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248 Cards in this Set
- Front
- Back
Which ribs are attached directly to the sternum?
|
the first seven
|
|
In adults, the lateral diamter _____ the AP diameter.
|
exceeds
|
|
What are the primary muscles of respiration?
|
The diaphrgam and the intercostal muscles
|
|
What the movement of the diaphragm during inspiration?
|
The diaphragm contracts and moves downward during inspiration
|
|
The external intercostal muscles increased the ______ chest diameter during _____.
|
AP
inspiration |
|
Name some accessory chest muscles.
|
Sternocleidomastoid
Trapezius |
|
The internal intercostals decrease the _______diameter during expiration.
|
Lateral
|
|
How many lobes does the right lung have?
|
3
|
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How many lobes does the left lung have?
|
2
|
|
What portion of the left lung is considered the "counterpart" of the right middle lobe?
|
The lingula
|
|
What is the dividing structure between the upper and lower lobes of both lungs?
|
The oblique fissure
|
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What is the dividing structure between the right middle and upper lobes?
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The horizontal fissure
|
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What are the surface landmarks used to find the horizontal fissure?
|
It can be found at the level of the 5th rib in the axilla and the 4th rib anteriorly
|
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What are the anterior and posterior limits for the apexes of the lung?
|
Anterior- extends 4cm above the first rib into the base of the neck in adults
Posterior-level of T1 |
|
Where can the lower borders of the lung be found on deep inspiration?
|
T12
|
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What are the anterior and posterior structures to the trachea?
|
The trachea is anterior to the esophagus and posterior to the isthmus of the thyroid
|
|
What is the level of bifurcation of the trachea?
|
T4/5 and just below angle of Louis
|
|
Which bronchus is more susceptible to aspiration of foreign bodies?
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The right bronchus- it is shorter, wider and more vertically placed
|
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What is the blood supply for the bronchi?
|
The bronchial arteries branch from the anterior thoracic aorta and the intercostal arteries
|
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What is the venous drainage of the bronchi?
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Most of the blood supply is returned by the pulmonary veins
|
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Anteriorly, where can we find the oblique fissure on both lungs?
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The lower lobe is set off by a diagnonal fissure stretching from the 5th rib at the axilla to the 6th at the midclavicular line
|
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Posteriorly, the lower lobe extends from ___ to ______ during the respiratory cycle
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T3
T10 - 12 |
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What are the surface markers for the left oblique fissure?
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The level of the third rib medially to the 6th rib anteriorly
|
|
What are the surface markers for the right oblique fissure?
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At the level of the 5th rib in the midaxillary line and the 6th rib more anteriorly
|
|
What is the normal measurement of the costal angle?
|
The angle is formed by the blending together of the costal margins at the sternum. It is usually no more than 90 degrees
|
|
Describe the lung structure at 4 weeks gestation.
|
The lung is a groove on the ventral wall of the gut
|
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What is the role of the passive movements of the lung during gestation?
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They prepare the term infant to respond to postnatal chemical and neurological respiratory stimuli
|
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How much does the passive respiratory movements open the alveoli and lung fields?
|
They do not open the alveoli or move the lung fields
|
|
In a child, when is the fastest rate of lung development?
|
The first 2 years
|
|
What are the changes to the pulmonary arteries immediately after birth?
|
The pulmonary arteries expand and relax
|
|
What stimulates the closure of the foramen ovale
|
The decrease in pulmonary vascular pressure
|
|
What stimulates the closure of the ductus arteriosus?
|
The increased oxygen tension in the arterial blood usually stimulates the contraction and closure of the ductus arteriosus
|
|
What are the chest wall anatomic changes that occur in a pregnant woman?
|
The lower ribs flare include an increase in the lateral diameter of about 2 cm and an increase in the circumference of 5 to 7cm. The subcostal angle progressively increases from about 68.5 degrees to approx 103.5 in later pregnancy
|
|
What are the causes of the barrel chest seen in many older adults?
|
There are three causes:
1. Loss of muscle strength in the thorax and diaphragm 2. Loss of lung resiliency 3. Skeletal changes resulting in an emphasized dorsal spine --> increased AP diameter |
|
What are the changes to alveoli related to aging
|
The aveoli become less elastic and relatively more fibrous
The associated loss of some of the interalveolar folds decrease the alveolar surface available for gas exchange. There is underventiliation of the alveoli in the lower lung fields due to loss of some of the tensile strength in the muscles of respiration |
|
What is the difference between orthopnea and playpnea?
