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317 Cards in this Set
- Front
- Back
What makes up the chest anteriorly
|
sternum, manubrium, xiphoid process and costal cartilages
|
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what makes up the chest laterally
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12 pairs of ribs
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what makes up the chest posteriorly
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12 thoracic vertebrae
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which ribs are connected to the thoracic vertebrae
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all of threm
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which diameter is greater in adults, lateral or AP
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lateral
|
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what are the primary muscles of respiration
|
diaphragm and intercostals
|
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what is the function of the external intercostals
|
increase the AP chest diameter during inspiration
|
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internal intercostal function
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decrease the lateral diameter during expiration
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how do the sternocladomastoid and trap muscles assist with respiration
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during exercise or pulmonary compromise
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three interior divisions of the c
hest |
left and right plural cavities and the mediasteinum
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what is located in the mediasteinum
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all of the thoracic viscera except the lungs
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what lines the pleural cavities
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visceral, parietal and serous pleura
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where is the lingula located
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upper left love of the lungs
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what does the horizontal fissure divide
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upper and middle lobes of the right lung at the 5th rib in the axilla and 4th rib anteriorly
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what limits lung expansion
|
elastic subpleural tissue
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how far does the lung extend above the first rib in adults
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4 cm
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posteriorly, to what level to the lungs extend anteriorly
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T1
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what do the borders of the lung extend to inferiorly on deep inspiration and forced expiration
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t12 and t9
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how long is the trachea
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10 or 11 cm, 2 cm diamter
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where does the trachea bifurcate
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t4 t5
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why is the right bronchus more prone to obstruction
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wider, shorter and more vertically placed than the left
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how are the main bronchi divided
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3 on the right, 2 on the left
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where do the bronchial arteries come from
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anterior thoracic aorta and intercostal arteries
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where is the bronchial vein formed
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hilum of the lung
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what is the main conduit of blood leaving the lungs
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pulmonary veins
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why is the right lung higher than the left
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dome of the liver
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posterior - lobe extension during inspiration and expiration
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T3 to T10/t12
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left lateral - lung extension
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axilla to 7 or 8th rib
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oblique fissue left lateral
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3rd rib medially to 6th rib anteriorly
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manubriosternal junction - what rib articulates with it
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2nd
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in intercostal spacing, which rib forms the top of each space
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the number of each space corresponds to the rib above it
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costal angle
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angle formed by blending of the costal margins at the sternum
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what are the costal angles
|
90 degrees with ribs at 45 degrees
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what are the lungs at 4 weeks gestation
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groove on the ventral wall of the gut
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what is fetal gas exchange mediated by
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placenta
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what causes blood to flow through the lungs at birth
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lesser resistance in pulmnonary circulation ass opposed to systemic
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what closes when pulmnonary pressure declines
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foramen ovale
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what contracts with increased oxygen content in blood
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ductus arteriosus
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what is the diameter relationship of the newborn
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AP is equal to lateral
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when do alveoli proliferate
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first 2 years of life
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when does alveoli proliferation slow down
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8 years old
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what changes respiratory activity in pregnant women
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expanding uterus and circulating progesterone
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rib changes in pregnant women
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increase in lower rib lateral diameter of 2cm and increase in circumference of 5 to 7 cm
|
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diaphrapgm rises how much in pregnancy
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4cm
|
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what ventillatory changes happen in pregnancy
|
minute ventilation increased due to increased tidal volume
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why does barrel chest occur
|
loss of muscle strength in the thorax and diaphragm
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changes in dorsal curve of the thoracic spine do what
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increased AP chest diameter
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what happen to alveoli as you get older
