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respiratory > Resp Final > Flashcards

Resp Final Flashcards

1
Q

OMT is indicated for adults with SD related to…

A

URI (rhinitis, sinusitis, cold, Eustachian tube dysfunction), headache (cephalgia), temporomandibular joint dysfunction (TMJ), pharyngitis, cranial neuropathies, head trauma, vertigo, psych

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2
Q

OMT is indicated for kids with SD related to…

A 
NAS
Difficulty  latching
Plagiocephaly
Otitis media
URI
Head Trauma
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3
Q

Symptoms of sinusitis

A

Headache/facial pain
Runny nose
Nasal congestion
Fever

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4
Q

Causes of sinusitis

A

Viral
Bacterial
Fungal

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5
Q

What decreases the body’s immune response regarding anatomy of sinusitis?

A

Tissue swelling
Impaired blood flow
Impaired lymphatic drainage

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6
Q

Increased sympathetic tone from upper thoracics can cause ___________ and thicken mucus as well as _________ lymphatic flow and response.

A

Vasoconstriction; decreasing

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7
Q

__________ parasympathetic tone can cause tearing and runny nose.

A

Increased

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8
Q

Dysfunction of the upper cervical/suboccipital areas can cause irritation of the _____ nerve

A

Vagus

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9
Q

Cranial dysfunction can affect the ______ of the sinuses as well as ____________ to the head

A

Drainage; parasympathetics

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10
Q

Goals for treatment of URI

A

Improve drainage
Treat offending organism
Support patient

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11
Q

What are the 5 models of osteopathic care?

A
  • Respiratory-circulatory
  • Neurological
  • Biomechanical
  • Metabolic-energy
  • Behavior
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12
Q

What can facial effleurage be used for?

A

Promote lymphatic drainage from the head (resp-circ model)

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13
Q

Neurological model with URI

A

Trigeminal stimulation, sphenopalatine ganglion stimulation

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14
Q

Primary headaches

A
  • Migraine headache
  • tension-type headache
  • trigeminal autonomic cephalgias (cluster)
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15
Q

Secondary headaches

A

Due to another pathology/injury

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16
Q

Red flags

A
  • First and/or worst headache of the patient’s life
  • Headache beginning after 50 years of age or before 5 years of age
  • Occipital headaches in children
  • Headache with signs of systemic illness (fever, stiff neck, rash)
  • Abnormal neurologic exam
  • Headache subsequent to head trauma
  • Headache associated with alteration in or loss of consciousness
  • Headache triggered by exertion, sexual activity, or Valsalva maneuver
  • New or severe hypertension
  • New headache in patients with cancer, immunosuppression, pregnancy
  • Different than the normal pattern
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17
Q

Migraine headaches

A
  • Side: unilateral (usually frontotemporal)
  • Character: pulsating
  • Intensity: moderate to severe
  • Duration: 4-72 hours
  • Triggers: maybe
  • Associated symptoms: nausea/vomiting and/or photophobia/phonophobia; may have auras or prodromes
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18
Q

Tension-type

A
  • Side: bilateral
  • Character: tightening/pressure
  • Intensity: mild to moderate
  • Duration: 30 minutes to 1 week
  • Triggers: anxiety, stress, depression, poor posture
  • Associated symptoms: may have photophobia or phonophobia, but not both
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19
Q

Cluster

A
  • Side: strictly unilateral, orbital, supraorbital and/or temporal
  • Intensity: severe to very severe
  • Duration: 15 minutes to 3 hours or longer
  • Triggers: alcohol, histamine, or nitroglycerine during a cluster period
  • Associated symptoms: occur in series or clusters; ipsilateral facial symptoms such as edema, congestion, lacrimation, sweating, miosis, and more; restless/agitated
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20
Q

TMJ

A
  • Describes a number of clinical problems: clicking/grating within the joint, mechanical restrictions, jaw/ear/facial pain, headache, neck pain, and stiffness
  • May be acute or chronic
  • Most common non-dental cause facial pain
  • It is believed that the etiology is likely multifactorial
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21
Q

TMJ joint itself…

A
  • Synovial joint between condyle of mandible and mandibular fossa of temporal bone
  • Fibrocartilaginous disc
  • Complex motion - hinge, lateral glide, protraction, retraction
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22
Q