|
Orthopnea is the SOB that starts or worsens when the patient lies down but platypnea is dyspnea that increases in the upright position
|
|
What is dyspnea?
|
difficult and labored breathing with shortness of breath
|
|
What symptoms of a patient's chest pain generally exclude a cardiac origin?
|
1. no radiation of the pain
2. made worse by pressing on the precordium 3. Constant ache that lasts all day 4. it is located in the shoulders or between the shoulder blades 5. the duration is for only a second or two and it is a fleeting needlelike jab |
|
What pulmonary infections should e suspected with recent travel to the southeastern or midwestern US?
|
Histoplasmosis
|
|
What pulmonary infections should be suspected with recent travel to east and southwest Asia or the Caribbean?
|
Schistosomiasis
|
|
Why is it important to ask about cocaine use in an adult who complains of chest pain?
|
Cocaine can cause tachycardia, hypertension, coronary artery spasm, and pnuemothorax
|
|
What is the importance of tangential lighting when inspecting the chest?
|
Tangential light is needed to highlight chest movement. It is needed to accentuate subtle movements like pulsations or retractions or indicate deformities
|
|
Compared to the lateral diameter, the AP diameter is generally ______
|
Less
|
|
What imaginary line is used to identify the inferior borders of the lungs?
|
midclavicular line
|
|
What disease processes result in barrel chest deformity?
|
Generally the barrell chest deformity results from compromised respiration like in chronic asthma, emphysema or cystic fibrosis
|
|
What are the specific structural changes that occur to result in the barrel chest?
|
1. The ribs are more horizontal
2. the spine is somewhat kyphotic 3. sternal angle is more prominent |
|
What is the thoracic ratio?
|
AP diameter/Lateral diameter
It is expected to be about .70 to 0.75 |
|
What Thoracic ratio value indicates a chronic thoracic problem vs aging related thoracic changes?
|
Although the thoracic ratio increases with age; when the AP diameter approaches or equals the lateral diameter ( a ratio of 1.0 or even greater), there is most often a chronic condition
|
|
Describe pectus carinatum
|
There is a prominent sternal protrusion
|
|
Describe pectus excavatum
|
There is an indentation of the lower sternum above the xiphoid process
|
|
What is the expected ratio of respirations to heartbeats ?
|
1: 4
|
|
What is the difference between tachypnea and bradypnea?
|
Tachypnea is respiration rate greater than 20
Bradypnea is respiration rate less than 12 |
|
Describe Biot respiratory pattern.
|
Biot respiration has irregularly, interspersed periods of apnea in a disorganized sequence of breaths
|
|
What is the difference between Biot and Cheyne-Stokes patterns of respiration?
|
Cheyne-Stokes respirations have VARYING PERIODS OF INCREASING DEPTH interspered with apnea
Biot respiration has irregularly, interspersed periods of apnea in a disorganized sequence of breaths |
|
What is the difference between tachypnea and hyperpnea?
|
Tachypnea is respiration faster than 20 breaths but hyperpnea is DEEP BREATHING at more than 20 breaths a minute
|
|
What intrabdominal processes can result in rapid shallow breathing?
|
Massive liver enlargement or abdominal ascites may prevent the descent of the diaphragm
|
|
Aspirin overdose can be expected to cause ______ of the rate and depth of breathing
|
increase
|
|
A pons lesion can be expected to cause _____ in the rate and depth of breathing but a cerebrum lesion can be expected to cause _____ in the rate and depth of breathing
|
increase
decrease |
|
What is the causative metabolic disorder of Kussmaul respirations?
|
Metabolic acidosis
|
|
Describe Cheyne-stokes respirations
|
It is a crescendo/decrescendo sequence of respiration- it is a REGULAR periodic pattern of breathing with intervals of apnea
|
|
When are cheyne-Stokes respirations normal?
|
Children and Older adults
|
|
When are Cheyne-Stokes respirations abnormal?
