Chapter 18 Thorax And Lungs

Front 1

What is the Thoracic Cage composed of

Back 1

Sternum, 12 pairs of ribs, 12 thoracic vertebrae, diaphragm

Front 2

How are the ribs arranged?

Back 2

Ribs 1-7 attach to the sternum via COSTAL CARTILAGES

Ribs 8-10 attach to the costal cartilage above

Ribs 11-12 are just "floating"

Front 3

Costochondrial Junction

Back 3

Point at which ribs join with their cartilages

Front 4

Suprasternal Notch

Back 4

hollow U-shaped depression above sternum between clavicles

Front 5

Sternum

Back 5

the breast bone. It has 3 parts: the manubrium (w/Angle of Louis or Manubriosternal angle), the body, and the xiphoid process

Front 6

Manubriosternal angle/Angle of Luis/ Sternal Angle

Back 6

Articulation of manubrium and body of sternum. Continuous with the second rib and marks site of tracheal bifurcation into right and left main bronchi, corresponds with upper border of atria of heart, and lies above fourth thoracic vertebra on back.

Front 7

Costal Angle

Back 7

Where right and left costal margins meet at xiphoid process and form and angle. It is NORMALLY 90 degrees or less and increases when rib cage is chronically overinflated (emphysema)

Front 8

Vertebral Prominens

Back 8

C7; flex head and feel for most prominence bony spur protruding at base of neck

Front 9

Inferior border of Scapula

Back 9

Lower tip of scapula that is usually at the 7th or 8th rib

Front 10

Spinous Processes

Back 10

Knobs on the vertebrae. They align with their same numbered ribs only down to T4

Front 11

Twelfth Rib

Back 11

Free tip can be palpated midway between spine and person's side

Front 12

Reference Lines

Back 12

Midsternal Line, Midclavicular Line, Scapular Line, Vertebral Line, Anterior, Posterior, and Midaxiallary lines

Front 13

Mediastinum

Back 13

Middle section of thoracic cavity that contains esophagus, trachea, heart, and great vessels; the mass of tissues and organs separating the two pleural sacs, between the sternum in front and the vertebral column behind, containing the heart and its large vessels, trachea, esophagus, thymus, lymph nodes, and other structures and tissues

Front 14

Right Lung vs. Left Lung

Back 14

Right lung shorter than left lung because of underlying liver

Right Lung has 3 lobes, Left Lung has 2 (the lobes are separated by fissures)

Front 15

Functions of the Respiratory System

Back 15

There are Four: Supply O2 to rest of the body for energy production, Remove CO2, Maintain acid/base balance of arterial blood, maintain heat exchange (not as important in humans)

Front 16

Structures of the Respiratory System

Back 16

Trachea, Tracheal Bifurcation, Bronchial Trees, Bronchioles, Alveolar sac, Alveolus, and Interalveolar septum, Visceral pleura, Parietal Pleura, Pleural cavity, and Costodiaphragmatic Recess

Front 17

Pleurae

Back 17

Visceral, Parietal, and Pleural Cavity; Pleural cavity filled with lubricating fluid and normally has vacuum or negative pressure to hold lungs tightly against chest wall.; Pleurae extends 3cm below lungs to from Costodiaphragmatic Recess

Front 18

Trachea and Bronchial Tree

Back 18

Right main bronchus is shorter, wider, and more vertical

Make up dead space

Bronchial tree lined with goblet cells and cilia to protect alveoli

Front 19

Acinus

Back 19

the functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and alveoli

Front 20

Mechanics of Respiration

Back 20

Contolled by Pons and Medulla based on change in CO2 and O2 in blood and Hydrogen ion level

Front 21

Hypercapnia

Back 21

Too much oxygen in blood; main stimulus for breathing

Front 22

Hypoxemia

Back 22

Decrease of O2 in blood; also a stimulus for breathing but less effective than hypercapnia

Front 23

Inspiration

Back 23

Sternum elevates, diaphragm descends&flattens, vertical diameter increases, upper ribs elevate, increased anteroposterior diameter. Increase in size of thoracic container creates slightly neg. pressure so air rushes in to fill vacuum

Front 24

Respiration

Back 24

passive; air flows out due to positive pressure

Front 25

Symmetric Chest Expansion

Back 25

Placing hands on back with thumbs at T9 or T10 and ask person to breathe to see symmetrical movement

Front 26

Tactile Fremitus

Back 26

Sounds from larynx are transmitted through patent bronchi and through lung to chest wall.

