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CPD > Resp > Flashcards

Resp Flashcards

1
Q

How do the external intercostal muscles run?

A

Obliquely anteriorly and inferiorly in the intercostal spaces

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2
Q

How do the internal intercostal muscles run?

A

Obliquely posteriorly and inferiorly in the intercostal spaces deep to, and at right angles, to the external intercostals

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3
Q

What are the disease processes involving the pleural lining?

A 
Pleuritis
Pleural adhesion
Pneumothorax
Hemothorax
Pleural exudates/effusion
Empeyma (pyothorax)
Chylothorax
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4
Q

What is the complication with hemo or pneumothorax?

A

Compression of the parenchyma tissues of the lung resulting in respiratory distress

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5
Q

What are the lower borders of the costal pleura?

A

8th rib - MCL
10th rib - MAL
12th rib - neck

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6
Q

How can you safely access the pericaridal sac?

A

At the left parasternal area, between costal cartilages 4 and 6
Can be entered without piercing the pleural space and lungs

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7
Q

Where are the three places the pleura extends below the costal margins

A

Right xiphisternal angerl

Right and left costovertebral angles

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8
Q

Anteriorly, what is the upper border of the lung?

A

Apex rises about 2-4cm above the inner (medial) third of the clavicle

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9
Q

The slow of the lower borders of the lung run….?

A

2 ribs above the plerual reflection

Lower border crosses the 6th rib at the MCL and T10 in MSL

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10
Q

Where do you find the oblique fissure?

A

Begins on the anterior chest at the level of the 6th rib MCL and extends laterally upward
Crosses the 5th rib in the MAL
Crosses the 4th rib and 4th interspace
Ends at the spinous process of T4

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11
Q

Where do you find the horizontal fissure?

A

Extends form the fourth rib at the sternal border
Follows the contour of the costal cartilage of the 4th rib
Crosses the foruth interspace and ends at the oblique fissue, after crossing the 5th rib in the MAL

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12
Q

Where does the trachea bifurcate?

A

Anteriorly - level of the sternal angle

Posteriorly - T4 spinous process

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13
Q

Where is the right hemidiaphragm located?

A

At the level of the 5th rib anteriorly

T9 posteriorly

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14
Q

Describe the vena caval hiatus

A

T8/9 disc

Inferior vena cava and branches of the right phrenic nerve

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15
Q

Describe the esophageal hiatus

A

10th rib

Esophagus, anterior and posterior vagus nerve, esophageal branches of the left gastric vessels

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16
Q

Describe the aortic hiatus

A

T12
Azygos vein, thoracic duct, lymph vessels
NOT the aorta - it runs posterior the the median arcuate ligament and anterior to the 12th rib

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17
Q

Describe the steronocostal hiatuses?

A

T10

Superior epigastric vessels

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18
Q

What are the structures that pass through the diaphragm without a specific hiatus?

A

Sympathetic trunk
Thoracic splanhnic nerves
Hemiazygos vein
Branches of the phrenic nerves

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19
Q

That thoracic landmark is at level: T2?

A

Jugular notch

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20
Q

That thoracic landmark is at level: T3?

A

Base of scapular spine

Top of aortic arch

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21
Q

That thoracic landmark is at level: T4?

A

Sternal angle (manubriosternal junction)
Second costal cartilage
Tracheal bifurcation
Upper end of the ascending aorta
Beginning of descending aorta
Arch of azygos vein and its entrance into the superior VC
Fusion of right and left mediastinal pleura in anterior midline

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22
Q

That thoracic landmark is at level: T7?

A

Inferior angle of scapula

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23
Q

That thoracic landmark is at level: T8/9 disc?

A

Vena caval hiatus

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24
Q

That thoracic landmark is at level: T9?

A

Xiphoid process

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25
Q

That thoracic landmark is at level: T10?

A

Esophageal hiatus

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26
Q

That thoracic landmark is at level: T12?

A

Aortic hiatus

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27
Q

What are the boundaries of the triangle of auscultation? What is it over?

A

Bounded by the trapezius, latissimus dorsi and medial border of the scapula
Found over the inferior lobe of the corresponding lung

28
Q

What is the normal ratio of AP diameter/transverse diameter?

A

1:2 5:7
From PAL to AAL
From AAL to AAL

29
Q

Define a Barrel chest

A

Increase in the AP diameter of the chest with teh AP diameter approximating that of the transverse diameter
Caused by COPD

30
Q

Define kyphosis

A

Abnormal curvature that is convex posteriorly (thoracic)
Causes: osteoporosis, compression fractures, hunch back
Slows up as a restrictive pattern on pulmonary function tests

31
Q

Define scoliosis

A

Lateral curvature (often accompanied by a rotary deformity)
Thoracic spine
Restricts rib movement, placing the respiratory muscles at a mechanical disadvantage and displaces the organs of the thoracic cavity
Chest wall and lung compliance decreases

32
Q

Define pectus excavatum (AKA funnel chest)

A

AP diameter of the chest is decreased, primary in the mediastinum
Structures in the midline of the thorax get displaced
Becomes systematic with exertion (Decreased stamina, endurance, easy fatigability and tachycardia)

33
Q

Define Pectus carnatum (AKA pigeon breast)

A

The AP diameter of the chest is increased - overgrowth and buckling onto the sternum of the anterior costal cartilages.
Results in a ridged chest - fixed in a position of near full inspiration
during respiration, there is heavy relance on the accessory muscles of respiration
Has a restrictive pattern

34
Q

What can cause asymmetrical movement?