|
It can be found in those with brain damage at the cerebral level or with durg associated respiratory compromise
|
|
Why can air trapping lead to a barrel chest?
|
Air trapping is the result of a prolonged but inefficient expiratory effort that causes the rate of respiration to increase in compensation. However, the effort becomes more shallow--> allowing the amount of trapped air to increase and the lung inflate
|
|
What intrabdominal processes can result in rapid shallow breathing?
|
Massive liver enlargement or abdominal ascites may prevent the descent of the diaphragm
|
|
Aspirin overdose can be expected to cause ______ of the rate and depth of breathing
|
increase
|
|
A pons lesion can be expected to cause _____ in the rate and depth of breathing but a cerebrum lesion can be expected to cause _____ in the rate and depth of breathing
|
increase
decrease |
|
What is primary apnea?
|
A self-limited condition --> breathing will restart without intervention
It is not uncommon after a blow to the head |
|
What is the difference between primary and secondary apnea?
|
Primary apnea is a self-limited condition whereas breathing stops and it will not spontaneously restart without resuscitative measures
|
|
What is the causative metabolic disorder of Kussmaul respirations?
|
Metabolic acidosis
|
|
Describe Cheyne-stokes respirations
|
It is a crescendo/decrescendo sequence of respiration- it is a REGULAR periodic pattern of breathing with intervals of apnea
|
|
When are cheyne-Stokes respirations normal?
|
Children and Older adults
|
|
When are Cheyne-Stokes respirations abnormal?
|
It can be found in those with brain damage at the cerebral level or with durg associated respiratory compromise
|
|
Why can air trapping lead to a barrel chest?
|
Air trapping is the result of a prolonged but inefficient expiratory effort that causes the rate of respiration to increase in compensation. However, the effort becomes more shallow--> allowing the amount of trapped air to increase and the lung inflate
|
|
What is the trigger for reflex apnea?
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When irritating or nausea-provoking vapors or gases are inhaled --> temporary halt to respiration
|
|
What damaged CNS structure is responsible for apeusitic breathing?
|
pons
|
|
When should we expect to observe periodic apnea of the newborn?
|
during REM sleep
|
|
What neurological disorder is responsible for periodic apnea of the newborn?
|
none.
it is a normal condition that is usually associated with REM sleep |
|
What respiratory pattern should we expect with damage to the medulla?
|
Biot respiration:
Irregular respirations that vary in depth and interrupted by irregular intervals of apnea |
|
What is the difference in breathing patterns with medulla damage vs pons damage
|
With medulla damage --> biot respirations : irregular respirations varying in depth and interrupted by intervals of apnea
With pons damage --> long inspiration but expiration apnea; gasping |
|
Describe apneustic breathing.
|
characterized by a long inspriation and expiration apnea --> gasping
|
|
What are the expected changes to the costal margin with outflow obstruction
|
The costal margin widens beyond 90 degrees
|
|
In the setting of outflow obstruction, we expect to see bulging on ______
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expiration
|
|
In what scenario, do we expect to see primary apnea?
|
It is especially noted immediately after the birth of a newborn, who will breathe spontaneously when sufficient carbon dioxide accumulates in the circulation
|
|
What is the trigger for reflex apnea?
|
When irritating or nausea-provoking vapors or gases are inhaled --> temporary halt to respiration
|
|
What damaged CNS structure is responsible for apeusitic breathing?
|
pons
|
|
When should we expect to observe periodic apnea of the newborn?
|
during REM sleep
|
|
What neurological disorder is responsible for periodic apnea of the newborn?
|
none.
it is a normal condition that is usually associated with REM sleep |
|
What respiratory pattern should we expect with damage to the medulla?
|
Biot respiration:
Irregular respirations that vary in depth and interrupted by irregular intervals of apnea |
|
What is the difference in breathing patterns with medulla damage vs pons damage
|
With medulla damage --> biot respirations : irregular respirations varying in depth and interrupted by intervals of apnea
With pons damage --> long inspiration but expiration apnea; gasping |
|
Describe apneustic breathing.
|
characterized by a long inspriation and expiration apnea --> gasping
|
|
What are the expected changes to the costal margin with outflow obstruction
|
The costal margin widens beyond 90 degrees
|
|
In the setting of outflow obstruction, we expect to see bulging on ______
|
expiration
|
|
What are the potential points of retraction in the chest wall?
