- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
203 Cards in this Set
- Front
- Back
|
True Ribs
|
1-7
|
|
Primary muscles of inspiration
|
Diaphragm and internal intercostals
|
|
Increase the AP diameter during inspiration
|
External intercostals
|
|
Decreases the transverse diameter during expiration
|
Internal intercostals
|
|
Contains all the thoracic viscera except the lungs
|
Mediastinum
|
|
Location of the lingula
|
Inferior portion of Left Upper Lobe
|
|
Location of Horizontal fissure
|
Divides the upper and middle right lobes at the 5th rib in the axilla and the 4th rib anteriorly
|
|
Apex extends how far above the 1st rib
|
4cm
|
|
Posteriorly, apex extends how far
|
T1
|
|
Lower borders extend how far
|
T12 on inspiration
T9 on expiration |
|
Location of trachea
|
Anterior to esophagus and posterior to isthmus of thyroid
|
|
Location of tracheobronchi junction
|
T4-T5
|
|
Bronchus that is more susceptible to foreign objects
|
Right bronchus
Shorter, wider, and more vertical |
|
Transports air and traps noxious foreign particles
|
Bronchi
|
|
Acini consists of
|
respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli
|
|
Bronchial arteries derived from
|
thoracic aorta and intercostal arteries
|
|
Bronchial vein formed where
|
Hilum of the lung
|
|
Movement of air back and forth from the alveoli to the outside
|
Ventilation
|
|
Gas exchange across the alveolar-pulmonary capillary membrane
|
Diffusion and perfusion
|
|
Respond to changes in the H ion concentration of the blood
|
Medulla
|
|
Nerve impulses from the medulla travel here to control the respiratory muscles
|
Pons
|
|
What may cause the Right lung to be slightly higher
|
Liver
|
|
Anterior view of the R Lung is mostly
|
Upper and middle lobe
|
|
Is the middle lobe viewed posteriorly
|
NO!
|
|
Borders of middle lobe
|
4th rib at sternum to the 5th rib mid axillary and then extending inferomedially to the 6th rib at the midclavicular line
|
|
Posteriorly, the Lower lobe extends from?
|
T3-T10 or T12
|
|
The Posterior lung is mostly what lobe?
|
At T3, the oblique fissure separates the upper and lower lobes. So the lower lobe is dominant posteriorly.
|
|
Path of the oblique fissure
|
Spinous process of T3 to the 6th rib at the midclavicular line anteriorly
|
|
Stabilizes the alveoli by lessening surface tension at the air-liquid interface
|
Surfactant
|
|
Shape of a newborns chest? ratio of AP-Transverse Diameter.
|
Round
1:1 Circumference is equal to that of an adults head. |
|
Alveoli increase rapidly up to what age?
|
2 yrs
|
|
How much does the transverse diameter increase in a pregnant woman? Circumference?
|
2cm
5-7 cm |
|
How much does the diaphragm rise in the pregnant woman? How much does the subcostal angle increase?
|
4cm
From 68.5 degrees to 103.5 |
|
Results from loss of muscle strength in the thorax and diaphragm of older adults
|
barrel chest
this is couple with loss of lung resiliency |
|
What results from underventilation of the alveoli from decreased alveolar surface, decreased inspiratory muscle strength, and decreased lung resiliency?
|
Decrease in vital capacity and increase in residual volume
|
|
Predisposes the older adult to respiratory infections
|
Aging mucous membranes become dry and encourages bacterial growth
|
|
The Cardia should have what type of percussive sound?
|
Flat
|
|
Hyperresonance may be associated with what diseases
|
Emphysema, pneumothorax, or asthma
|
|
Dullness or flatness to percussion suggests
|
Atelectasis, pleural effusion, pneumothorax, or asthma
|
|
The diaphramatic excursion may be limited by what?