" 99"

Vibrations should be symmetrical
Fremitus may feel stronger on right side than left since right side is closer to bronchial bifurcation

Front 27

Anteroposterior to Transverse Diameter

Back 27

AP< T; 1:2 to 5:7

Front 28

Things that affect intensity of tactile fremitus

Back 28

Location of bronchi to chest wall, Thickness of Chest wall, Pitch and Intensity

Front 29

Diaphragmatic Excursion

Back 29

should be equal bilaterally and measure about 3-5cm in adults but may be 7-8cm in well conditioned people

Front 30

Bronchial Breath Sounds (Tracheal)

Back 30

harsh, hollow, tubular, high pitch, loud, inspiration < expiration

trachea and larynx

Front 31

Bronchovesicular breath sounds

Back 31

moderate pitch, moderate amplitude, inspiration = expiration, mixed quality

major bronchi where fewer alveoli are located; posterior: between scapulae especially on right

anterior: around upper sternum in first and second intercostal spaces

Front 32

Vesicular Breath Sounds

Back 32

Low pitch, soft, inspiration > expiration, rustling like sound of wind on trees

over peripheral lung fields where air flows through smaller bronchioles and alveoli

Front 33

Adventitious sounds: Crackles

Back 33

abnormal, discontinuous, heard on inspiration

Front 34

Wheeze

Back 34

high pitches, musical, squeaking

Front 35

Adventitious sounds: Atlectatic crackles

Back 35

Not pathologic; short, popping, cracklings ound that sounds like fine crackles but don't last beyond a few breaths

Occurs when sections of alveoli aren't fully aerated and they deflate slightly & accumulate secretions. Crackles are heard when sections are expanded by few deep breaths.

Heard only in periphery

Front 36

Bronchophony

Back 36

spoken voice heard through stethoscope: instead of soft, muffled, and indisctinct over normal lung tissue

Front 37

Egophony

Back 37

voice sounds of "eee" hear through stethoscope each time stethoscope is moved

Front 38

Whispered pectoriloquy

Back 38

whispered phase heard through stethoscope that sounds faint and inaudible over normal lung tissue

Front 39

Barrel Chest

Back 39

AP = Transverse Diameter, ribs are horizontal instead of a normal downward slope. Chest appears as if held in continuous inspiration. Occurs with chronic emphysema, normal aging, asthma, as result of hyperinflation of lungs

Front 40

Pectus Excavatum

Back 40

sunken sternum and adjacent cartilages (also called funnel breast)

depression begins at 2nd intercostal space, becoming depressed most at junction of xiphoid with body of sternum. More noticeable on inspiration

Congenital; usually not symptomatic

Front 41

Pectus Carinatum

Back 41

Forward protrusion of sternum with ribs sloping back at either side and vertical depressions along costochondrial junctions

Less common than pectus excavatum but requires no treatment

Front 42

Scoliosis

Back 42

lateral, S-shaped curvature of thoracic and lumbar spine

usually with involved vertebrae rotation, unequal shoulder and scapular height, unequal hip levels, rib interspaces flared on convex side.

If severe (>45 degrees), may reduce lung volume

Front 43

Kyphosis

Back 43

exaggerated posterior curvature of thoracic spine causing back pain and limited mobility

severe: may affect cardiopulmonsary functioning

associated with aging and related to physical fitness

Front 44

Tachypnea

Back 44

rapid shallow breathing > 24 breaths per minute

normal response to fever, fear, or exercise.

also occurs with respiratory insufficiency, pneumonia, alkalosis, pleurisy,a nd lesion in pons

Front 45

Bradypnea & what does it occur with

Back 45

slow breathing <10 bpm

decreased but regular rate

occurs with drug-induced depression of repiratory center in medulla, increased intracranial pressure, and diabetic coma

Front 46

Hyperventilation

Back 46

increased rate and depth of breathing

blows off CO2 causing decreased level in blood: alkalosis

Front 47

Hypoventilation

Back 47

irregular shallow pattern due to overdos of narcotics or anesthetics, prolonged bed rest, or conscious splinting of chest to avoid pain

Front 48

Cheyne-Stokes Respiration

Back 48

Respirations gradually wax and wane in regular pattern increasing rate and depth and then decreasing.