|
retractions are when the chest wall seem to cave in at the sternum, between the ribs, at the suprsternal notch, above the clavicles and interspaces
|
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Retractions indicate an obstruction with _______
|
inspiration
|
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Why do we notice retractions with inspiratory blockage
|
An obstruction at any point in the respiratory tract causes the intraplueral pressure to become increasingly negative so that the musculature pulls back in an effort to overcome blockage
|
|
In what setting would we notice unilateral retraction?
|
A foreign body in a bronchus
|
|
describe paradoxical breathing
|
On inspiration the lower thorax is drawn in and on expiration the lower thorax is drawn out
|
|
What are some causes of paradoxical breathing
|
Paradoxical breathing occurs when negative intrathoracic pressure is transmitted to the abdomen
this can occur due to : a weakened poorly functioning diaphragm; Obstructive airway disease; during sleep in the event of upper airway obstruction |
|
Where does clubbing occur?
|
It is the terminal enlargement of the phalanges of the fingers
|
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What is the difference in the quality of stridor with above vs. below the glottis obstruction?
|
Above the glottis- the stridor tends to be quieter
Below the glottis- the stridor tends to be louder, more rasping |
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With a supraglottal obstruction, how is the voice quality and the ability to swallow?
|
The voice is muffled and swallowing is more difficult
|
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What are some causes of crepitus?
|
It is caused by air in the subcutaneous tissue from a rupture somewher in the respiratory system or by infection with a gas-producing organsim
|
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What is pleural friction rub?
|
A palpable coarse grating vibration, usually on inspiration, that is caused by inflammation of the pleural tissues
|
|
Where is the best location to assess tactile fremitus?
|
It is best heard parasternally at the 2nd intercostal space at the level of the bifurcation of the bronchi
|
|
How do you assess thoracic expansion?
|
Stand behind the patient and place your thumbs along the spinal processes at the level of the 10th rib, in contact with the posterolateral surfaces. Monitor in quiet and deep breathing
|
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What are some causes of increased fremitus?
|
This occurs in the presence of fluids or a solid mass within the lungs and may be caused by lung consolidation, heavy bronchial secretions
tumors compressed lung |
|
What are some causes of decreased fremitus?
|
may be caused by excess air in the lungs;
emphysema pleural thickening or effusion massive pulmonary edema |
|
During an exam, you notice a slight barely noticeable deviation of the trachea to the right, what should you suspect?
|
Nothing, it is a normal variant
|
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When a patient experiences more ease with stridor with head extension, what disease process should you suspect?
|
Ease of stridor with head extension indicates that there is a retropharyngeal abscess
|
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When a patient experiences more ease with stridor with head tilting to the left, what disease process should you expect?
|
Easing of stridor with head tilted to the left indicates that there is a peritonsillar abscess on the left
|
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How may a patient attempt to relieve tracheal compresssion due to an anterior mediastinal mass?
|
The patient may sit up and lean forward in an attempt to relieve that compression
|
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Where would you expect the position of the trachea to be with a right tension pneumothorax?
|
The trachea will deviate to the left ( away from the affected side)
|
|
Where can you expect the placement of the trachea to be with a left pneumothorax?
|
The trachea will deviate to the left.
|
|
What disease processes will cause the trachea to be deviated away from the affected side?
|
Thyroid enlargement or pleural effusion
|
|
What structural lung problems will cause deviation of the trachea to the affected side?
|
Volume loss
This can occur either from fibrosis or atelectasis |
|
What is tracheal tug?
|
A palpable pull out of midline with respiration
|
|
What maneuver pulls the scapulae laterally to expose more lung fields?
|
Have the patient sit with head bent forward and arms folded in front
|
|
Tympany is associated with the _____
|
abdomen
|
|
What is the expected sound of percussion over normal lungs?
|
Resonance
|
|
What is the expected sound of percussion over hyperinflated lungs i.e. emphysema, pneumothorax
|
Hyperresonance
|
|
What is the pattern of tracheal deviation in the setting of mediastinitis?
|
The trachea may be push forward
|
|
What is the usual diaphragmatic excursion?
|
The excursion distance is usually 3 to 5 or 6 cm
|
|
Where is the best position that should you listen for the right middle lobe?