|
Emphysema
abdominal tumors or ascites Fractured rib |
|
Excursion diameter
|
3-5 or 6 cm
|
|
Cinnamon breath
|
Pulmonary tuberculosis
|
|
Fishy, stale Breath
Ammonia Breath |
Uremiea (trimethylamines)
Uremia (ammonia) |
|
Musty fish, clover smell
|
Fetor Hepaticus
liver failure, portal vein thrombosis |
|
Foul, feculent breath
|
Int obstruction
|
|
Hallitosis
|
Tonsillitis, gingivitis, respiratory infections
|
|
Foul, putrid breath
|
Nasal sinus pathology or respiratory infections
|
|
A slight deviation of the trachea to the right may indicate
|
Nothing, its normal
|
|
What may cause the trachea to be pushed to the contralateral side
|
Tension pneumothorax, tumor, nodal enlargements
|
|
What may cause deviation of the trachea
|
Atelectasis
thyroid enlargement significant parenchymal or pleural fibrosis pleural effusion |
|
Thoracic respiration is primarily the use of
|
Intercostal muscles
|
|
It is not unusual to see what accessory muscles used in inspiration in young infants
|
Abdominal muscles
|
|
Pregnant women are more likely to use what type of respiration?
|
Thoracic
|
|
Prolonged expiration and bulging on expiration
|
Outflow obstructions or valvelike compression by a tumor, aneurysm, or enlarged heart
|
|
Suggests an obstruction to inspiration at any pt in the respiratory tract
|
Retractions
|
|
Chest asymmetry is associated with
|
Collapsed lung, tumor, extrapleural fluid/air
|
|
Usually symmetric and painless, and may be associated disease or be hereditary
|
Clubbing
|
|
Occurs when a negative intrathoracic pressure is transmitted to the abdomen by a poorly functioning diaphragm
|
Paradoxic breathing
|
|
Unilateral retraction without suprasternal notch involvement
|
Foreign body in the bronchi
|
|
Retraction of the lower chest
|
Bronchiolitis and asthma
|
|
Characteristics of upper airway obstruction.
Severe? |
Inspiratory stridor
A hoarse cough Flaring of Nasal Ali Retraction at suprasternal notch Stridor on inspiration and expiration Barking cough Cyanosis |
|
Upper airway obstruction above the glottis
Below the glottis? |
Muffled voice
Stridor is quiet Difficulty swallowing There is no cough Awkward position of head and neck Lound, rasping Strider Hoarse Voice Swallowing not affected Harsh Cough Head Position not a factor |
|
Common sign of air hunger, especially when the alveoli are involved
|
Flaring of Nasal Ali
|
|
Accompaniment of increased expiratory effort
|
Pursing of lips
|
|
It may be a good idea to auscultate what part of the lung first in older pts
|
The Base
|
|
The sounds of the middle lobe and lingula are best heard where on auscultation
|
Over the axillae
|
|
Bronchial sounds
|
Heard over trachea
High pitch Loud and long expirations |
|
Bronchovesicular sounds
|
heard over main bronchi anteriorly and upper right posterior lung field.
Medium pitch Expirations=Inspirations |
|
Vesicular
|
Heard over lung fields
Low pitch soft and short expirations |
|
When examining a pt with CHF, it is best to start auscultation where? Why?
|
In the base
To detect crackles that may disappear upon repeated exaggerated respirations |
|
What is the Lords of the Congregation?
|
Scottish nobility coming together stating that they are for reformation
|
|
What condition may give an inconclusive anterior thoracic expansion
|
Barrel chested pt with COPD. The chest is so inflated that it cannot expand further and your hands may come together.
|
|
Palpable coarse, grating vibration on inspiration
|
Pleural friction rub
|
|
Tactile Fremitus is best felt where
|
Parasternally over the 2nd intercostal space at the level of the bifurcating bronchi
|
|
How do you tell the difference between lobar pneumonia and pleural effusion
|
Breath sounds are absent in pleural effusion but may be bronchial in pneumonia
On palpation, the tactile fremitus is absent when an effusion is present, but present with pneumonia. Both conditions have dullness to percussion |
|
Increase in the AP diameter
|
Barrel chest: COPD, asthma, emphysema
|
|
Ratio of respirations to heart beats
|
1:4
|
|
Thoracic ratio
|
.7-.75
|
|
Acute unknown chest pain in a young adult
|
Possible cocaine abuse
|
|
When does chest pn not originate in the heart?