A

Pneumonia, large pleural effusion, pneumothorax, rib fracture

35
Q

Define hemiplegic breath movements?

A

During normal breathing, the affected side moves more than the unaffected side, but moves less during forced breathing

36
Q

What can cause paradoxical sternal movement?

A

Trauma with multiple rib fractures

37
Q

What causes paradoxical abdominal muscle movement?

A

Muscles move out during expiration

Caused by paralyzed diaphragm, respiratory failure, exercise fatigue during exacerbation of COPD

38
Q

What causes epigastric depression with inspiration?

A

Large pericardial effusion

39
Q

What can movement of one side of the chest be do to in respiration?

A

One side moving more laterally (aletlectasis, subphrenic abscess)
One side moving more medially (intercostal muscle paralysis, pleural effusion, tension peneumothroax)

40
Q

What does intercostal retraction signify?

A

Imbalance between negative intrathoracic pressure generated and the ability of the lungs to expand during inspiration
Retraction may be generalized (inspiratory obstruction), focal (bronchial obstruction, fail chest, constrictive pericadritis).
Unilateral loss of retraction (pleural effusion, pnuemothorax and consolidation)

41
Q

What causes bulging interspace during inspiration?

A

Tension pneumothorax, large pleural effusion, emphysema, reactive airway disease

42
Q

What causes unilateral bulging of the apex?

A

Large pleural effusion (lungs floating on fluid)

43
Q

What is the normal slope of the ribs? When is there a change?

A

Normal angle of insertion of the ribs to the spine and costal cartilages (costochondral junction) is 45 degrees.
In COPD there is elevation of the ribs, with a loss of normal slope

44
Q

What are causes of subcutaneous emphysema?

A

Pneumothorax secondary to rib fracture
Ruptured bronchus (penetrating injury, deep biopsy)
Ruptured esophagus (forceful vomiting, penetrating injury)
Fracture of the facial bones invovling the sinuses
Positive pressure ventilation

45
Q

How do you interpret Tactile fremitus?

A

Increases in volume with consolidation

Decrease in volume with pleural effusion, pneumothroax, COPD

46
Q

When does the trachea deviate to the same side of the injury?

A

Lung fibrosis
Post pneumonectomy
“Being pulled”

47
Q

When does the trachea deviate to the opposite side of the injury?

A

Pleural effusion
Penumothroax
“Being pushed”

48
Q

What does a tracheal tug indicate?

A

Over inflation of the lungs

Thoracic aneurysm

49
Q

When do you hear resonance?

A

Loud, low pitch hollow sound of long duration

Normal

50
Q

When do you hear hyper-resonance?

A

Loud, low pitch booming sound of long duration

Emphysema

51
Q

When do you hear dullness?

A

Medium soft, with a thud-like sound

Lobar pneumonia

52
Q

When do you hear flat?

A

Soft, high pitched, with a short duration

Pleural effusion

53
Q

What are the adventitious sounds?

A 
Crackles
Wheezes
Rhonchi
Stridor
Pleural rub
54
Q

Define vesicular breathing

A

Slow and low pitched sounds heard over most of the lung fields
Inspiratory sounds are louder and longer than expiratory sounds and there is no gap between inspiration and expiration

55
Q

Define bronchial sounds

A

Loud, high pitched (harsh)
May be heard over the manubrium
Inspiratory sounds are shorter than expiratory sounds
Both have the same intensity
There is a gap between inspiration and expiration
Characteristically heard in consolidation and the upper level of the pleural effusion

56
Q

Define broncho-vesicular breathing

A

Has midway characteristics between vesicular and bronchial breathing
Both inspiratory and expiratory sounds are equal in duration and there is no gap between inspiration and expiration

57
Q

Describe crackles

A

Results from opening of previously closed aiway
Inspiratory, discontinuous, intermittent, nonmusical and brief sounds
The coarser the crackles the larger the airways of origin (bronchiectasis)
The later they occur in the inspiratory cycle, the more distal the site of origin (pulmonary fibrosis)

58
Q

Describe wheezing

A

Results from vibration of the walls, as air passes through, narrowed, almost closed airways.
Characterized by continuous, musical sounds, the lower the pitch, the larger the obstructed airways

59
Q

When do you hear high pitched wheezes?

A

Due to multiple distal airway obstruction heard in asthma

60
Q

When do you hear low pitched wheezes?

A

When a single large airways becomes blocked

I.e. tumor or aspirated foreign body

61
Q

What can cause wheezes through out the chest?

A

Asthma, chronic bronchitis, COPD, congestive heart failure

62
Q

Define rhonchi

A

Similar to wheezing but they are low pitched
Due to secretions in the larger airways with airway narrowing
Often clear after coughing

63
Q

Define stridor

A

Monophonic, high pitch sounds produced by tubulent airfolw in narrowed airway at the level of the supraglottis, glottis, subglottis and/or trachea
Can be harsh, musical or breathy
Can be inspiratory (laryngeal), expiratory (tracheobronchial) or biphasic (glottic or subglottic)
Usually affects infants and children

64
Q

Define a peural rub (AKA Crackles)

A

Pleura is inflamed - friction and resistance to movement on the passing, during respiration
Grating or creaking sounds during both phases of respiration
Tends to be localized

65
Q

How is vocal fremitus heard in consolidation?

A

Spoken words are loud and clear

66
Q

How is whispered pectoriloquay heard in pleural fluid or overinflation?

A

Barely percieved or absent

CPD (12 decks)

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