|
Right axilla
|
|
Where is the best place to listen for the left lingula ?
|
Left axilla
|
|
Why should you use the diaphragm and not the bell for lung auscultation?
|
The diaphragm of the stethoscope is preferable because the high pitched sounds are heard better and it provides a larger base
|
|
In a frail patient, who cannot breathe deeply for prolonged periods of time, where should you start your exam?
|
Start at the lung bases before fatigue sets in.
|
|
When you start to measure diaphragmatic excursion, what phase of respiration should you measure first?What is the pattern of percussion ?
|
Inspiration
percuss along the scapular line until you locate the lower border, It will be marked by a change from resonance to dullness |
|
When you have the patient in expiration phase, during diaphragmatic excursion what is the pattern of precussion?
|
You percuss up from dull to resonance
|
|
Vesicular breath sounds are ___ pitched and ___ intensity.
|
low
low |
|
What is the expected breath sounds over the healthy lung tissue ?
|
Vesicular breath sounds
|
|
What is amphoric breathing?
|
Resembles the noise made by blowing across the mouth of a bottle.
It is heard with a large, relatively stiff, walled pulmonary cavity or in a tension pnuemothorax with a bronchopleural fistula |
|
Which breath sounds have the highest pitch and intensity?
|
Bronchial breath sounds
|
|
What are the best positions to hear bronchovesicular breath sounds?
|
It is heard over the main bronchus area and over the right upper posterior lung field
|
|
If you notice that over the Left lower lobe, you hear medium pitch and intensity lung sounds, with expiration phase the same as inspiration, how would you describe this findings?
|
As bronchovesicular breath sounds
|
|
What lung pathology can actually make breath sounds easier to hear?
|
When the lungs are consolidated; the mass surrounding the tube of the respiratory tree promotes sound transmission
|
|
Crackles are ______ vs wheeze and rales which are ________
|
discontinuous
continuous |
|
What is the cause of crackles?
|
They are caused by the disruptive passage of air through the small airways in the respiratory tree
|
|
What is the cause of wheezes?
|
It is caused by a relatively high-velocity air flow through a narrowed or obstructed airway
|
|
How does one distinguish between rhonchi and crackles?
|
Rhonchi tend to disappear after coughing; Crackles do not
|
|
How do you distinguish between rhonchi and wheezes?
|
Rhonchi are deeper, more rumbling, low and coarse sounds
Wheezes are continuous, high-pitched, musical sound |
|
Friction rub occurs _____ the respiratory tree.
|
outside
|
|
If a friction is heard over the lungs, it indicates ____ but if heard over the heart it indicates _____.
|
pleurisy
pericarditis |
|
What is the Hamman sign?
|
Also known as mediastinal crunch- it is found in the mediastinal emphysema.
This is where loud crackles, clicking and gurgling sounds are synchronous with the heartbeat but not with respirations |
|
What manuevers accentuate Hamman sign?
|
The sounds are more pronounced toward the end of expiration and are easiest to hear when the patient leans to the left or lies down on the left side
|
|
What pathology should be suspected with unilateral wheezing?
|
This can occur with a foreign body or with external compression due to a tumor
|
|
What is the cause of a pleural friction rub?
|
It is usually caused by inflammation of pleural surfaces.
|
|
Describe pleural friction rub
|
It is a dry rubbing or grating sound
|
|
What is the best position to hear a pleural friction rub?
|
It is loudest over lower lateral anterior surface
|
|
What disease process results in diminished vocal resonance and loss of intensity of tactile fremitus?
|
When there is a loss of tissue within the respiratoty tree i.e with the barrel chest of emphysema
|
|
What other findings are expected with extreme bronchophony?
|
Whispered pectoriloquy , where even a whisper is heard clearly and intelligibly.
|
|
What is bronchophony?
|
Greater clarity and increased loudness of spoken sounds
|
|
When you auscultate with the stethoscope and you hear an increased intensity of the spoken voice but a nasal quality, how would you describe this?
|
Egophony
|
|
Coughs are usually preceded by a _______.
|
deep inspiration
|
|
At the beginning of a cough, the glottis ______ and at the end of the cough, the glottis ______
|
closure
opening |
|
describe the cough pattern in pertussis.
