Flashcards in Quiz 3 Chapter 18 Thorax and Lungs Abnormalities Deck (29):
ribs are horizontal instead of the normal downward slope. associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.
sunken sternum and adjacent cartilages (also called funnel breast). depression begins at 2nd intercostal space, becoming depressed most at junction of sternum and xiphoid process. more noticeable on inspiration.
forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breasts).
lateral s-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation. unequal shoulder and scapular height and unequal hip levels, rib interspaces flared on convex side. more prevalent in adolescent girls. severe=45 degrees or greater. severe may reduce lung volume and then person is at risk for impaired cardiopulmonary function.
an exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility. severe deformities impair cardiopulmonary function. if the neck muscles are strong, compensation occurs by hyperextension of head to maintain level of vision. can be associated with aging, especially in the familiar "dowager's hump" of postmenopausal osteoporotic women. related to physical fitness; women with adequate exercise habits are less likely to have kyphosis
occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (compression or consolidation [pneumonia]). must be a patent bronchus and consolidation must extend to lung surface for increased fremitus to be apparent.
increased tactile fremitus
occurs when anything obstructs transmission of vibrations (an obstructed bronchus, pleural effusion or thickening, pneumothorax, and emphysema). any barrier that gets in the way of the sound and your palpating hand decreases fremitus
decreased tactile fremitus
vibrations felt when inhaled air passes through thick secretions in the larger bronchi. this may decrease somewhat by coughing.
produced when inflammation of the parietal or visceral pleural causes a decrease in the normal lubricating fluid. then the opposing surfaces make a coarse grating sound when rubbed together during breathing. best detected by auscultation. feels like two pieces of leather grating together when palpated. synchronus with respiratory excursion. also called palpable friction rub.
pleural function fremitus
pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex.
pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae).
pleural friction rub
diffuse airway obstruction from acute asthma or chronic emphysema
wheeze (high pitched)
bronchitis, single bronchus obstruction from airway tumor
wheeze (low pitched)
coup and acute epiglottitis in children and foreign inhalation obstructed airway may be life threatening.
say "ninety-nine". abnormal, you auscultate a clear "ninety-nine". increased lung density
say "eeeee". abnormal, sounds like "aaaaa". area of consolidation or compression.
whisper. abnormal, whispered words are clear. consolidation.
collapsed shrunken section of alveoli or an entire lung as a result of 1) airway obstruction, the alveolar air beyond it is gradually absorbed by the pulmonary capillaries, and the alveolar walls cave in; 2) compression on the lung; and 3) lack of surfactant (hyaline membrane disease). chest expansion decreased on effected side.
infection in lung parenchyma leaves alveolar membrane edematous and porous, so RBCs and WBCs pass from the blood to alveoli. alveoli progressively fill up (become consolidated) with bacteria, solid cellular debris , fluid, and blood cells, which replace alveolar air. this decreases surface area of the respiratory membrane, causing hypoxemia. crackles.
proliferation of mucus glands in the passageways, resulting in excessive mucus secretions. inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. sections of lung distal to obstruction may be deflated. bronchitis may be acute or chronic with recurrent productive cough. chronic bronchitis is usually caused by cigarette smoking. crackles over deflated areas. may have wheeze.
caused by destruction of pulmonary connective tissue (elastin, collagen); characterized by permanent enlargement of air sacs distal to terminal bronchioles and rupture of interalveolar walls. this increases airway resistance, especially on expiration--producing a hyperinflated lung and an increase in lung volume. cigarette smoking accounts for 80% to 90% of cases of emphysema.
an allergic hypersensitivity to to certain inhaled allergens (pollen), irritants (tobacco, ozone) , microbes, stress, or exercise that produces a complex response characterized by bronchospasm and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus in airways. these factors greatly increase airway resistance, especially during expiration, and produce the symptoms of wheezing, dyspnea, and chest tightness. bilateral wheezing on expiration, sometimes inspiratory and expiratory wheezing.
asthma (reactive airway disease)
collection of excess fluid in the intrapleural space, with compression of overlying lung tissue. effusion may contain watery capillary fluid (transudative), protein (exudative), purulent matter (empyemic), blood (hemothorax), or milky lymphatic fluid (chylothorax). gravity settles fluid in dependent areas of thorax. presence of fluid subdues all lung sounds.
pleural effusion (fluid) or thickening
pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. dependent air sacs are deflated. pulmonary capillaries engorged. bronchial mucosa may be swollen. crackles at lung bases.
free air in pleural space causes partial or complete lung collapse. air in pleural space neutralizes the usual negative pressure present; thus lung collapses. usually unilateral. pneumothorax can be 1) spontaneous (air enters pleural space through rupture in lung wall, 2) traumatic (air enters through opening or injury in chest wall), or 3) tension (trapped air in pleural space increases, compressing lung and shifting mediastinum to the unaffected side).
virulent form of pneumonia is a protozoal infection associated with AIDS. the parasites p. jiroveci (p. carinii) is common in the United States and harmless to most people, except to the immunocompromised, in whom a diffuse interstitial pneumonitis ensues. cysts containing the organism and macrophages form in alveolar spaces, alveolar walls thicken, and the disease spreads to bilateral interstitial infiltrates to foamy, protein-rich fluid.
pneumocystis jiroveci (p. carinii) pneumonia
inhalation of tubercle bacilli into the alveolar wall starts: 1) initial complex is acute inflammatory response--macrophages engulf bacilli but do not kill them. tubercle forms around bacilli. 2) scar tissue forms, lesion calcifies and shows on x-ray. 3) reactivation of previously healed lesion. dormant bacilli now multiply, producing necrosis, cavitation, and caseous lung tissue (cheeselike). 4) extensive destruction as lesion erodes into bronchus, forming air-filled cavity. apex usually has the most damage. crackles over upper lobes common, persist following full expiration and cough.
undissolved materials (thrombus or air bubbles, fat globules) originating in legs or pelvis detach and travel through the venous system returning blood to right heart and lodge to occlude pulmonary vessels. over 95% arise from deep vein thrombi in lower legs as a result of stasis of blood, vessel injury, or hypercoagulability. pulmonary occlusion results in ischemia of downstream lung tissue, increased pulmonary artery pressure, decreased cardiac output, and hypoxia. more often, small to medium pulmonary branches occlude, leading to dyspnea. these may resolve by fibrolytic activity. crackles, wheezes.