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get less elastic and more fibrotic, less area for gas exchange
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what is the end result of the loss of elasticity and loss of tolerance for exertion in the lungs
|
decrease in vital capaicty and increase in residual capacity
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mucous membranes as you get older
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become drier and become harder to remove, increase propensity for bacterial growth
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dyspnea
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difficult and labored breathing with shortness of breath
|
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what factors can cause dyspnea
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pulmonary or cardiac compromise
|
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what can cause dyspnea in an otherwise well person
|
being a fat fuck - sedentary lifestyle and obesity
|
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orthopnea
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shortness of breath that begins or increases when the patient lies down - ask if they have to sleep on a pillow or not
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paroxymal nocturnal dyspnea
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sudden shortness of breath after a period of sleep
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platypnea
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dyspnea that occurs in the upright posture
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constant ache that lasts all day (chest pain)
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chest pain that does not originate from the heart
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chest pain that does not radiate
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chest pain that does not originate from the heart
|
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chest pain that is not made worse by pressing on the pecordium
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chest pain that does not originate from the heart
|
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chest pain that is a fleeting, needle like jab that only lasts for a second or two
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chest pain that does not originate from the heart
|
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chest pain that is situated between the shoulders or in between the shoulderblades in the back
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chest pain that does not originate from the heart
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chest pain associated with what symptoms can indicate a problem
(5) |
trauma, coughing, lower respiratory infections, recent anesthesia, history of thrombophlebitis
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chest pain that occurs simultaneously with what can indicate some fucked up shit happening (6)
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shallow breathing, fever, coughing, anxiety about getting air, radiation of pain to neck or arms
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what can happen when you snort too many lines of coke
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severe, acute chest pain, tachycardia, hypertension, coronary artery spasm, and pneumothorax
|
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what is the order of the exam for lungs
|
inspection, palpation, percussion and ascultation
|
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dullness on percussion is present with what
|
pleural effusion and lobar pneumonia
|
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breath sounds are absent in what
|
pleural effusion
|
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bronchial breath sounds in what
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lobar pneumonia
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tactile fremitus is absent in what
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effusion
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tactile fremitus is increased in what
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pneumonia
|
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chest pain that is situated between the shoulders or in between the shoulderblades in the back
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chest pain that does not originate from the heart
|
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chest pain associated with what symptoms can indicate a problem
(5) |
trauma, coughing, lower respiratory infections, recent anesthesia, history of thrombophlebitis
|
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chest pain that occurs simultaneously with what can indicate some fucked up shit happening (6)
|
shallow breathing, fever, coughing, anxiety about getting air, radiation of pain to neck or arms
|
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what can happen when you snort too many lines of coke
|
severe, acute chest pain, tachycardia, hypertension, coronary artery spasm, and pneumothorax
|
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what is the order of the exam for lungs
|
inspection, palpation, percussion and ascultation
|
|
dullness on percussion is present with what
|
pleural effusion and lobar pneumonia
|
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breath sounds are absent in what
|
pleural effusion
|
|
bronchial breath sounds in what
|
lobar pneumonia
|
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tactile fremitus is absent in what
|
effusion
|
|
tactile fremitus is increased in what
|
pneumonia
|
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bronchopulmonary dysplasia and transient tachypnea of the newborn can lead to low birth weight
|
that shit cray
|
|
what kind of light is needed to highlight chest movement
|
bright tangental
|
|
what defects can be noticed with tangental light situations
|
minimial pulsations or retractions or presence of deformities
|
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what is the difference in the AP diameter as opposed t o the lateral
|
AP is about half lateral
|
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what does barrel chest arise from
|
compromised respiration (chronic asthma, emphysema, cystic fibrosis)
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what are the physiological changes that occur in barrel chest
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ribs are more horizontal, and somewhat kyphotic, sternal angle is more prominent, posterior trachea
|
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thoracic ratio in barrel chest
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normally .70-.75, can approach 1.0 in chronic conditions
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where is the midsternal line
|
vertically down the midline of the sternum
|
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where are the right and left midclavicular lines
|
parallel to the midsternal line, at midclavicular, inferior borders of the lung go to 6th rib at MCL
|
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right and left midaxillary lines
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parallel to midsternal, begin at midaxilla
|
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right and left posterior axillary lines
|
parallel to midsternal lines, beginning at posterior axillay folds
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vertebral line
|
vertically down spinal processes
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right and left scapular lines
|
parallel to vertebral line, though inferior angle of scapula
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posterior spine deviation
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kyphosis
|
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lateral spine deviation
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scoliosis