|
regular and paroxysmal; produces an inspiratory whoop at the end of the paroxysm of coughing
|
|
What should you suspect with a cough that begins soon after a person has reclined or assumed an erect position
|
A post nasal drip or a pooling of secretions in the upper airway
|
|
Snoring and gurgling suggest a stimulus in the _______.
|
nasopharynx
|
|
A chronic cough should strongly suggest an _______ change
|
Anatomic
i.e. tumor, cavitation, bronchectasis |
|
Name the five factors involved in the Apgar score.
|
Heart rate
Respiratory effort Muscle tone Response to catheter in nostril Color |
|
A heart rate of 80 earns an Apgar score of ____
|
1
this represents a slow heart rate ( <100 beats/ min) |
|
When the newborn coughs with the introduction of a catheter in the nostril, what is the rating in the Apgar?
|
2
|
|
When are the newborn's Apgar scores calculated?
|
At 1 and 5 minutes
|
|
What is the average chest circumference for a newborn?
|
30 to 36 cm
|
|
How does the chest circumference compare to the head circumference?
|
The chest circumference is usually 2 to 3 cm smaller
|
|
What is the expected respiratory rate for newborns?
|
40-60 respirations
|
|
How would the respiratory rate of a baby delivered vaginally compare to a Cesarean section baby?
|
The C/S baby would have a faster respiratory rate than the vaginally delivered baby
|
|
Should we expect a baby to breathe through their nose or mouth?
|
Through the nose.
They are obligate nose breathers |
|
What is a common breathing pattern for newborns?
|
Periodic breathing
This is a sequence of relatively vigorous respiratory efforts followed by apnea of as long as 10 to 15 seconds |
|
What changes to the periodic breathing should cause concern in a newborn?
|
You should be concerned if the apneic episodes are prolonged and the baby tends to become centrally cyanotic
|
|
How long should we expect periodic breathing in a full term newborn?
|
In the term infant, periodic breathing should wane a few hours after birth
|
|
A preterm infant is ______ likely to have periodic breathing.
|
more.
The more premature an infant at birth, the more likely some irregularity in the respiratory pattern will be present |
|
Upon physical exam of a newborn , you notice repeated sneezing, what pathology should you consider?
|
None
Sneezing is frequent and expected- it clears the nose |
|
A nurse asks you to check an infant with frequent, irregular bouts of hiccuping, should you consider this alarming?
|
Yes
Although silent frequent hiccups are expected after meals; overall frequent hiccups can suggest seizures, encephalopathy, drug withdrawals. |
|
Upon observation, you notice that the newborn's abdomen distends on inspiration while the chest wall collapses, how do you document this type of breathing?
|
Paradoxical breathing.
It is common for newborns to use their abdominal muscles as well as their diaphragm |
|
Coughing is _____ in a newborn.
|
rare
Coughing should be considered a problem. |
|
What are some possible causes for asymmetric chest expansion in a newborn?
|
pneumothorax
atelectasis diaphragmatic hernia |
|
A fractured clavicle could be expected with a _______ delivery.
|
difficult forceps
|
|
Why are adventitious breath sounds suspected after delivery?
|
Crackles and rales are commonly heard immediately after birth because fetal fluid has not been completely cleared
|
|
Stridor is a high-pitched, piercing sound heard most often, during which phase of respiration?
|
Inspiration
|
|
What is respiratory grunting?
|
it is a mechanism where the infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
|
|
In the presence of stridor, hoarsenss, coughing and retractions of the chest wall; where can the potential obstruction be localized?
|
High in the respiratory tree.