|
1. There is a constant achiness
2. It stays in one position 3. It is made worse by pressure on the precordium 4. It is situated in the shoulders or between the shoulder blades. |
|
Difficult and labored breathing with shortness of breath
|
Dyspnea
|
|
Shortness of breath that begins or worsens upon laying down
|
Orthopnea
|
|
Protective splinting from pain of a broken rib, pleurisy, or liver enlargement/abdominal ascites may cause what type of respiration
|
Shallow hyperventilation
|
|
Neurologic or electrolyte imbalances
|
Bradypnea
|
|
Rapid deep breathing
|
Kassmaul: Metabolic acidosis
|
|
Regular periodic pattern of breathing with intervals of of apnea followed by a crescendo/descendo sequence of respiration
|
Cheyne-Stokes: cerebral brain damage, and drug-induced compromise.
May also be normal in children or older adults. |
|
An occasional deep, audible sigh that punctuates an otherwise regular respiratory pattern
|
Emotional distress
|
|
Prolonged but inefficient expiratory effort, in which the rate of respiration increases in order to compensate
|
air trapping:
obstruction of pulmonary tree |
|
Irregularly interspersed periods of apnea in a disorganized sequence of breaths
|
Biot respiration:
Severe and persistent intracranial pressure, drug overdose, or lesions of the medulla |
|
Significant disorganization with irregular and varying depths of respiration
|
Ataxia
|
|
Long inspiration with strained expirations
|
Apneustic respirations:
lesion of the pons |
|
Primary apnea
|
Self-limited and common with blow to the head
|
|
Secondary apnea
|
Breathing does not restart unless resuscitative measures are taken
|
|
Will aspirin poisoning increase or decrease RR
|
increase due to metabolic acidosis
|
|
Are fat babies more prone to asthma?
|
Yes
|
|
What type of air irritates asthmatics
|
Cold air
Warm, humid air is better |
|
Incomplete expansion of the lung at birth, or the collapse of the lung at any age
|
Atelectasis
|
|
COPD characterized by airway inflammation and generally resulting from airway hyperactivity triggered by allergens, anxiety, URI, cigarette smoke, etc
|
Asthma
|
|
Inflammation of the mucus membranes of the bronchial tubes
|
Bronchitis
|
|
Can bronchitis present with fever and chest pn?
What is the usual cause? |
Yes
Irritation by a noxious stimulus |
|
Inflammatory process involving the visceral and parietal pleura.
What is it often associated with? |
Pleurisy
Result of pulmonary infections, bacterial or viral, and sometimes with neoplasms or asbestosis |
|
How does pleurisy typically present?
|
Sudden onset with acute chest pn. Pleura becomes dry and the rubbing can be felt and heard. respiration are rapid and shallow with diminished breath sounds. Pain close to the diaphragm can be referred to the shoulder.
|
|
Right angled area of dullness over the posterior chest, which can sometimes be percussed opposite a large pleural effusion. What percussive sound is heard superior to the dullness?
|
Grocco's triangle:
Seen in pleural effusion Hyper-resonance is heard above the lesion and is called Skodiac resonance. |
|
Flaring of the nasal alae, tachypnea, and a productive cough in the absence of crackles should alert you of
|
Acute bacterial pneumonia:
Crackles are commonly heard but not necessary for a diagnosis of pneumonia, especially in children. |
|
In pneumonia, infective agents lead to exudates that cause what?
|
consolidation of the lung resulting in tachypnea, dyspnea, and crackles, with diminished breath sounds and dullness to percussion over the area of consolidation.
|
|
Involvement of the right lower lobe can cause pain where?