Symptoms of TMJ

A
  • Chronic pain in the muscles of mastication described as a dull ache, typically unilateral
  • Pain may radiate to the ear and jaw and is worsened with chewing
  • Bruxism, teeth clenching
  • Locking of the jaw or asymmetrical movement when attempting to open the mouth
  • Clicking or popping, usually when displacement of the articular disk is present
  • A bite that feels uncomfortable or different from usual
  • Headache , neck, shoulder, and back pain
  • Increasing pain over the course of the day
  • History of jaw and/or facial trauma
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23
Q

Acute approach to treating TMJ

A

OMT
Stretching the joint capsule
NSAIDs if needed
Muscle relaxers if necessary

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24
Q

Chronic approach to TMJ

A
  • more difficult

- best managed with team approach

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25
Q

OMT techniques for TMJ

A
  • Suboccipital inhibition
  • C1 treatment
  • Temporalis MFR
  • Masseter inhibition
  • AC7 and AC8 counterstrain
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26
Q

Viscerosomatic reflexes SD in LRI

A
  • T2-T7 facilitation
  • OA dysfunction
  • Chapman points: 3,4 anteromedial intercostal spaces and T3-4 transverse processes
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27
Q

Structural factors for SD in LRI

A

Rib restriction, segmental restriction, muscular restriction

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28
Q

Lymphatic factors for SD in LRI

A

Diaphragm tension, MF restriction

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29
Q

Acute SD

A

Hot, moist, edema, tense, prolonged red reflex, type II

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30
Q

Chronic SD

A

Cool, dry, thick, ropy, blanching, type I and II

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31
Q

Neurologic model for LRI

A
  • Upper cervical treatment (parasympathetic normalization)
    • Suboccipital inhibition
    • OA myofascial release
  • T2-7 treatment (sympathetic normalization and improves chest excursion)
    • Soft tissue
    • Rib raising
    • Segmental myofascial release/ muscle energy
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32
Q

Suboccipital inhibition can be used to normalize _______ tone

A

Vagal

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33
Q

Biomechanical model for LRI

A
  • Restoring proper rib and vertebral segment motion:
    • Improves chest excursion
    • Helps decrease muscle fatigue
    • Helps to decrease the work of breathing
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34
Q

Respiratory/Circulatory model for LRI

A
  • Lymphatic OMT improves breathing and immune response
  • Diaphragm treatment improves breathing and lymphatic flow
    • Thoracolumbar (TL) Diaphragm
    • Cervicothoracic (CT) Diaphragm
      • Sibson’s fascia
  • Lymphatic pumps improve lymphatic and venous drainage
    • Thoracic pump
    • Pectoral traction
    • Pedal pump
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35
Q

CT diaphragm tension limits drainage from _____ ______. _______ duct passes through it twice

A

Entire body; thoracic

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36
Q

TL diaphragm tension limits drainage from…

A

Abdomen, pelvis, LE

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37
Q

Thoracic pump is contraindicated with…

A

aspiration, pulmonary embolism, acute congestive heart failure, COPD (rebound)

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38
Q

_______ ________ is a gentler alternative to thoracic pump

A

Pectoral traction

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39
Q

Relative contraindications for OMT for LRI

A

-Pulmonary embolism
-Unstable congestive heart failure
-Unstable arrhythmia
Others
-Acute rib fracture
-Lung cancer
-Aspiration
-Chronic obstructive pulmonary disease (Noll 2008)
-Severe osteoporosis/elderly

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40
Q

OMT for acute/subacute LRI

A
  • Thoracic, rib, diaphragm techniques
  • Autonomic normalization with rib raising, suboccipital inhibition
  • Thoracic pump
41
Q

OMT for chronic LR dysfunction

A
  • Every 1-4 months to help prevent exacerbations

- Daily home exercises for thoracic and rib mobility

42
Q

OMT for patients with LRI ultimately helps because it….

A
  • normalizes autonomics (reduces bronchospasm, reduces and thins secretions)
  • improves chest excursion, helps decrease muscle fatigue and the work of breathing
  • improves immune response and lymphatic and venous drainage.
43
Q

What is croup?