It signifies a problem in the larynx or in the trachea |
|
Name some signs of respiratory distress in an infant.
|
Inspiration much longer expiration ( I:E ratio of 3:1 or 4:1)
respiratory grunting Retraction at the supraclavicular notch and contraction of the sternocleidomastoid muscles Nasal flaring Stridor |
|
How does the respiratory rate of a newborn compare to a 3 year old?
|
A newborn has respirations of 30 to 80 where a three year old has respirations of 20 to 30
|
|
When should we start to look for intercostal muscle use in a child ?
|
By the age of 6 or 7
|
|
How does a pregnant woman adapt to pregnancy with her breathing?
|
By increasing her ventilation with deep breathing NOT frequent breathing
|
|
A 3 year old is brought to the ER by his mother who hears wheezing for the first time. Other than asthma, what should you suspect?
|
Foreign body
|
|
What is the difference between kyphosis and gibbus?
|
Kyphosis is a pronounced dorsal curvature that is often seen in an adult but gibbus is extreme kyphosis
|
|
What cardiac complications can arise from severe bronchitis?
|
Sever chronic bronchitis may result in right ventricular failure with dependent edema.
|
|
Chronic Bronchitis is a result of chronic inflammation of _____ airways.
|
Large
|
|
What lung changes to you expect with chronic bronchitis?
|
Hyperinflation with decreased breath sounds and a flattened diaphragm.
|
|
What lung pathology is most frequently seen in cystic fibrosis patients?
|
Bronchiectasis
Chronic dilation of the bronchi or bronchioles. |
|
What is the underlying cause of bronchiectasis?
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Bronchectasis is the chronic dilation of the bronci or bronchioles that is caused by repeated pulmonary infections and bronchial obstructions that results in the malfunction of bronchial tone and loss of elasticity
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Would emphysema or chronic bronchitis lead to the most coughing and sputum production?
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Chronic bronchitis
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How does chronic bronchitis lead to emphysema?
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Chronic bronchitis is a common precursor leading to dilation of the air spaces beyond the terminal bronchioles and rupture of alveolar walls, permanently hyperinflating the lung
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What are the effects of emphysema on gas exchange?
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Alveolar air is trapped in expiration so gas exchange is compromised
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What changes to the breathing pattern should we expect in emphysema?
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Inspiration is limited with a prolonged expiratory effort.
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Which disease requires supplemental O2, chronic bronchitis or emphysema?
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Emphysema.
Dyspnea is common even at rest |
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In a habitual smoker, what lung sounds should make you seriously suspect chronic bronchitis over emphysema?
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Chronic bronchitis has inspirational crackles, wheezing and postpertussive rhonchi (sonorous wheezes). Emphysema has only occasional adventitious sounds.
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Should you expect diminished breath sounds in chronic bronchitis or in emphysema?
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You can expect diminished breath sounds in both.
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What are the most prominent features in COPD?
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cough, chronic and often excessive sputum production, and dyspnea.
Irreversible expiratory airflow obstruction |
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What are the main conditions to consider with COPD?
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Chronic bronchitis
Bronchiectasis Emphysema |
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Bronchiolitis is _____ airway disease vs. Bronchitis is _____ airway disease.
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small
large |
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What is the usual causative agent for bronchiolitis?
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Respiratory syncytial virus
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What age group is most affected by bronchiolitis?
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infants younger than 6 months
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What is the expected breathing pattern in an infant with bronchiolitis?
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Difficult expirations with rapid and short breaths.
Generalized retractions and perioral cyanosis can develop |
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What is tracheomalacia?
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A lack of rigidity or a floppiness of the trachea or airway.
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What is the treatment for tracheomalacia?
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None.
This tends to be benign and self-limited with increasing age. |
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What is the most common age range for croup?
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1 1/2 to 3 years
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What is the common age range for epiglottis?
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It most often occurs in children between the ages 3 and 7
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What are the key differences between croup and epiglottitis?
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Epiglottitis-
NO COUGH unable to swallow, has drooling from an open mouth HIGH FEVER child sits straight up with neck extended and head held forward Croup- HARSH, BARKLIKE COUGH NO FEVER labored breathing, retraction, hoarsenss, and inspiratory stridor |
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Where is the inflammatory process located in croup?
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Subglottic and may involve areas below the larynx.
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What are involved organ systems with cystic fibrosis?
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Lung
Pancreas Sweat glands |
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What GI abnormalities are associated with cystic fibrosis?
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malabsorption
poor weight gain intestinal obstruction |
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How do many states screen for cystic fibrosis?
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They check for mutations of CTFR ( cystic fibrosis transmembrane conductance regulator)
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What pathological lung changes can we expect with cystic fibrosis?
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Bronchiectasis with cyst formation
Thick mucus causing progressive clogging of the bronchi and bronchioles |
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What is the most common location for a diaphragmatic hernia?