|
Irritation of the 10th and 11th thoracic nerves can cause right lower quadrant pn and an abdominal process
|
|
Pt presents with tachypnea, fever, and foul breath. Percussion is dull with distant breath sounds. The pt recently was seen for a tooth abscess
|
Lung abscess:
May also be caused by aspiration of food or infected material from the upper respiratory tract. |
|
Purulent exudate that collects in the pleural spaces. How does this present?
|
Empyma
Pt presents with diminished breath sounds, dull to precussion, absent vocal fremitus, tachypneic and febrile |
|
50 y/o pt presents with sputum producing cough, and fever. Hx of smoking. What may this result in?
|
Chronic bronchitis:
may result in Right ventricular failure and cor pulmonale |
|
Chronic dilation of the bronchioles from repeated pulmonary infections and bronchial obstructions. The extent of exam findings is based on? What are the major clues?
|
Bronchiectasis:
Degree of wetness Cough and expectoration |
|
Autosomal recessive condition characterized by bronchiectasis
|
Kartegener's
|
|
Major risk factor for COPD
|
smoking
|
|
Dilation of the air space distal to the terminal bronchioles, with destruction of alveoli and hyperinflation of the lung. What is a common precursor? Common presentation?
|
Emphysema
chronic bronchitis Dyspnea, hyper-resonant percussion, prolonged expiration, barrel chest and thin. |
|
How is TB transmitted. What population is especially susceptible?
|
Through the airborne moisture of coughs and sneezes of infected persons.
HIV infected persons |
|
Pt presents with an unexplained but persistent tachycardia.
|
Minimal pneumothorax
|
|
Presence of air or gas in the pleural cavity. When this occurs spontaneously, how does it present?
|
Pneumothorax:
A rupture of a congenital bleb may cause it to occur spontaneously in which it presents most often when the pt is at rest, and has boom-like sounds. |
|
What can a "coin click" help to diagnose?
|
Pneumothorax
|
|
Pleuritic chest pn without dyspnea and low grade fever
|
Pulmonary embolism
|
|
Lung cancer generally refers to?
|
Bronchogenic carcinoma:
Malignant tumor arising from bronchial epithelium. |
|
Blood on the pleural cavity. May be the result of? How can this be differentiated from pneumothorax?
|
Hemothorax
Trauma or invasive medial proedure Breath sounds are distant like in pneumothorax, but the percussion is dull not booming and "coin click" is absent. |
|
Acute cor pulmonale is often caused by?
|
Pulmonary embolism
|
|
Breath sounds are easier to hear in what abnormality?
|
Consolidation
|
|
Low-pitch, low-intensity breath sounds heard over healthy lung tissue
|
vesicular
|
|
Moderately ptiched and intense breath sounds heard over major bronchi
|
bronchovesicular
|
|
High pitched and intense sounds heard only over the trachea
|
bronchial/tracheal
|
|
When is amphoric breathing most often heard
|
1. Stiff walled pulmonary cavity
2. Tension pneumothorax with with bronchopleural fistula |
|
Cavernous breathing heard when
|
pulmonary cavity with a stiff wall
|
|
Abnormal respiratory sound heard more often upon inspiration and characterized by discrete discontinuous sounds
|
Crackles
|
|
How can you seperate Crackles from wheezes/rhonchi
|
Crackles are discontinuous and wheezes/ronchi are continuous
|
|
High pitched crackles
Low pitched crackles |
Sibilant
Sonorous |
|
Dry crackles, more crisp than gurgling are more apt to occur where in the respiratory tree?
|
Higher than lower
|
|
A radio static like sound lacking a musical pitch. When is this heard?
|
White Noise
Expiratory and inspiratory wheezing. Caused by a narrowed central airway in people with asthma or chronic bronchitis. |
|
Pleural friction rubs are loudest where
|
Lower lateral anterior surface
|
|
Course, low pitched continuous sound, more pronounced on expiration. What conditions are they heard?
