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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
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
What is the dividing structure between the right middle and upper lobes?
The horizontal fissure
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
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
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?
The right bronchus- it is shorter, wider and more vertically placed
What is the blood supply for the bronchi?
The bronchial arteries branch from the anterior thoracic aorta and the intercostal arteries
What is the venous drainage of the bronchi?
Most of the blood supply is returned by the pulmonary veins
Anteriorly, where can we find the oblique fissure on both lungs?
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
Posteriorly, the lower lobe extends from ___ to ______ during the respiratory cycle
T3
T10 - 12
What are the surface markers for the left oblique fissure?
The level of the third rib medially to the 6th rib anteriorly
What are the surface markers for the right oblique fissure?
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
What is the role of the passive movements of the lung during gestation?
They prepare the term infant to respond to postnatal chemical and neurological respiratory stimuli
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?
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
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
Retractions indicate an obstruction with _______
inspiration
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
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
With a supraglottal obstruction, how is the voice quality and the ability to swallow?
The voice is muffled and swallowing is more difficult
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
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
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
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
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
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
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?
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
Would emphysema or chronic bronchitis lead to the most coughing and sputum production?
Chronic bronchitis
How does chronic bronchitis lead to emphysema?
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
What are the effects of emphysema on gas exchange?
Alveolar air is trapped in expiration so gas exchange is compromised
What changes to the breathing pattern should we expect in emphysema?
Inspiration is limited with a prolonged expiratory effort.
Which disease requires supplemental O2, chronic bronchitis or emphysema?
Emphysema.
Dyspnea is common even at rest
In a habitual smoker, what lung sounds should make you seriously suspect chronic bronchitis over emphysema?
Chronic bronchitis has inspirational crackles, wheezing and postpertussive rhonchi (sonorous wheezes). Emphysema has only occasional adventitious sounds.
Should you expect diminished breath sounds in chronic bronchitis or in emphysema?
You can expect diminished breath sounds in both.
What are the most prominent features in COPD?
cough, chronic and often excessive sputum production, and dyspnea.
Irreversible expiratory airflow obstruction
What are the main conditions to consider with COPD?
Chronic bronchitis
Bronchiectasis
Emphysema
Bronchiolitis is _____ airway disease vs. Bronchitis is _____ airway disease.
small
large
What is the usual causative agent for bronchiolitis?
Respiratory syncytial virus
What age group is most affected by bronchiolitis?
infants younger than 6 months
What is the expected breathing pattern in an infant with bronchiolitis?
Difficult expirations with rapid and short breaths.
Generalized retractions and perioral cyanosis can develop
What is tracheomalacia?
A lack of rigidity or a floppiness of the trachea or airway.
What is the treatment for tracheomalacia?
None.
This tends to be benign and self-limited with increasing age.
What is the most common age range for croup?
1 1/2 to 3 years
What is the common age range for epiglottis?
It most often occurs in children between the ages 3 and 7
What are the key differences between croup and epiglottitis?
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
Where is the inflammatory process located in croup?
Subglottic and may involve areas below the larynx.
What are involved organ systems with cystic fibrosis?
Lung
Pancreas
Sweat glands
What GI abnormalities are associated with cystic fibrosis?
malabsorption
poor weight gain
intestinal obstruction
How do many states screen for cystic fibrosis?
They check for mutations of CTFR ( cystic fibrosis transmembrane conductance regulator)
What pathological lung changes can we expect with cystic fibrosis?
Bronchiectasis with cyst formation
Thick mucus causing progressive clogging of the bronchi and bronchioles
What is the most common location for a diaphragmatic hernia?
On the left side (90%)
What is the typical presentation of an infant with diaphragmatic hernia?
Bowel sounds heard in the chest with a flat or scaphoid abdomen with a usually displaced heart to the right
When is respiratory distress syndrome most common?
most frequently seen with decreasing gestational age, maternal diabetes and acute asphyxia
What is the underlying cause for RDS?
Surfactant deficiency
What are some risks factors for pulmonary embolism?
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
What is the most common cause of acute cor pulmonale?
Pulmonary embolism
In acute cor pulmonale, you expect the heart to be ______ but in the chronic cor pulmonale you expect the heart to be _____
dilated
hypertrophied
What should expect to find on physical examination with cor pulmonale?
Right-sided heart failure with right ventricular heave
Elevated JVP and lower extremity edema
Name the different types of lung cancer.
Squamous cell
Small cell ( oat cell)
Adenocarcinoma
Large cell
What is hemothorax?
The presence of blood in the pleural cavity.
What medial procedures can have hemothorax as a complication?
Thoracoentesis
Central line placement
Pleural biospy
With pneumothorax, you expect the diaphragm to be _____ on the affected side.
depressed
Describe the breath sounds over a pneumothorax.
distant
In atelectasis, you expect the trachea to be deviated _____, but in pneumothorax, the trachea is deviated ______
ipsilaterally
contralaterally
In atelectasis, the apical cardiac impulse is deviated ______ but in pneumothorax the cardiac apical impulse is deviated ______
ipsilaterally
contralaterally
You have just examined a patient with bronchophony,whispered pectoriloquy, and egophony. What should be on your list of differential diagnoses?
Atelectasis
Pleural effusion
Pneumonia with consolidation
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?
Pleural effusion will have diminished tactile fremitus but expect increased fremitus in the setting of pneumonia with consolidation,
What are the pulmonary findings in latent TB?
There are none
What symptoms should you suspect in active disease of TB?
fever
cough
weight loss
night sweats
What pulmonary findings should you expect with active TB?
consolidation and or pleural effusion
cough with blood streaked sputum
What pathological lung changes do you expect with severe influenza?
The entire respiratory tract may be overwhelmed by interstitial inflammation and necrosis extending throughout the bronchiolar and alveolar tissue
What is the difference between pleural effusion and an empyema?
Pleural effusion is excessive non-purulent fluid in the pleural space
Empyema is purulent exudative fluid in the pleural space
What are the most common causes of lung abscess?
Aspiration of food or infected material from upper respiratory or dental sources of infection
In pleural effusion, the percussion note above the perfusion is _____ but over the perfusion is _____
hyperresonant
dull
Pneumonia is an acute infection of _________
pulmonary parenchyma i.e. alveolia and bronchioles
Why should we have to consider pneumonia with a right upper quadrant abdominal pain?
If it involves the right lower lobe, it can stimulate the 10th and 11th thoracic nerves and simulate an abdominal process
What is pleurisy?
It is an inflammatory process involving the visceral and parietal pleura that becomes edematous and fibrinous
What is the referral pain pattern in pleurisy?
Pain can be referred to the ipsilateral shoulder if the pleural inflammation is close to the diaphragm
What are often the pulmonary findings in pleurisy?
Pleural friction rub with diminished breath sounds; rapid and shallow breathing
What is the cardiac response to asthma?
Tachycardia
What is the cause of the small airway obstruction in asthma?
Mucosal edema, increased secretions and bronchconstriction with increased airway resistance with impeded respiratory flow
Acute bronchitis is usually due to _____ but chronic bronchitis is due to _______.
infection
irritant exposure
Acute bronchitis has a ____ cough but chronic bronchitis has a ___ cough.
non-productive
productive