Pulmonary

Front 1

visible and palpable angulation of the sternum, and the point at which the second rib articulates with the sternum
The ribs and intercostal spaces may be counted from this point.

Back 1

manubrio-sternal junction
(angle of Louis)

Front 2

 The trachea bifurcates into its mainstem bronchi at the level of the sternal angle of Louis anteriorly, and the __ spinous process posteriorly.

Back 2

T4

Front 3

The left lung consists of __ lobes and the right, ___ lobes.

Back 3

two, three

Front 4

 The left upper lobe has an inferior tongue-like projection, the _______, which is analogous to the right middle lobe.

Back 4

lingula

Front 5

 The _____________ lines the inside of the thoracic cavity wall and the upper surface of the diaphragm, while the ____________ lines the outer surface of each lung.

Back 5

parietal pleura, visceral pleura

Front 6

refers to the elasticity of the lung, and reflects a measure of the ease of its distension, or the volume change resulting from the application of a pressure differential.

Back 6

compliance

Front 7

normal diaphragmatic excursion

Back 7

3 to 5 cm

Front 8

 The ______________ muscles increase the antero-posterior chest diameter during inspiration.

Back 8

external intercostals

Front 9

the muscles of inspiration

Back 9

diaphragm
external intercostals

Front 10

the muscles of expiration

Back 10

internal intercostals
internal and external obliques
transversus abdominis

Front 11

 The trachea is 10 to 11 cm long and about 2 cm in diameter, and it divides into the right and left mainstem bronchi at about the level of _________, and just below the manubrio- sternal joint

Back 11

T4 or T5

Front 12

 The _____ bronchus is wider, shorter, and more vertically placed than the ____ bronchus, and therefore more susceptible to aspiration of foreign bodies.

Back 12

right, left

Front 13

the terminal respiratory unit

Back 13

acinus

Front 14

what does the acinus consist of:

Back 14

respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

Front 15

the upper airway accounts for ___% of total airway resistance

Back 15

50%

Front 16

what % of the body's total oxygen consumption is used in the act of breathing:

Back 16

5%

Front 17

circulatory system transport of oxygen to, and carbon dioxide from, the peripheral tissues

Back 17

perfusion

Front 18

 The best indicator of adequate ventilation is the PaCO2 whose normal range is ____________ mm Hg.

Back 18

35 to 45 mm Hg

Front 19

states that there is an inverse relationship between pressure and volume, increased volume results in decreased pressure

Back 19

Boyle's gas law

Front 20

refers to the movement of blood through the capillaries in direct communication with the alveoli

Back 20

perfusion

Front 21

the process by which gases in the alveoli and the blood exchange by way of the alveolar-capillary membrane

Back 21

diffusion

Front 22

 The volume of gas remaining in the lungs at the end of normal expiration is called the

Back 22

functional residual capacity

Front 23

 The gas in the conducting airways does not participate in alveolar exchange, and is called

Back 23

dead space ventilation

Front 24

What is the most important factor influencing the oxygen carrying capacity of hemoglobin? The higher the ____, the greater the O2 saturation of hemoglobin (Hb).

Back 24

Partial pressure of oxygen (PO2)

Front 25

Which law is this:high CO2 = high acidity = release of O2 from Hb; low CO2 = low acidity = binding of O2 to Hb.
(Oxygen-Hemoglobin Dissociation Curve)

Back 25

Bohr effect of pH

Front 26

within limits, (increased or decreased) temperature = release of O2 from Hb as heat is a by-product of metabolism.

Back 26

increased

Front 27

 The pattern of breathing refers to the:

Back 27

respiratory rate and rhythm,
-the depth of breathing, and
-the relative amount of time spent in inspiration and expiration.

Front 28

rapid large-volume breathing indicating intense stimulation of the respiratory center, seen in metabolic acidosis

Back 28

Kussmaul’s respiration

Front 29

a rhythmic waxing and waning of both rate and depth that includes regular periods of apnea, seen in patients with end- stage left ventricular failure or neurologic disease

Back 29

Cheyne-Stokes respiration

Front 30

is defined as no respiration for > 20 seconds.

Back 30

apnea

Front 31

Tachypnea is an increased rate of breathing and is commonly associated with

Back 31

a decrease in tidal volume.

Front 32

is defined as difficulty breathing or shortness of breath.

Back 32

dyspnea

Front 33

is defined as dyspnea upon assuming a recumbent position, and it is quantified by the number of pillows the patient uses for sleeping, or by the fact that the patient needs to sleep sitting up.

Back 33

orthopnea

Front 34

is dyspnea that awakens the patient several hours after going to sleep.

