Chest and lungs Flashcards
(176 cards)
1
Q
primary muscles of respiration (2)
A
diaphragm and intercostals
2
Q
which intercostals are important to inspiration?
A
external
3
Q
which of the lobes on the left lobe contains the lingula?
A
left upper lobe
4
Q
at what rib levels (axilla and anterior) is the oblique fissure on the right? on the left?
A
5th rib in axilla and 6th rib at midclavicular; 6th rib at midclavicular
5
Q
posteriorly the apexes of the lungs rise to what vertebral level?
A
T1
6
Q
upon deep inspiration the lower borders of the lungs descend to which vertebral level?
A
T12
7
Q
upon forced expiration the lower borders of the lungs ascend to which vertebral level?
A
T9
8
Q
at what vertebral level does the trachea bifurcate?
A
T4/5
9
Q
main bronchi are divided into ____ branches on the right and ____ on the left
A
3:2
10
Q
acini consists of these 4 parts:
A
respiratory bronchioles, alveolar ducts, alveolar sacs and alveoli
11
Q
bronchial arteries branch from where? (2)
A
anterior thoracic aorta and intercostal arteries
12
Q
most of the blood from the lungs is drained via the:
A
Pulmonary Veins
13
Q
chemoreceptors are found in these 2 places and each is stimulated by what
A
medulla oblongota (H+) and carotid body (low O2 and high CO2)
14
Q
chemoreceptors send signals to the respiratory center in this part of the brain
A
medulla oblongota
15
Q
nerve impulses from the medulla send signals to this part of the brain that controls respiratory muscles
A
Pons
16
Q
anterior right lung consists mainly of which 2 lobes?
A
upper and middle
17
Q
posterior lung is mainly which lobe(s)?
A
lower lobe
18
Q
lower lobe extends between which vertebral levels?
A
T3-T10/12
19
Q
at what rib levels is the horizontal fissure at axilla and anteriorly?
A
axilla at 5th rib and anteriorly at 4th rib
20
Q
the lateral lung extends between which landmarks?
A
peak of axilla to 7th or 8th rib
21
Q
the number of each intercostal space corresponds to that rib immediately below/above it?
A
above
22
Q
is the resistance in the pulmonary circulation less than or greater than that in systemic circulation?
A
less than
23
Q
what stimulates the closure of the foramen ovale?
A
decrease in pulmonary pressure
24
Q
what stimulates the closure of the ductus arteriosus?
A
increase in O2 tension in arterial blood
25
barrel chest seen in older adults is the result of what?
loss of muscle strength in thorax and diaphragm
26
underventilation of alveoli in lower lung fields and decreased tolerance for exertion in older age are result of what? (3)
alveoli become less elastic and more fibrous, interalveolar folds decrease which decreases alveolar surface area, and loss of strength of resp muscles
27
what predisposes older adults to respiratory infections?
aging mucous membranes become drier and can't get rid of mucous
28
what 5 sx associated with chest pain signals a circumstance not involving the heart?
constant achiness, stays in 1 position, made worse by pressing on precordium, fleeting needle-like jab and location in shoulders or between shoulder blades
29
possible cause of severe, acute chest pain in adults and adolescents
cocaine use
30
prominent sternal protrusion
pectus carinatum (pigeon chest)
31
indentation of lower sternum above xiphoid
pectus excavatum
32
superficial venous patterns over the chest may indicate what?
heart disorders or vascular obstruction
33
the scapular lines go through which part of the scapula?
inferior angle
34
normal RR
12 to 20
35
normal RR:HR
1:4
36
these 2 conditions can cause dyspnea in an otherwise normal person
obesity and sedentary lifestyle
37
difficult and labored breathing with SOB
dyspnea
38
SOB that begins or increases when the patient lies down
orthopnea
39
sudden onset of SOB after a period of sleep
paroxysmal nocturnal dyspnea
40
dyspnea that increases in upright posture
platypnea
41
these 4 non-resp conditions can cause hyperventilation
protective splinting from broken rib or pleurisy or massive liver enlargement or abd ascites
42
these 4 conditions can cause bradypnea
neuro or electrolyte disturbance, infection or protection against pain
43
10 Ps of rapid onset dyspnea
pneumonia, pneumothorax, pulm constriction/asthma, peanut (foreign body), pulm embolus, pericardial tamponade, pump failure, peak seekers, psychogenic, poision
44
these 6 conditions cause increased resp rate and depth
metabolic acidosis, CNS (pons) lesion, anxiety, ASA poisoning, hypoxia, pain
45
these 5 conditions cause decreased resp rate and depth
metabolic alkalosis, CNS (cerebrum) lesion, MG, narcotic overdose, obesity
46
regular period of breathing with intervals of apnea followed by crescendo/decrescendo sequence of respr
Cheyne-Stokes (periodic) breathing
47
Cheyne-Stokes breathing occurs in those with these 2 probs
cerebral brain damage or drug-caused resp compromise
48
irregular resp varying in depth and interrupted by intervals of apnea, but lacking the repetitive pattern of periodic respiration
biot resp
49
biot respiration is associated with what 3 conditions?
