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107 Cards in this Set

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When assessing the lungs of babies, where is the most likely location of retractions from respiratory distress?
Along the posterior axillary line
What technique allows a HCP to differentiate congestion in the upper respiratory tract as opposed to the lower lungs?
Listen in both the CHEEK and the lungs
When auscultating the posterior thorax, which lobes are you hearing most?
the Lower LOBES
What is right middle lobe syndrome>
wheezes that are only heard in that location. must auscultate midaxillary
Children have a (larger/smaller) tongue than adults
Larger!!
Tonsils reach their maximum size by age __
7
COmpared to adults, the larynx of children is located __ and more __ in the neck
higher; anterior
Describe the epiglottis in peds.
-Floppy and omega shaped
-secretions increased
CHildren have a (increased/decreased) angle between their epiglottis and laryngeal opening.
increased
Children have redundant ____ fold in the supraglottic region.
aryepiglottic
The airway of children is (broader/narrower) than adults
narrower
What causes croup?
swelling of mucosa airway lined with hair cells, lysosymes, mucus and IgA
What sign upon Xray indicates croup?
Steeple sign
What are the 2 most common infections leading to croup?
1. parainfluenza
2. RSV
ToF: children have a greater amount of soft tissue surrounding their airway.
True
ToF: alveoli continues to develop during the first 5 years of life?
true
The sternum and ribs of children are predominatly ___
cartilaginous
Why are retractions easily seen in young children with respiratory distress?
-Poorly developed intercostal and accessory muscles
-Thin chest wall
According to the WHO, children younger than 2 months are said to be tachypneic if they have ___ breaths a minute
60
If a child is breathing > 50breaths a minute and said to be tachypnic, how old are they
2 months to 12 months
for a child 1-5 years old, they must breath __ times a minute to be tachypnic.
>40
Any child > 5years old that is breathing > __ breaths a minute is tachypnic
20
What is the most sensitive indicator of respiratory distress?
Respiratory rate!
Describe what will be inspected with a high obstruction to the airway?
suprasternal and severe
Where are retractions seen with a low obstruction?
infrasternal but less intense
What is an important symmetry finding to assess for in the thorax? What can cause it?>
-precordial bulge: may indicate cardiac defect, pneumothorax or chlronic localized ches disease
Pectus ___ can shift the heart (PMI) to the left of midclavicular line
excavatum
What is a description of pectus carinatum?
pigeon chest
When does the tingling of tactile fremitus decrease?
-airway obstruction
-pleural effusion
when percussing a child's lung fields, what position must the child be in and why?
Their head must be midline.
if the head is turned, there will be dullness on the other side
YOu can hear a flat percussion over the ___
thigh
Dullness upon percussion is heard over the __
liver
The lung field should have a ___ percussion
resonant
Where is tympanny heard?
over the abdomen
ToF: palpation of tactile fremitus increases over areas of lung consolidation.
TRue
Decreased or absent vibration from tactile fremitus is heard when the bronchus is ___ or occupied by ___
obstructed; fluid
inspiratory sounds should be ___ time as long as expiratory sounds if they are vescicular.
three
Breath sounds in a child can be almost all ___ or ___
bronchovesicular or bronchial
If the inspiratory phase is twice as long as expiration, what kind of breath sound is it?
bronchovescicular
What type of breath sounds have equal length of inspiration and expiration
tracheal
Describe the timing of bronchial sounds
expiration is very slightly long
When listening over the neck and trachea, what are the quality of these sounds
tracheal: very loud expiratory sound and relatively high pitched expiratory sound
If listening over the manubrium, what is the pitch of a normal breath sound
bronchial: very loud, high pitched and sound heard close to the stethescope.
-intermediate expiratory sound
Where are bronchovesicular breath sounds heard best?
in the 1st and 2nd ICS (anterior chest) and between the scapulaue (posterior chest). over the mainstem bronchi
If bronchovesicular sounds are heard anywhere other than over the mainstem bronchi, they are signs of ___
consolidation
Which sounds are heard over most of the lung: axillary and lung bases?
vesicular
Describe fine rales and crackles.
soft, high pitched and very brief
what are course rales and crackles like?
somewhat louder, lower in pitch and longer in duration
Rales are heard at lower parts of the chest in __ ___
heart failure
rales heard in __ __ in indicative of interstitial lung disease
late inspiration
ToF: all rales have significance.
False: rales heard after coughing have no significance
___ are lower pitched and have a snoring quality.
rhonchi
Describe wheezes, how are they heard best?
High pitched