|
Rhonchi (sonorous wheeze):
Airway obstructed by thick secretions, muscular spasms, growths, or external pressure. |
|
Sibilant high-pitched ronchi are found where? Lower-pitched ronchi?
|
Smaller bronchi as in asthma
Larger bronchi, tracheobronchitis |
|
Coughing may clear what adventitious sound
|
ronchi
|
|
Loud, bubbly noises heard during inspiration
|
coarse crackles:
Low pitched, high amplitude, long duration |
|
High pitched, low amplitude with short duration, heard more at the end of inspiration.
|
Fine crackles
|
|
Pt is observed sitting up and leaning forward...
|
Anterior mediastinal mass
|
|
Vocal fremitus greater in men or women?
|
Men: due to lower pitched voice
|
|
Pulmonary infarction and a pulmonary crisis called "chest syndrome" is often seen in pts with?
|
SCC
|
|
How can you differentiate between pericarditis and pleurisy
|
The respiratory rub disappears when the breath is held and the pericardial does not
|
|
Pleurisy occurs where along the respiratory tree
|
outside the tree
|
|
A continuous, high-pitched, musical sound heard during inspiration or expiration. is it louder on inspiration or expiration?
|
Wheeze:
Usually louder on expiration |
|
The longer the wheeze, and the louder the pitch...
|
the worse the obstruction
|
|
bilateral wheeze is associated with?
|
bronchospasm associated with asthma
or bronchitis |
|
Unilateral wheezing may be associated with?
|
Foreign object
|
|
If infection is the source of wheezing...
|
...it is a virus
|
|
Air and fluid simultaneously present within the pleural cavity or in large cavities
|
Succussion splash
|
|
Mediastinal crunch is found with?
the characteristics of ? Synchronous with? |
emphysema:
also called hammans sign loud cracking and gurgling sounds The heartbeat |
|
What CNS lesion will increase RR? lower?
|
Pons
Medulla |
|
When is a mediastinal crunch easiest to hear?
|
When a pt is leaning to the left or lying on their left side.
|
|
Extreme bronchophony, with a clear voice on whisper is seen in what condition?
|
Lung consolidation as in pneumonia.
|
|
Vocal resonance diminishes when there is?
|
Blockage of the respiratory tree for any reason
|
|
In the past, what disease was known as wool-sorters?
|
Anthrax, after the people who sorted wool that was contaminated with bacillus anthracis
|
|
Pt presents with flu-like fever, chills, achiness and sniffles. Pleural effusion then develops a few hours later. What must you suspect?
|
Anthrax
|
|
Anthrax txmt must be given...
|
Before lab confirmation is known. It is curable if treated early, but is not later on.
|
|
Common complication to smallpox virus
|
Pneumonia occurs
|
|
Smallpox agent
|
variola virus
|
|
Cough of acute onset generally occurs with..
|
infection
|
|
A regular, paroxysmal cough is heard when?
|
Pertussis
|
|
Hoarse dry cough associated with?
|
Croup
|
|
Dry brassy cough
|
Compression of the respiratory tree as with a tumor
|
|
Maximal inspiration followed by maximal expiration
|
Vital capacity
|
|
The blow out test is performed about how far away from the pt?
|
10-15 cm
|
|
Maximum flow of air that can be expelled
|
Peak expiratory flow rate
|
|
How do you measure forced vital capacity?
|
Have pt exhale fully and then hold the breath. count the number of sec until the pt has to take the next breath and multiply by 50
|
|
Yellow, green, rust colored with possible blood, or purulence in the sputum
|
Bacterial inf
|
|
Viscous, mucoid, with possible blood streaked sputum
|
Viral inf
|
|
Slight, persistent blood streaking
|
Carcinoma
|
|
Large amounts of clotted Blood in sputum
|
Pulmonary infarction
|
|
Large amounts of non-clotted blood
|
Tuberculous cavity
|
|
What might be responsible for a 250% increase in bronchiolitis hospitalization rates over the past 20 years?
|
Pulse ox:
The 5th vital sign |
|
Supernumerary nipples are more common in?
|
Blacks
|
|
Epiglottitis is an acute life threatening illness caused by?
