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60 Cards in this Set
- Front
- Back
What is the Thoracic Cage composed of
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Sternum, 12 pairs of ribs, 12 thoracic vertebrae, diaphragm
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How are the ribs arranged?
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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" |
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Costochondrial Junction
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Point at which ribs join with their cartilages
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Suprasternal Notch
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hollow U-shaped depression above sternum between clavicles
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Sternum
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the breast bone. It has 3 parts: the manubrium (w/Angle of Louis or Manubriosternal angle), the body, and the xiphoid process
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Manubriosternal angle/Angle of Luis/ Sternal Angle
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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.
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Costal Angle
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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)
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Vertebral Prominens
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C7; flex head and feel for most prominence bony spur protruding at base of neck
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Inferior border of Scapula
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Lower tip of scapula that is usually at the 7th or 8th rib
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Spinous Processes
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Knobs on the vertebrae. They align with their same numbered ribs only down to T4
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Twelfth Rib
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Free tip can be palpated midway between spine and person's side
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Reference Lines
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Midsternal Line, Midclavicular Line, Scapular Line, Vertebral Line, Anterior, Posterior, and Midaxiallary lines
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Mediastinum
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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
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Right Lung vs. Left Lung
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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) |
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Functions of the Respiratory System
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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)
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Structures of the Respiratory System
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Trachea, Tracheal Bifurcation, Bronchial Trees, Bronchioles, Alveolar sac, Alveolus, and Interalveolar septum, Visceral pleura, Parietal Pleura, Pleural cavity, and Costodiaphragmatic Recess
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Pleurae
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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
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Trachea and Bronchial Tree
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Right main bronchus is shorter, wider, and more vertical
Make up dead space Bronchial tree lined with goblet cells and cilia to protect alveoli |
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Acinus
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the functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and alveoli
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Mechanics of Respiration
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Contolled by Pons and Medulla based on change in CO2 and O2 in blood and Hydrogen ion level
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Hypercapnia
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Too much oxygen in blood; main stimulus for breathing
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Hypoxemia
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Decrease of O2 in blood; also a stimulus for breathing but less effective than hypercapnia
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Inspiration
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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
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Respiration
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passive; air flows out due to positive pressure
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Symmetric Chest Expansion
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Placing hands on back with thumbs at T9 or T10 and ask person to breathe to see symmetrical movement
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Tactile Fremitus
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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 |
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Anteroposterior to Transverse Diameter
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AP< T; 1:2 to 5:7
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Things that affect intensity of tactile fremitus
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Location of bronchi to chest wall, Thickness of Chest wall, Pitch and Intensity
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Diaphragmatic Excursion
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should be equal bilaterally and measure about 3-5cm in adults but may be 7-8cm in well conditioned people
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Bronchial Breath Sounds (Tracheal)
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harsh, hollow, tubular, high pitch, loud, inspiration < expiration
trachea and larynx |
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Bronchovesicular breath sounds
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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 |
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Vesicular Breath Sounds
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Low pitch, soft, inspiration > expiration, rustling like sound of wind on trees
over peripheral lung fields where air flows through smaller bronchioles and alveoli |
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Adventitious sounds: Crackles
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abnormal, discontinuous, heard on inspiration
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Wheeze
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high pitches, musical, squeaking
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Adventitious sounds: Atlectatic crackles
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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 |
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Bronchophony
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spoken voice heard through stethoscope: instead of soft, muffled, and indisctinct over normal lung tissue
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Egophony
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voice sounds of "eee" hear through stethoscope each time stethoscope is moved
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Whispered pectoriloquy
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whispered phase heard through stethoscope that sounds faint and inaudible over normal lung tissue
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Barrel Chest
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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
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Pectus Excavatum
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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 |
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Pectus Carinatum
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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 |
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Scoliosis
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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 |
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Kyphosis
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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 |
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Tachypnea
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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 |
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Bradypnea & what does it occur with
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slow breathing <10 bpm
decreased but regular rate occurs with drug-induced depression of repiratory center in medulla, increased intracranial pressure, and diabetic coma |
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Hyperventilation
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increased rate and depth of breathing
blows off CO2 causing decreased level in blood: alkalosis |
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Hypoventilation
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irregular shallow pattern due to overdos of narcotics or anesthetics, prolonged bed rest, or conscious splinting of chest to avoid pain
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Cheyne-Stokes Respiration
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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 |
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Biot's Respiration
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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
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Increased Tactile Fremitus
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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 |
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Decreased Tactile Fremitus
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occurs when anything obstructs transmission of vibrations. Any barrier that gets in way of sound and palpating hand decreases fremitus
PNEUMOTHORAX or EMPHYSEMA |
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Fine Crackles (rales)
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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 |
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Coarse Crackles
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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 |
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Pleural Friction Rub
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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 |
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Wheeze (sibilant)
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High pitched, musical squeaking sounds that sound polyphonic; dominate in expiration but can occur during expiration and inspiration
sounds like vibrating weed |
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Wheeze (sonorous)
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low pitched, monophonic single note, musical snoring, moaning sounds; heard throughout the cycle butmore prominent on expiration; cleared somewhat by coughing
bronchitis |
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Atelectasis
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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 |
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Lobar Pneumonia
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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 |
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Bronchitis
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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 |
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Emphysema
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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 |