increased ICP, drug poisoning, and medulla brain damage
50
axtaxic resp is a more severe form of what other resp?
biot
51
what causes secondary apnea?
anything that limits O2 from getting into the blood
52
what 3 things can cause primary apnea?
blow to the head, newborn (needs more CO2 build up) and inhalation of irritating vapor or gases
53
this is characterized by long inspiration and what amounts to expiration apnea
apneustic breathing
54
Dx: chest asymmetry
collapsed lung or limitation of expansion by extrapleural air, fluid or mass
55
Dx: unilateral or bilateral bulging
resp obstruction
56
Dx: retractions
inspiratory obstruction
57
Dx: stridor
obstruction high in resp tree
58
Dx: unilateral retraction without suprasternal notch involvement
foreign body in bronchi
59
Dx: retraction of lower chest
asthma and bronchiolitis
60
sx of upper airway obstruction
inspiratory stridor, hoarse cough, nasal flaring and suprasternal notch retraction
61
sx of severe upper airway obstruction
inspiratory and expiratory stridor, barking cough, retractions also involve subcostal and intercostal spaces, cyanosis
62
sx of obstruction above glottis
quieter stridor, muffled voice, difficult swallowing, no cough, awkwardly positioned head
63
sx of obstruction below glottis
louder stridor, hoarse voice, swallowing ok, harsh cough
64
this is done during increased expiratory effort and reduces the effort of dyspnea
lip pursing
65
3 diseases associated with clubbing
lung fibrosis, CHD and CF
66
Dx: crepitus
air in subcut tissue from ruptured resp tract or infection by gas-producing org
67
palpable, coarse, grating vibration during inspiration
pleural friction rub
68
Dx: pleural friction rub
inflam of pleural surfaces
69
posteriorly at what vertebral level do you place your hands to eval thoracic expansion?
T10
70
where is tactile fremitus best felt?
parasternally at the 2nd intercostal space at the level of the bifurcation of the bronchi
71
Dx: decreased fremitus (5)
emphysema, pleural thickening or effusion, pulm edema, bronchial obstruction
72
Dx: increased fremitus (2
fluids or solid mass in the lungs
73
Dx: displacement of trachea (7)
atelectasis, thyroid enlargement, fibrosis, pleural effusion, tension pneumothorax, tumor, nodal enlargement
74
Dx: hyperresonance upon percussion
emphysema, pneumothorax, asthma
75
Dx: dullness or flatness over lung fields
atelectasis, pleural effusion, pneumothorax or asthma
76
normal diaphragmatic excursion
3-6 cm
77
sweet/fruity breath
DKA
78
fishy/stale breath
uremia (trimethylamines)
79
ammonia-like breath
uremia (ammonia)
80
musty fish/clover breath
fetor hepaticus, hepatic failure, portal vein thrombosis, portacaval shunts
81
foul, feculent breath
intestinal obstruction/diverticulum
82
foul/putrid breath
nasal/sinus pathology, resp infections
83
halitosis breath
tonsillitis, gingivitis, resp infection, angina, GERD
84
cinnamon breath
pulm TB
85
where do pulm pathologic conditions generally occur in older adults?