|
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pidgeon chest
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pectus carnaitum
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funnel chest
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pectus excavatum - indentation lower sternum above the xyphoid process
|
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what happens to someones breath when they have an intrathoracic infection
|
it becomes malodorous
|
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supernumary nipples
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sign of congenital anomalies
|
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superficial venous patterns
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sign of heart disorders or vascular obstruction
|
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normal respiratory range
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12 to 20
|
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respirations to heart beat ratio
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1:4
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what factors can affect the rate of respiration
|
age of the individual and degree of exertion
|
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how should the chest expand normally during inspitation
|
bilaterally symmetric
|
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normal respiration
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regular and comfortable 12 to 20 PM
|
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air trapping
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increasing difficulty in getting breath out
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bradypnea
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slower than 12 breaths per minute
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cheyne stokes breathing
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varying periods of increasing depth with interspesed apnea
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tachypnea
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breathing more than 20 per minute
|
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kussmaul breathing
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rapid deep labored
|
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hyperventilation - hyperpnea
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greater than 20 deep breaths per minute
|
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biot
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irregular interspersed periods of apnea in a disorganized sequence of breaths
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sighing
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frequently interspersed deeper breath
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ataxic
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significant disorganization with irregular and varying depths of respiration
|
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gender effects on respiratory disability
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greater differences in men, but differences between sexes gets less as age increases
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what happens as a result of protective splinting from a broken rib or pleurisy
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increased shallow rapid breathing
|
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pleurisy
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infection of lung plerura
|
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liver enlargement or ascities can also cause what
|
shallow rapid breathing
|
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what causes bradypnea
|
neurologic or electrolyte disturbance, infection or a response to proetect against pain of pleurisy
|
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when does cheyene stokes come about
|
seriously ill or breathing associated with damage to respiratory area in brainstem
|
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what type of breathing is associated with emotional distress
|
sighing - just like making these goddamn flash cards is making me do
|
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what is biot respiration associated with
|
elevated intracrania pressure, respiratory compromise
|
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rate and depth of breathing will increase with ( 6)
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acidosis, CNS lesions (pons) , ANxiety, aspirin overdose, hypoxemia, pain
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rate and depth of breathing will decrease with ( 5)
|
alkalosis, CNS lesions (cerebrum) , myasthenia gravis, narcotic overdose, extreme obesity
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apnea
|
absence of spontaneous respiration
|
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primary apnea
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self limited condition that occurs after a blow to the head, noted after the birth of a newborn
|
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secondary apnea
|
breathing stopping and will not resume unless resusicative measures are taken, anything that limits oxygen absorption into the blood will cause this
|
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reflex apnea
|
when irritating or nausea provoking vapors are inhaled, can temporarily halt respiration
|
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sleep apnea
|
periods of absence of breathing during sleep, airflow is obstructed during sleep
|
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apneustic breathing
|
long inspiration and expiration apnea - affection of respiration center in pons
|
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periodic apnea of newborn
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irregular pattern of rapid breathing interspersed with brief periods of apnea that are associated with REM sleep
|
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what is normal respiration
|
symmetric without use of accessory muscles
|
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what can unequal chest rise be associated with
|
collapsed lung, limitation of expansion by extrapleural air, fluid or a mass
|
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what is prolonged expiration and bulging on expiration caused by
|
outflow obstruction or the valvelike compression by a tumor, anyurism, or enlarged heart
|
|
what happens when something compresses the lungs inside the chest
|
the costal angle opens up beyond 90 degrees
|
|
retractions
|
chest wall caves in at the sternum
|
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what does retractions indicate
|
obstruction to inspiration at any point in the respiratory tract
|
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when are retractions seen
|
inspiration
|
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what happens when you have restrictions higher up in the laryngeal tree
|
stridor
|
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what is seen with paradoxic breathing
|
when the lower thorax is drawn in on inspiration and vice versa
|
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what causes paradoxic breathing
|
poorly functioning diaphragm, obstructive airway disease, upper airway obstruction during sleep
|
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what causes unilateral retraction
|
foreign body in the bronchus
|
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what happens with retraction of the lower chest
|
asthma and bronchiolitis
|
|
2 causes of clubbing
|
pulmonary/cardiac disease or congenital
|
|
pursing of the lips is a sign of
|
respiratory difficulty
|
|
what changes are associated with clubbing
|
emphysema, lung cancer, cyanosis of congenital heart disease, cystic fibrosis
|
|
flaring of the nasal alai
|
air hunger
|
|
Capritta hates it when mollie does what?