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On the left side (90%)
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What is the typical presentation of an infant with diaphragmatic hernia?
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Bowel sounds heard in the chest with a flat or scaphoid abdomen with a usually displaced heart to the right
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When is respiratory distress syndrome most common?
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most frequently seen with decreasing gestational age, maternal diabetes and acute asphyxia
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What is the underlying cause for RDS?
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Surfactant deficiency
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What are some risks factors for pulmonary embolism?
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Age older than 40
History of venous thromboembolism surgery with anesthesia longer than 30 minutes Heart disease Cancer Pelvic and leg bone fracture Obesity Acquired or Congenital thrombophilia |
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What is the most common cause of acute cor pulmonale?
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Pulmonary embolism
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In acute cor pulmonale, you expect the heart to be ______ but in the chronic cor pulmonale you expect the heart to be _____
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dilated
hypertrophied |
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What should expect to find on physical examination with cor pulmonale?
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Right-sided heart failure with right ventricular heave
Elevated JVP and lower extremity edema |
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Name the different types of lung cancer.
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Squamous cell
Small cell ( oat cell) Adenocarcinoma Large cell |
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What is hemothorax?
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The presence of blood in the pleural cavity.
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What medial procedures can have hemothorax as a complication?
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Thoracoentesis
Central line placement Pleural biospy |
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With pneumothorax, you expect the diaphragm to be _____ on the affected side.
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depressed
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Describe the breath sounds over a pneumothorax.
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distant
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In atelectasis, you expect the trachea to be deviated _____, but in pneumothorax, the trachea is deviated ______
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ipsilaterally
contralaterally |
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In atelectasis, the apical cardiac impulse is deviated ______ but in pneumothorax the cardiac apical impulse is deviated ______
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ipsilaterally
contralaterally |
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You have just examined a patient with bronchophony,whispered pectoriloquy, and egophony. What should be on your list of differential diagnoses?
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Atelectasis
Pleural effusion Pneumonia with consolidation |
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You have just examined a patient with bronchophony,whispered pectoriloquy, and egophony. What can help you tell the difference between pleural effusion and a simple pneumonia with consolidation?
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Pleural effusion will have diminished tactile fremitus but expect increased fremitus in the setting of pneumonia with consolidation,
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What are the pulmonary findings in latent TB?
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There are none
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What symptoms should you suspect in active disease of TB?
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fever
cough weight loss night sweats |
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What pulmonary findings should you expect with active TB?
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consolidation and or pleural effusion
cough with blood streaked sputum |
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What pathological lung changes do you expect with severe influenza?
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The entire respiratory tract may be overwhelmed by interstitial inflammation and necrosis extending throughout the bronchiolar and alveolar tissue
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What is the difference between pleural effusion and an empyema?
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Pleural effusion is excessive non-purulent fluid in the pleural space
Empyema is purulent exudative fluid in the pleural space |
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What are the most common causes of lung abscess?
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Aspiration of food or infected material from upper respiratory or dental sources of infection
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In pleural effusion, the percussion note above the perfusion is _____ but over the perfusion is _____
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hyperresonant
dull |
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Pneumonia is an acute infection of _________
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pulmonary parenchyma i.e. alveolia and bronchioles
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Why should we have to consider pneumonia with a right upper quadrant abdominal pain?
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If it involves the right lower lobe, it can stimulate the 10th and 11th thoracic nerves and simulate an abdominal process
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What is pleurisy?
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It is an inflammatory process involving the visceral and parietal pleura that becomes edematous and fibrinous
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What is the referral pain pattern in pleurisy?
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Pain can be referred to the ipsilateral shoulder if the pleural inflammation is close to the diaphragm
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What are often the pulmonary findings in pleurisy?
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Pleural friction rub with diminished breath sounds; rapid and shallow breathing
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What is the cardiac response to asthma?
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Tachycardia
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What is the cause of the small airway obstruction in asthma?
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Mucosal edema, increased secretions and bronchconstriction with increased airway resistance with impeded respiratory flow
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Acute bronchitis is usually due to _____ but chronic bronchitis is due to _______.
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infection
irritant exposure |
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Acute bronchitis has a ____ cough but chronic bronchitis has a ___ cough.
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non-productive
productive |