lung base
86
breathing that resembles the noise made by blowing over bottle mouth
amphoric
87
amphoric breathing is usually heard with what conditions? (2)
stiff walled pulm cavity or tension pneumothorax with bronchopulm fistula
88
Dx: decreased or absent breath sounds (4)
fluid or pus in pleural space, secretions or foreign body in bronchi, hyperinflation of lungs, splinting due to pain
89
Dx: increased breath sounds
consolidated lungs
90
discontinuous adventitious resp sound heard more often during inspiration
crackle
91
crackles are caused by
disruptive passage of air through the small airways of resp tract
92
sibilant crackles are ___ pitched while sonorous are ___ pitchced
high, low
93
prolonged or continuous adventitious resp sounds heard more often during expiration
rhonchi
94
rhonchi are caused by
passage of air through an airway obstructed by thick secretion, muscular spasm, new growth or external pressure
95
continuous high pitched musical adventitious resp sound heard during inspiration or expiration
wheeze
96
wheeze is caused by
high velocity air through narrowed or obstructed airway
97
dry crackly low pitched sound heard in expiration and inspriation
friction rub
98
sound heard with mediastinal emphysema, synchronous with heartbeat and more pronounced at end of expiration
Hamman sign (mediastinal crunch)
99
Dx: moist cough
infection
100
Dx: dry cough
cardiac probs, allergies, HIV etc
101
Dx: acute onset cough with/without fever
infection; foreign body, inhaled irritant
102
Dx: regular, paroxysmal cough
pertussis
103
amount of air that is expelled after max inspiration and max expiration
vital capacity
104
max amount of air that can be forcefully expired
peak expiratory flow rate
105
Dx: yellow, green, rust colored, clear/transparent, purulent, blood streaked, mucoid or viscid sputum
bacterial infection
106
Dx: mucoid, viscid, blood streaked sputum
viral infection
107
Dx: all colors particularly abundant in morning, occasionally large amounts of blood
chronic infectious disease
108
Dx: slight, persistent blood streaked sputum
carcinoma
109
Dx: blood clotted, large amounts of blood in sputum
infarction
110
Dx: large amounts of blood
TB
111
expected infant RR
40-60
112
Dx: frequent hiccups in infants (3)
seizures, drug withdrawl or encephalopathy
113
Dx: persistent GI gurgling heard in chest
diaphragmatic hernia
114
volume of air in lungs at end of quiet expiration
functional residual capacity
115
amount of air inhaled and exhaled during normal breathing
tidal volume
116
Dx: tachypnea, dyspnea, decreased fremitus, occasional hyperresonance, prolonged expiration, wheezes, decreased lung sounds
asthma
117
Dx: delayed chest wall movement, narrowed intercostal spaces, tachypnea, decreased fremitus, deviated trachea ipsilaterally, dullness over affected lung, wheezes/rhonchi/crackles, decreased breath sounds in lower lobe
atelectasis
118
Dx: tachypnea, hyperinflation, crackles, rhonchi
bronchiectasis
119
Dx: occasional tachypnea and shallow breathing, prolonged breath sounds, occasional crackles and expiratory wheezes
bronchitis
120
Dx: wheezing, cyanosis, distention of neck veins and peripheral edema, decreased vocal fremitus, occasional hyperresonance, inspirational crackles, decreased breath sounds
COPD
121
Dx: tachypnea, deep breathing, pursed lips, barrel chest, decreased fremitus, hyperresonance, decreased breath sounds, prolonged expiration
emphysema
122
Dx: decreased and delayed resp movement, trachea shifted contralaterally, decreased fremitus, dull to flat percussion, decreased breath sounds, bronchophony and whispered pectoriloquy, occasional friction rub
pleural effusion/thickening
123
Dx: tachypnea, shallow breathing, nasal flaring, occasional cyanosis, increased fremitus, dullness on percussion, crackles with rhonchi, bronchial breath sounds, egophony, bronchophony and whispered pectoriloquy
pneumonia consolidation
124
cyanosis, bulging intercostal spaces, resp lag on affected side, tracheal deviation contralateral, decreased fremitus, hyperresonance, decreased breath sounds, Hamman sign or succussion splash, decreased breath sounds
pneumothorax
125
3 organisms that cause cough with sinus infection
H. influenzae, M. catarrhalis, Strep pneumoniae
126
mucosal edema and bronchoconstriction caused by airway hyperreactivity triggered by environmental factors
asthma
127
Dx: paroxysmal dyspnea, tachypnea, cough, wheezing on expiration and inspiration, prolonged expiration
asthma
128
does cold or warm air aggravate asthma?