|
cleans herself
|
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inspiratory stridor with what I:E ratio is consistent with
|
upper airway constriction
|
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Memorize the table on 348
|
No way to put that into questions, just stare at it
|
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crepitus
|
crackling sensation that can be heard and felt
|
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what does crepitus indicate
|
air in the subcutaneous tissue from a rupture somewhere in the respiratory system or by infection with a gas producing organism
|
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what is suggested by a coarse grating vibration on inspiration
|
pleural friction rub
|
|
tactile fremitus
|
palpable vibration of the chest wall that results from speech or other verbilizations
|
|
where is tactile fremitus best felt
|
parasternally at the second intercostal space at the level of the bifurcation of the bronchii
|
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what obscures fremitus
|
scapulae
|
|
what are the two most common findings of pleural effusion
|
dullness on percussion and tactile fremitus
|
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what is indicated by decreased or absent fremitus
|
excess air int he lungs, emphysema, pleural thickening, effusion, massive pulmonary edema, bronchial obstruction
|
|
increased fremitus
|
fluids, solid mass in the lungs, lung consolidation, bronchial obstructions, compressed lungs or tumors
|
|
gentle tremulous fremitus occurs
|
with some lung consolidation, some inflammatory and infectious processes
|
|
where should the trachea be midline
|
area above the suprasternal notch
|
|
what deviation of the trachea is normal
|
slight to the right
|
|
what happens with volume lung disorders
|
trachea deviates to the affected side
|
|
thyroid enlargement or pleural effusion
|
trachea deviates away from the affected side
|
|
pneumotorax on trachea
|
either side depending on if there is tension or not
|
|
tension pneumotorax deviation
|
away from the affected side
|
|
collapsed lung
|
towards the affected side
|
|
anterior mediasteinal tumor
|
pushes it posteriorly
|
|
mediasteinitis
|
pushes it anteriorly
|
|
pull out of midline with respiration
|
tug
|
|
what does a patient do to ease breathing when they have an anterior mediasteinal mass
|
lean forward (not like a cholo)
|
|
what to do when you are examining a womans chest
|
ask her to move her breasts out of the way (well what the fuck else are you supposed to do)
|
|
table on 350
|
just memorize it, its not worth typing out
|
|
where can resonance usually be heard over the lungs
|
over all areas of the lungs
|
|
hyperresonance with hyperinflation
|
emphysema, pneumothorax, asthma
|
|
dullness or flatness
|
pneumonis, atelecastasis, pleural effusion, pneumothorax or asthma
|
|
tympany is heard where
|
percussion over abdomen
|
|
what pathologic processes limit diaphragmatic excursions
|
pulmonary, abdominal, fractured ribs
|
|
why is the diaphragm higher on the right than the left
|
liver be all up in the diaphragms shit
|
|
what is the usual excursion distance
|
3 to 5 or 6 cm
ribs on ribs on ribs |
|
sweet fruity breath
|
diabetic or starvation ketoacidosis
|
|
fishy stale breath
|
uremia (trimethylamines)
|
|
ammonia like breath
|
uremia (ammonia)
|
|
musty fish, clover breath
|
hepatic involvement, hepatic failure, portal vein thrombosis, portacaval shunts
|
|
foul, feculent breath
|
intestinal obstruction
|
|
foul putrid breath
|
nasal, sinus pathology, infection, foreign body, respiratoy infections, empyema, lung abscess, bronchiesctasis
|
|
halitosis
|
tonsilitis, gingivitis, respiratory infections, vincent angina, GI reflux
|
|
cinnamon breath (this sound good actually)
|
pulmonary TB (Oh shit nevermind)
|
|
how can you characterize the sounds of ascultation
|
intensity, pitch, quality and duration
|
|
what can be caused by hyperventilation
|
faintness
|
|
where do most pathologic lung conditions occur
|
base of the lungs
|
|
why do you use the diaphragm of the stethomoscope
|
transmits higher pitched sounds better
|
|
CHF lung sounds
|
base will have crackles
|
|
where are the sounds of the middle lobe of the right lung and linguila on the left best heard
|
respective axillae
|
|
three types of breath sounds
|
vesicular, bronchovesicular, tubular
|
|
vesicular
|
low pitched, low intensity heard over healthy lung tissue
|
|
bronchovesicular
|
med pitch and intensity heard in major bronchi
|
|
bronchial
|
highest in pitch and intensity, trachea only
|
|
amorphic breathing
|
sound heard by blowing across a bottle, heard with large stiff walled pulmonary cavity, tension pneumothorax
|
|
cavernous breathing
|
cavern sounding, pulmonary cavity in which wall is ridgid
|
|
what make it more difficult ot hear breath sounds
|
pus or fluid in the pleural space
|
|
what makes breath sounds easier to hear
|
consolidation of lung tissue
|
|
mass surrounding the bronchial tree does what to sounds
|
make it easier to transmit than air filled alveoli
|
|
back hair causes what
|
extraneous breath sounds (ha ha ha) #brownpeopleproblems
|
|
sickle cell does what to pulmonary
|
frequent pulmonary problems, arching of the back to make breathing easier
|
|
memorize table on 356
|
living in a gangstas paradise
|
|
crackle
|
heard more often in inspiration, disruptve passage of air through the respiratory tree
|
|
high pitched crackles
|
sibilant
|
|
low pitched crackles
|
sonorous
|
|
dry non gurging pitched crackles heard where
|
higher in the respiratory tree
|
|
rhonchi
|
deeper more pronounced, during expiration, passage of air through airway constricted by thick secretions, muscular spasm or external pressure
|
|
higher pitched rionchi from where
|
smaller bronchi
|
|
lower pitched rionchi
|
larger bronchi
|
|
tracheobronchitis
|
larger bronchi infection
|
|
when do rhonchi dissapear and crackles do now
|
after coughing
|
|
wheeze (wheezy?)