Back 34

Paroxysmal nocturnal dyspnea (PND)

Front 35

 The use of _____________(contraction of the sternocleidomastoid or supraclavicular
muscles during inspiration) indicates increased work of breathing.
 At rest, the use of _________________ is a sign of significant pulmonary impairment

Back 35

accessory muscles

Front 36

refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks

Back 36

tactile fremitus

Front 37

To detect fremitus, use the _____ surface of your hand to optimize the vibratory sensitivity of the bones in your hand. Ask the patient to repeat the words "______"

Back 37

ulnar, ninety-nine

Front 38

 Fremitus is decreased or absent when the transmission of vibrations from the larynx to the surface of the chest is ______.

Back 38

impeded

Front 39

what helps you establish whether the underlying tissues are air-filled, fluid-filled, or solid.

Back 39

Percussion

Front 40

______________ replaces resonance when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers.

Back 40

dullness

Front 41

heard over the periphery of the lung are soft, low-pitched sounds heard throughout inspiration, continuing without pause through expiration, and fading away about one third of the way through expiration

Back 41

vesicular breath sounds

Front 42

inspiratory and expiratory sounds about equal in length, sometimes separated by a silent interval.

Back 42

brochiovesicular breath sounds

Front 43

louder and higher in pitch, with a short silence between inspiratory and expiratory sounds, and with the expiratory phase lasting longer than inspiratory phase.

Back 43

bronchial breath sounds

Front 44

 Abnormal lung sounds (also called “____________” breath sounds) may be continuous or discontinuous.

Back 44

adventitious

Front 45

continuous lungs sounds include:

Back 45

wheezes and rhonchi

Front 46

discontinuous lungs sounds are also called:

Back 46

crackles or rales

Front 47

high-pitched, musical sounds with a distinct whistling quality, occurring either during inspiration or expiration, often audible at the mouth as well as through the chest wall.

Back 47

wheezes

Front 48

They occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure.
They occur in the setting of bronchospasm, mucosal edema, or excessive secretions.

Back 48

wheezes

Front 49

lower-pitched, snoring sounds that may have a gurgling quality, occurring either during inspiration or expiration.
They originate in the larger airways due to excessive secretions and abnormal airway collapsibility, and frequently clear after cough.

Back 49

rhonchi

Front 50

brief, discrete, non-musical sounds with a popping quality.

Back 50

discontinuous sounds: crackles and rales

Front 51

Late inspiratory crackles result from a series of tiny explosions when small airways, deflated during expiration, pop open during inspiration.
______________- result from air bubbles flowing through secretions or slightly closed airways during respiration.
Are louder, lower-pitched, and slightly longer in duration. They are heard in pneumonia, obstructive lung disease, and late pulmonary edema.

Back 51

Coarse crackles

Front 52

are soft, high-pitched and crisp. They are heard in interstitial diseases or early pulmonary edema.

Back 52

fine crackles

Front 53

a high-pitched, noisy respiration, which is indicative of upper respiratory obstruction, usually in the trachea or larynx:

Back 53

stridor

Front 54

indicates a site of obstruction above the vocal cords (supraglottic or glottic obstruction), and becomes evident at about 70% occlusion of the airway.

Back 54

inspiratory stridor

Front 55

indicates obstruction below the vocal cords (subglottic or tracheal obstruction)

Back 55

expiratory stridor

Front 56

usually occur during the expiratory phase of respiration, and are specific to lower respiratory tract disease such as pneumonia, asthma, and bronchiolitis.
[often heard in infants: a bad sign]

Back 56

grunting respirations

Front 57

Ask the patient to say “ninety-nine”. Normally the sounds transmitted through the chest wall are muffled and indistinct. Louder, clearer voice sounds are called ___________.

Back 57

bronchophony

Front 58

Ask the patient to say “ee”. You will normally hear a muffled long E sound. When “ee” is heard as “ay”, or E changes to A with a nasal sounding quality, this is called ___________, and suggests lobar consolidation.

Back 58

egophany

Front 59

Ask the patient to whisper “ninety-nine”. The whispered voice is normally heard faintly and indistinctly, if at all. Louder, clearer whispered sounds are called :

Back 59

whispered petroliloquy.

Front 60

is a blue or bluish-gray discoloration of the skin or mucous membranes caused by increased amounts of unsaturated hemoglobin in capillary blood.

Back 60

cyanosis

Front 61

cyanosis appears when the PaO2 is less than _____ and the unsaturated hemoglobin is greater than _________

Back 61

40 mm Hg, 5 grams/dL

Front 62

Since the oxygen saturation at which cyanosis becomes clinically apparent is a function of hemoglobin concentration, _____ may prevent cyanosis from appearing

Back 62

anemia

Front 63

 Central cyanosis results from insufficient oxygenation of hemoglobin in the lungs.
The most reliable site for detecting central cyanosis is the _______.

Back 63

tongue

Front 64

results from insufficient cardiac output, obstruction of blood flow, or vasoconstriction due to cold temperature.

