesion, dormant bacilli now multiply & produce necrosis, cavitation, caseous lung tissue, 4) extensive destruction as lesion erodes into bronchus, forming air-filled cavity; apex usu. has most damage
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Pulmonary embolism
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Undissolved materials originating in legs/pelvis detach & travel to R heart & lodge to occlude pulm. vessels; over 95% arise from DVT in lower legs as result of stasis of blood, vessel injury, hypercoaguability; pulm. occlusion --> ischemia of downstream lung tissue, incresased pulm. artery pressure, decreased cardiac output, hypoxia; rarely, saddle embolus in bifurcation of pulm. arteries --> sudden death from hypoxia; more often, small to medium pulm. branches occlude --> dyspnea
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Acute Respiratory Distress Syndrome (ARDS)
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Acute pulm. insult (trauma, gastric aide aspiration, shock, sepsis) damages alveolar capillary membrane --> increased permeability of pulm. capillaries & alveolar epithelium, & pulm. edema; gross
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