|
continuous high pitched musical sound, heard during inspiration of expiration
|
|
what causes wheezing
|
high velocity air flow through a narrowed or obstructed airway
|
|
bilateral wheeze
|
bronchospasm of asthma, acute or chronic bronchitis
|
|
unilateral or sharp wheezing or stridor
|
foreign body
|
|
tumor compressing part of the bronchial tree can create
|
consistent wheeze or whistel of single pitch at site of compression
|
|
friction rub ourside of the respiratory tree
|
dry crackling, low pitched sound, inspiration and expiration
|
|
friction rub heard over what doesnt mean anything
|
liver spleen
|
|
friction rub over heart indicates what
|
inflammed, roughened surfaces rubbing together
|
|
what does frinction rub over the pericardium indicate
|
pericarditis
|
|
friction rub over the lungs
|
pleurisy
|
|
respiratory rub vs cardiac rub
|
respiratory dissapears when breath is held
|
|
mediasteinal crunch (hamman sign)
|
mediasteinal emphysema, more pronounced with expiration, easier to hear when pt leans to left or lies down ont he left side
|
|
lower pitched voices od men do what to vocal resonance
|
more fremitus than of women
|
|
vocal sounds through the lungs usually are
|
muffled and indistinct, best heard medially
|
|
factors that influence vocal resonance also infleunce what
|
tactile fremitus
|
|
greater clarity and increased loudness of spoken sounds
|
bronchophony
|
|
whispered pectoriloquy
|
when you can hear a whisper clearly
|
|
egophony
|
when nasal quality has been attributed to speech
|
|
what can the above conditions all arise from
|
consolidation of lung tissue,
|
|
what can decrease vocal resonance
|
loss of tissue in respiratory tree (barrel chesting)
|
|
coughs
|
usually reflexive response to irritants such as foreign bodies, infectious agents or masses compressing the respiratory tree
|
|
COPD
|
4th largest cause of death in USA, 20% who die never smoked,
|
|
dry or moist cough
|
infection and can accompanied by sputum production
|
|
onset
|
acute with fever means infection, absense of fever is foreign body or inhaled irritants
|
|
frequency of occurence
|
infrequent is allergens
|
|
regularity
|
paroxymal cough heard in peritussis
|
|
pitch and loudness cough
|
high pitch and loud or low and quiet
|
|
postural influences cough
|
soon after reclines or erect position, (nasal drip or pooling of secretions)
|
|
dry couggh brassy
|
if it is caused by compression of the respiratory tree
|
|
horse cough
|
croup
|
|
pertussis
|
inspiration whoop at the end of paroxysm in older children and adults
|
|
tables on page 359
|
lean with it?