Back 64

peripheral cyanosis

Front 65

what are these:
It is dependent on a pulsatile blood flow, therefore it may be inaccurate in situations that result in peripheral vasoconstriction.
-It does not detect hypoventilation or modest changes in the PaO2.
-Carboxyhemoglobin is misinterpreted as oxygenated hemoglobin.
[carbon monoxide poisoning]
-Methemoglobin causes SaO2 readings in the neighborhood of 84%.
[turns pt blue, can be caused by certain medications]

Back 65

limitations of pulse oximetry

Front 66

Oximetry readings of < 94% require supplemental oxygenation and ABG analysis.
-An SaO2 of 90% correlates with a PaO2 as low as _____, and requires immediate oxygenation with or without intubation.
-Nitroglycerin applied to the probe area has been reported to overcome some of the problems associated with low blood flow to the probe site.

Back 66

59

Front 67

a simple test of pulmonary function that plots a tracing of the lung volume against time in seconds.
 The patient takes as deep a breath as possible, then exhales rapidly and forcefully, while the airflow is measured and plotted.
 The result is stated as a percentage of predicted values, which are derived from normal individuals grouped by gender, age, and height.
 The range of normal is 80 to 120% of predicted value.

Back 67

spirometry

Front 68

It is useful in distinguishing obstructive lung disease from restrictive lung disease.
It may be used both as a diagnostic test as well as a monitoring tool.
It can be used to determine the severity of functional impairment as well as to assess response to treatment.

Back 68

spirometry

Front 69

the volume of air inhaled and exhaled with each resting breath during normal, quiet breathing .
(normal is about 500 to 800 mL).

Back 69

tidal volume

Front 70

is the amount of air that can be inhaled after normal inspiration

Back 70

inspiratory reserve

Front 71

is the amount of air that can be exhaled after expiration

Back 71

expiratory reserve

Front 72

the total amount of air that can be exhaled following a maximal inhalation.

Back 72

vital capacity

Front 73

the volume of air left in the lungs after maximal expiration that cannot be exhaled due to the limit of elasticity, or because of the trapping of air in disease states (residual volume is not measured by spirometry).

Back 73

residual volume

Front 74

 The vital capacity and the residual volume together constitute the ______________, which is the total amount of air in the lungs at the end of a maximal inhalation.

Back 74

total lung capacity (TLC)

Front 75

the maximum volume of air that can be expelled from the lungs following a maximal inspiration, performed as rapidly and forcefully as possible.

Back 75

forced vital capacity

Front 76

the volume of air that is forcefully expired during the first second after a deep breath, or the portion of the FVC exhaled in one second (normal subjects expel approximately 80% of the FVC in the first second).

Back 76

forced expiratory volume in one second (FEV1)

Front 77

 The normal FEV1 /FVC ratio is ≥ _____.

Back 77

70%

Front 78

disease results in a lower than normal FEV1%.

Back 78

obstructive

Front 79

disease is marked by a normal to increased FEV1%.

Back 79

restrictive

Front 80

refers to an increase in airway resistance, as a result of a reduction of elastic recoil and /or compromise of the air passage.
It results in a decrease in peak expiratory flow (PEF), and a decrease in the FEV1 (FEV1% < 70%).

Back 80

obstructive disease

Front 81

________ airflow is reduced more than expiratory volume, and there is a prolonged expiratory time.

Back 81

expiratory

Front 82

examples of obstructive disease are:

Back 82

COPD, chronic bronchitis, emphysema, asthma

Front 83

refers to a reduction in lung capacity, secondary to scarring or extraneous material.

Back 83

restrictive disease

Front 84

It results in a decrease of forced vital capacity (FVC), and a decrease in the FEV1 (causing the FEV1% to increase or remain normal).

Back 84

restrictive disease

Front 85

Expiratory volume is reduced more than expiratory airflow, the expiratory time is very short, and chest expansion is poor.

Back 85

restrictive disease

Front 86

what are these:
edema, fibrosis, and infection;
large, space-occupying lesions;
atelectasis;
pleural effusion; and
pneumothorax.

Back 86

restrictive disease

Front 87

where are the clavicles in a PA chest x-ray

Back 87

clavicles are superimposed over the upper lungs

Front 88

what do these refer to:
The identification markings and writing are reversed.
-The heart appears slightly large.
-The clavicles are usually higher than in the PA view.

Back 88

AP chest x-ray

Front 89

 A good inspiratory effort in a PA view should result in the appearance of ____ posterior ribs, or _______ anterior ribs on the right above the dome of the right hemi-diaphragm on the PA chest X-ray.

Back 89

9 to 10 posterior
5 to 6 anterior

Front 90

what effort shows a large appearing, rather poorly defined heart, enlarged pulmonary vessels, and apparent blunting of the lung bases.

Back 90

poor inspiratory effort

Front 91

 All lung markings in a normal chest X-ray are made by ____________, and not by bronchi or bronchioles.

Back 91

pulmonary arteries and veins