The breathing periods last 30 to4 5 seconds with around 20 seconds of apnea.

Cause: severe heart failure, renal failure, meningitis, durg OD, increased intracranial pressure

Normal in infants and aging persons during sleep

Front 49

Biot's Respiration

Back 49

Similar to Cheyne-Stokes except pattern is irregular. Series of normal respiration followed by period of apnea. Cycle length is variable and seen with head trauma, brain abscess, heat stroke, spinal meningitis, and encephalitis

Front 50

Increased Tactile Fremitus

Back 50

increase density of lung tissue making it a better conducting medium for vibrations

patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent

PNEUMONIA

Front 51

Decreased Tactile Fremitus

Back 51

occurs when anything obstructs transmission of vibrations. Any barrier that gets in way of sound and palpating hand decreases fremitus

PNEUMOTHORAX or EMPHYSEMA

Front 52

Fine Crackles (rales)

Back 52

discontinuous, high pitched, short crackling, popping sounds during inspiration that aren't cleared by coughing.

inhaled air collides with previously deflated airways; airways suddenly pop open making cackling sound as gas pressures between two compartments equalize

LATE: restrictive disease
EARLY: obstructive disease
POSTURALY induced crackles: fine crackles that appear with change from sitting to supine position or with change from supine to supine with elevated legs like after acute MI and associated with increased mortality

Front 53

Coarse Crackles

Back 53

loud, low pitched, bubbling and gurgling sounds that start in early inspiration and may be present expiration. May decrease a bit by suctioning or coughing but will reappear; sounds like Velcro

inhaled air collides with secretions in trachea and large bronchi

pulmonary edema, pneumonia, pulmonary fibrosis

Front 54

Pleural Friction Rub

Back 54

Superficial, coarse, low pitch like two pieces of leather being rubbed together; sounds like crackles but CLOSER to ear.

Caused when pleurae become inflamed and lose normal lubricating fluid and the two pleurae rub against each other like in pleuritis

Front 55

Wheeze (sibilant)

Back 55

High pitched, musical squeaking sounds that sound polyphonic; dominate in expiration but can occur during expiration and inspiration

sounds like vibrating weed

Front 56

Wheeze (sonorous)

Back 56

low pitched, monophonic single note, musical snoring, moaning sounds; heard throughout the cycle butmore prominent on expiration; cleared somewhat by coughing

bronchitis

Front 57

Atelectasis

Back 57

Collapsed shrunken section of alevioli or entire lung as a result of airway obstruction, compression on lungs, or lack of surfactant.

Inspection: cough, lag on expansion on affected side, increased rate and pulse, possible cyanosis

Palpation: chest expansion decreased on affected side, tactile fremitus decreased or absent over area

Percussion: dull over area

Auscultation: breath sounds decreased vesicular or absent over area. voice sounds variable, usually decreased or absent over affected area

No adventitious sounds if bronchus obstructed. Occasional fine crackles if bronchus is patent

Front 58

Lobar Pneumonia

Back 58

Alveoli consolidated with fluid, bacteria, RBC's, WBC's

Increased respiratory rate, chest expansion decreased on one side, dull to percussion over one lobe, breath sounds louder with fine crackles over same lobe, tachypnea, hypoxemia, breath sounds louder, voice sounds have increased clarity

Front 59

Bronchitis

Back 59

inflammation of bronchi with partial obstruction of bronchi due to excessive mucous secretion. Productive cough for at least 3 months of the year for 2 years in a row

hacking cough, if chronic: dyspnea, fatigue, cynaosis, possible clubbing of fingers

tatctile fremitus normal, resonant percussion, normal vesicual sounds and voice sounds, crackle over deflated areas and possible wheeze

Front 60

Emphysema

Back 60

COPD; enlargement of alveoli distal to terminal bronchioles; caused by destruction of pulmonary connective tissue; increases airway resistance especially on expiration producing hyperinflated lung and increase in lung volume.

increased anteroposterior diameter, barrel chest, uses accessory muscles to aid respiration, tripod position, SOB, respiratory distress, tachypnea, decreased tactile fremitus, chest expansion, hyperresonant percussion, decreased diaphragmatic excursion, decreased breath sounds, prolonged expiration, muffled heart sounds, and usually no adventitious sounds