Cold
129
what may coexist in a person with asthma?
allergic skin conditions
130
incomplete expansion of lungs at birth or collapse at any age
atelectasis
131
affect of atelectasis on lung sounds
to dampen or mute the sounds
132
a high birthweight (4.5 kg) predisposes a newborn to ____ in childhood?
obesity
133
inflammation of mucous membranes of bronchial tubes
bronchitis
134
Dx: excessive secretion of mucous in bronchial tree
chronic bronchitis
135
inflammatory process involving visceral and parietal pleura
pleurisy
136
what happens to the pleura in pleurisy?
becomes edematous and fibrinous
137
Dx: acute pain, difficulty breathing, pleural rub heard and felt, rapid and shallow respirations, decreased breath sounds
pleurisy
138
excessive non-purulent fluid in the pleural space can cause this:
permanent fibrotic thickening
139
right angled area of dullness over posterior chest that can be percussed opposite a large pleural effusion
Grocco's triangle
140
what makes up the horiz and vertical parts of Grocco's triangle?
diaphragm and SPs
141
purulent exudate collects in pleural space
empyema
142
Dx: decreased breath sounds, dull percussion, no vocal fremitus, fever, tachypnea
empyema
143
well defined, circumscribed mass defined by inflammation, suppuration and central necrosis
lung abscess
144
Dx: dull percussion, decreased breath sounds, pleural friction rub, cough, fever, tachypnea, foul smelling breath
lung abscess
145
common causes of lung abscess
aspiration of food or infected matter from upper resp or dental source
146
inflammatory response of bronchioles and alveolar spaces to infective agent
pneumonia
147
involvement of R lower lobe in pneumonia can cause this
stimulation of 10th and 11th thoracic nerves and cause RLQ pain
148
Dx: (in immunocompromised) interstitial inflammation and necrosis throughout bronchiolar and alveolar tissue
influenza
149
air leaks continually into pleural space, becoming trapped on expiration and resulting in increasing pressure in pleural space
tension pneumothorax
150
Dx: decreased breath sounds, dull percussion and absent coin click
hemothorax
151
Dx: unexplained but persistent tachycardia
minimal pneumothorax
152
most common type of lung CA
bronchogenic carcinoma
153
Dx: cough, wheezing, patterns of emphysema and atelectasis, pneumonitis, hemptysis
lung CA
154
acute or chronic condition involving R sided heart failure
cor pulmonale
155
most common cause of acute cor pulmonale
PE
156
risk factors for PE (8)
> 40 yo, hx of venous thromboembolism, anesthesia > 30 min, heart disease, CA, pelvic or leg fracture, obesity, throbophilia
157
Dx: pleuritic chest pain without dyspnea
PE
158
autosomal recessive disease of exocrine glands involving lungs, pancreas and sweat glands
CF
159
Dx: salt loss, pulm infections, areas of hyperinflation and atelectasis
CF
160
hallmark sx of CF in those under 5 yo
cough with sputum
161
sx of mild CF in adults
nasal polyps, cough and male sterility
162
most common cause of epiglottitis
haemophilus influenzae type B (HiB)
163
in what age group does epiglottitis occur most often?
3-7
164
Dx: sitting up straight, neck extended, head forward, anxious, ill, unable to swallow, drooling, cough, fever
epigottitis
165
what should never be done if one suspects epiglottitis?
direct exam of throat
166
laryngotracheobronchitis is also known as
croup syndrome
167
most common cause of croup
parainfluenza viruses
168
Dx: bark-like cough in child, labored breathing, retractions, hoarseness, inspiratory stridor
croup
169
what mimics croup?
aspirated foreign body
170
4 risk factors for RDS
decreasing gestational age, maternal DM, acute asphyxia and fam hx
171
floppiness of trachea or airway
tracheomalacia
172
Dx: hyperinflation, difficult expiration, generalized retractions, perioral cyanosis, hyperresonant percussion, distended abdomen (in infant)
bronchiolitis
173
5 diseases that can be included in the COPD group
chronic bronchitis, emphysema, asthmatic bronchitis, bronchiectasis and CF
174
Dx: cough, sputum production, dyspnea with pursed lips, leaning forward, barrel chest, scattered crackles and wheezes
COPD
175
chronic dilation of bronchi or bronchioles caused by repeated pulm infections and bronchial obstruction
bronchiectasis
176
autosomal recessive condition characterized by bronchiectasis, sinusitis, dextrocardia and male infertility
Kartagener syndrome