|
|
production of sputum associated with what
|
cough
|
|
if actue onset of sputum
|
infection
|
|
chronic sputum
|
significant anatomical change
|
|
bacterial infection sputum
|
yellow, green , rust (blood with yellow), clear or transparent, purulent, blood streaked, mucoid, viscid
|
|
viral infection sputum
|
mucoid, viscid, blood streaked
|
|
chronic infectious disease sputum
|
everything mentioned, abundant in the early morning
|
|
carcinoma
|
slight perisstent, intermittent blood streaking
|
|
infarction
|
blood clotted, lots of blood
|
|
tuberculous cavity
|
occasional large amounts of blood
|
|
what at 1 and 5 minutes tells you a lot about birth
|
apgar scores
|
|
where does depressed respirations in the newborn come from
|
origins in the maternal environment
|
|
APgar score table page 360
|
I cant see how you hating from outside the club, you cant even get in
|
|
chest circumfurence of a newborn
|
30 to 36 cm, 2 to 3 smaller than head
|
|
IUGR infant chest circumference
|
smaller compared to head
|
|
diabetic mother chest circumference
|
larger than normal
|
|
differencebetween chest and head circumference increases with
|
prematurity
|
|
newborn lung function
|
susceptable to envionmental factors
|
|
pattern of respirations
|
vary with feeding and sleep
|
|
how much will the respiratory rate vary in the first minute
|
40 to 60 RPM, 80 not uncommon
|
|
C section babies respiratory rate vs vaginak birth
|
more rapid c section
|
|
babies breath through mouth or nose
|
obligate nose breathers
|
|
inceased prematureity means what with breathing
|
increased irregularity in breathing
|
|
periodic breathing
|
relatively vigorous respiration followed by apnea as long as 10 to 15 seconds
|
|
presistance of preterm breathing in infants is relative to the
|
gestational age of the baby
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apnetic period of breathing diminishes in frequency as
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baby approaches term status
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when should periodic breathing wane in a term infant
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few hours after birth
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coughing in newborn
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rare is a problem
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sneezing in newborn
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frequent and is expected
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purpose of sneezing in newborn
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clears nose
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when are hiccups found in newborn
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frequent after meals
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frequent hiccuping says what
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seizures, drug withdrawl or encephalopathy
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what muscle do newborns rely on for inspiration
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diaphragm (mostly) and abdominals
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is paradoxic breathing common in newborns
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yes in sleep
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if normal chest expansion is asymmetric then
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expect compromise to fill lungs
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when is crepitus common in babies
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around a fractured clavicle - common after difficult forceps delivery
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newborn xyphoid process
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mobile, moves back and forth under finger
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breath sounds from one area to another
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travel easily from one to another, localization difficult
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crackles and ronchi common when in newborn
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right after birth, fluid clearing
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ascultory findings asymmetric
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problem - aspiration of meconium
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GI gurgling in chest
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diaphragmatic hernia
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stridor with inspiration length
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3 to 4x longer than expiration
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stridor with I/E ratio
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3:1 or 4:!
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stridor accimanies with cough, hoarseness orretractions
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serious problem with trachea or larynx
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narrow tracheal lumen from tumor compression, abcess, or double aortic arch
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develop stridor
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respiratory grunting
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infant tries to expel trapped air or fetal lung fluid while trying to retain air and increase oxygen levels
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flaring of nasal alai
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respiratory distresss
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when do children use intercostal muscles for respitation
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6,7 years old
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newborn resp rate
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30-80
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1 year old resp rate
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20-40
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3 year old resp rate
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20-30
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6 year
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16 to 22
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10 year old
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16 to 20
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17 year old
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12 to 20
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increasing roundness of chest with age leads to what diagnosis
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cystic fibrosis/COPD (by 5 or 6 is ominous)
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when is it easier to hear breath sounds in a child
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after they breathe more deeply after running up and down hallway
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childs chest sounds vs adult
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thinner and more resonant than adult
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hyperresonance is more common in
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young child
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where may bronchovesivular sounds be heard in a child
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throughout the chest
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wheezing ina child for first time
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suspect foreign body
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audible crackles is not enough evidence for what
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pneumonia
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minimal pneumothorax causes what
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unexplained persistent tachycardia
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chest expansion is what in adults compared to children
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decreased
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respiratory muscle use in adults
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less able to use
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what can happen as a result of calcifications of rib articulations
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interfere with chest expansion, use of accessory muscles
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breathing pathology common in pregnancy
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dyspnea
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how can pregnant woman increase ventilation
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breathing more deeply, not quickly
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what curve of the spine is prominent in older adults
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dorsal curve - thoracic spine, also flattening of lumbar curve
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diameter changes in chest with older adults
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AP is increased in relation to lateral
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hyperresonance in older adults
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increased distensibility of lungs
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Table on 365, yeah it sucks
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your girlfriend a freak like cirq du solei (lil wayne always messes it up)
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