-push in on child's chest to hear them at the end
ToF: a child with asthma that has a quiet chest is a good sign?
FALSE: a quiet chest may be very bad!
What type of cough is common with asthma?
tight cough
A person with a staccato cough likely has ___
pneumonia
What 4 things should be noted when assessing for respiratory distress
-LOC
-Respiratory rate
-work of breathing
-color
What are examples of work of breathing.
-expiratory grunt: keeps the airway open
-nasal flaring
-retractions
If the child says 99 and a louder clearer voice is heard on auscultation, what is this?
bronchophony
What is egophony?
when the child is asked to say EEE and it sounds like AY
Describe whisper pectoriloquy.
Have the child whisper 1,2,3 it will be clear if there is a consolidation pneumonia/fluid
the site of origin of wheezes are the ___ ___
intrathoracic airways
The adventitious sound that can come from either or both intra and extrathoracic airways are ___
rattles
Stridor originates from the __ airway
extrathoracic
A snore originates from the ___
oro-naso pharyngeal airway
What is the site of origin of a grunt
alveloi/lung parenchyma
sounds from the nasal passages/naso-pharynx are often __
snuffles or snorts
chronic rattles are found in patients with __ __
neuromuscular disorders
An Acute rattle is often an acute ___ ___
viral bronchitis
acute pharyngitis and tonsillitis often causes what adventitious sound?
a snore
chronic snuffles are from ...
allergic rhinitis
An acute wheeze is often caused by...
intermittent asthma

-viral induced wheeze
A patient with chronically enlarged adenoids will often have a chronic ___
snore
what is the cause of a homophonic sound?
something trapped in large airway
What are the example of large airway obstructions causing wheezing.
-Monophonic or homophonic sound
-inhaled foreign body
-endotracheal tuberculosis
-bronchial adenoma
-enlarged mediastinal nodes
-achalasia
-malignant mediastinal tumors
in patients with monophonic localized wheezing, ___ __ needs to be considered.
mass lesion
what are the types of wheezing that result from a small airway obstruction?
polyphonic or heterophonus wheezing
give characteristics of small airway obstructions causing wheezing.
-expiratory predominant
-asthma, bronchiolitis
-TEW: transient early wheezing
-usually disappears in early childhood.
___ get misdiagnosed in young children as a wheeze
rattles
ToF: kids with psych problems can induce a wheeze
true
What aspect of respiration is a stridor heard?
predominantly inspiratory
What is stridor a sign of ?
upper airway obstruction
What are the supraglottis causes of stridor?
-epiglottitis
-aryepiglottic flods
-false vocal chords (prone to collapse resulting in obstruction)
What are the glottic causes of stridor?
True vocal cords:
-laryngeal warts, larngeal web: papillomatosis
What is papillomatosis? what does it cause?
Have laryngeal warts that can obstruct the airway and cause stridor. must be burned off periodically to allow for breathing
Where does the stridor of croup originate?
in the subglottic area.
What is the name of the disorder that has stridor with croup symptoms?
acute laryngotrachobronchitis
What is the diagnostic sign of epiglotitis?
the thumb sign on xray
How will a child with epiglotitis be acting?>
They will refuse to lay down, will have an acute high fever and will look sick
What causes a snore?
increase in resistance to airflow through the upper airways in the region of nasopharynx and oropharynx: big adenoids
ToF: infants should not have noisy breathing>
FALSE: it is a common finding to have noisy breathing
ToF: a rattle can be a symptom of asthma
false
ToF: it is common to mistake a wheeze for stridor.
true and a major error
ToF: current technology to support the use of acoustic analysis has been found to be effective.
FALSE!!!!!
What are the 3 phases of a cough?
-inspiratory
-compressive
-expiratory
A __ can be suppressed or initiated voluntary unless it is part of laryngeal expiratory reflex
cough
What are the 2 types of cough?
laryngeal and tracheobronchial
The suggested underlying processes of a barking or brassy cough are ...
-Croup
-tracheomalacia
-habit cough
What type of cough is a psychogenic cough?
honking
What is the cause of a paroxysmal cough
Pertussis and Parapertussis

(+/- inspiratory whoop)
An infant with a staccato cough is thought to have __
chlamydia
Plastic bronchitis or asthma is thought to produce what type of cough
one productive of casts
What type of cough accompanies suppurative lung disease?
chronic wet cough in am only
If a toddler presents with stridor and will only take in fluids and not solid food, what is a likely cuase?>
Foreign body aspiration!
where are retropharyngeal abscesses found most common?
Bordered posteriorly by prevertebral fascia and anteriorly by the esophagus
What are the most common causes of retropharyngeal abscesses?
-Staphylococcus aureus
-anaerobic bacteria
-beta hemolytic streptococci
How does a retropharyngeal abscess appear?
Use a lateral neck film: there is an increase in the width of the prevertebral space and anterior displacement of the airway