What age group is most often affected? |
Haemophilus influenzae B
children 3-7 |
|
Child presents sitting up with neck extended and head held forward. The child is drooling and unable to swallow. Cough is not present, but there is a high fever. What is characteristic finding? What should you not attempt?
|
Epiglottitis:
Epiglottis is beefy and red Should not attempt to visualize the epiglottis w/o artificial airway. |
|
Child awakens suddenly, with labored, retractive breathing and a harsh bark like cough? What age group is the most prevalent? Agent? Inflammation?
|
Croup:
1.5-3 yrs Parainfluenza virus Inflammation is subglottic with swollen tracheal tissue and may involve areas beyond larynx. |
|
Respiratory distress syndrome is associated with?
|
Surfactant deficiency
|
|
High-pitched piercing sound heard on inspiration. It is the result of? What is the I:E ratio? Signifies a serious problem where?
|
Stridor
Obstruction high in the respiratory tree 3 or 4:1 Trachea or Larynx |
|
What side is a diaphragmatic hernia usually on? Clinical findings?
|
Left
Bowel sounds heard in the chest and a flat or scaphoid shaped abdomen. Also, heart lays to the right. |
|
Newborns rely primarily on what for respiration?
|
Diaphragm, but also commonly use the abdominal muscles
|
|
What rarely occurs in the newborn and should be considered a problem?
|
coughing
|
|
Asymmetric chest expansion
|
Atelectasis
Pleural effusion Pneumothorax |
|
Asymmetry in the newborn could be from?
|
Pneumothorax
Diaphragmatic hernia |
|
Asymmetric auscultatory findings
|
aspiration of meconium
|
|
Persistance of a round barrel chest in a young child should alert you of?
|
COPD such as CF
|
|
In children, obvious intercostal exertion (retractions) is usually?
|
Asthma
|
|
RR:
Newborn 1 3 6 10 17 |
30-80
20-40 20-30 16-22 16-20 12-20 |
|
What lung sound is common in children
|
Hyper-resonance. The child is usually skinnier than the adult and resonance is louder.
|
|
Mechanism by which the infant tries to expel trapped air or fetal lung fluid while trying to retain air
|
Respiratory grunting
|
|
the most apparent change in pregnant women's lung volume
|
A decrease in the functional residual capacity, which is the volume of air left after quiet expiration. However, vital capacity increases 100-200 mL
|
|
The tidal volume in a pregnant woman increases how much?
|
The amount of air inhaled and exhaled during normal breathing increases 40%
|
|
The pregnant woman increases her ventilation by?
|
breathing more rapidly and deeply
|
|
What lung sound is common in children
|
Hyper-resonance. The child is usually skinnier than the adult and resonance is louder.
|
|
Mechanism by which the infant tries to expel trapped air or fetal lung fluid while trying to retain air
|
Respiratory grunting
|
|
the most apparent change in pregnant women's lung volume
|
A decrease in the functional residual capacity, which is the volume of air left after quiet expiration. However, vital capacity increases 100-200 mL
|
|
The tidal volume in a pregnant woman increases how much?
|
The amount of air inhaled and exhaled during normal breathing increases 40%
|
|
The pregnant woman increases her ventilation by?
|
breathing more deeply
|
|
The chest circumference of a full-term infant. What can be used to measure the chest ratio?
|
30-36 cm
The distance between the nipple is 1/4th the circumference |
|
What is common in the newborn and can persist for several days without cause for concern?
|
Cyanosis in the hands and feet
|
|
What type of delivery is associated with a greater RR at birth
|
C-Section
|
|
What type of breathing is common in the newborn. When does it become a concern?
|
Periodic: A sequence of vigorous respiratory efforts followed by apnea of as long as 15 seconds.
When the episodes are prolonged and the baby is centrally cyanotic. |
|
A hot or cold room temperature can cause what in the newborn?
|
tachypnea
|