A

Inflammation of larynx, trachea, and large bronchi

44
Q

Clinical findings of croup

A

Inspiratory stridor is key

-Also barking cough, hoarse voice

45
Q

Diaphragm innervation

A

Phrenic n. from C3-5

46
Q

Right lobe has __ lobes

A

3

47
Q

Left lobe has __ lobes

A

2

48
Q

Perforating structures of diaphgram

A

IVC, esophagus, aorta, azygous vein, thoracic duct

49
Q

RALS

A

Right pulm a. Anterior to bronchus; Left is Superior

50
Q

Perforating structures “I ate 10 eggs at 12”

A
  • IVC @ T8
  • Esophagus @ T10
  • Aorta @ T12 (plus azygous v and thoracic duct)
51
Q

Non-cardiac chest pain

A

constant, point tenderness, pain changes with positional changes, located in shoulders or between scapula, made worse with pressure on precordium, epigastric region

52
Q

How many lung fields do you auscultate?

A

10

53
Q

Pack years…

A

PPD*number of years smoked

54
Q

In a patient with history of moderate-severe COPD, you would expect to inspect….

A

Barrel chest

55
Q

Pectus carinatum

A

Sternum protrudes outward

56
Q

Pectus excavatum

A

Lower sternum indents

57
Q

What breathing pattern leads to barrel chest?

A

Air trapping

58
Q

Cheyne-Stokes breathing

A

Varying periods of increasing depth interspersed with apnea

Seen in very sick patients, brain damage, cerebral or drug associated respiratory compromise

59
Q

Air trapping

A

Increased difficulty getting breath out

60
Q

Kussmaul breathing

A

Rapid, deep, labored
breaths
Seen in metabolic acidosis

61
Q

Biot breathing

A

Irregularly interspersed periods of apnea in a disorganized sequence of breaths
Seen in severe or persistent increase of intracranial pressure, respiratory compromise from drug poisoning, brain damage at medulla

62
Q

What is expected from someone with COPD with palpation?

A

Decreased tactile fremitus (more air produces less vibration) and chest excursion (doesn’t expand as much)

63
Q

Respiratory distress signs

A

Dyspnea, labored breathing, diaphoretic, retractions (sinking in with each breath), cyanosis or pallor, mental status, accessory muscle use, nasal flaring, lip pursing, tripod

64
Q

Accessory muscles during inspiration

A

Trapezius, scalenes, SCM

65
Q

Which lobe is an aspirated object most likely to land in when upright?

A

Right lower lobe

66
Q

Which lobe is an aspirated object most likely to land in when someone is laying down?

A

Right upper lobe

67
Q

Tension pneumothorax

A

Life-threatening condition in which air enters pleural space with each breath and stays trapped, compressing lung and other thoracic structures

68
Q

What would be a clue for suspected right-sided tension pneumothorax?

A

Trachea deviation to left

69
Q

Crackly, crinkly sensation on palpation or auscultation

A

Crepitus

70
Q

What does crepitus indicate?

A

Air in subcutaneous tissue (subcutaneous emphysema) - rupture somewhere in resp, infection with gas-producing organism

71
Q

Friction rub

A

Palpable, coarse, grating vibration; inspiration and expiration

72
Q

Hyperresonance

A

Hyperinflation (emphysema, pneumothorax)

73
Q

Dullness

A

Diminished air exchange or fluid (pneumonia)

74
Q

Normal lung sounds

A
  • Vesicular (low-pitched, low intensity - healthy lung tissue)
  • Bronchial (highest pitch and intensity - trachea)
  • Bronchovesicular (moderate pitch and intensity - major bronchi)
75
Q

Crackles/Rale

A
  • Character: fine, medium, or coarse crackling sound; high-pitched. Discontinuous sound.
  • When is it heard: inspiration
  • Cause: disruptive passage of air through the small airways.
76
Q

Crackels/rales possible pathologies

A

early inspiratory» chronic bronchitis;

late inspiratory&raquo_space; pneumonia, CHF, or atelectasis

77
Q

Rhonchi

A
  • Character: coarse low pitched; may clear with cough
  • When is it heard: inspiration and expiration
  • Cause: passage of air through an airway obstructed by thick secretions, muscular spasm, new growth or external pressure
78
Q

Rhonchi possible pathologies

A

Asthma, COPD, tumor

79
Q

Wheezes

A
  • Character: whistling, high pitched bronchus, musical-like sound/squeak
  • When it is heard: inspiration or expiration, generally louder on expiration
  • Cause: relatively high velocity air flow through a narrowed or obstructed airway
80
Q

Wheezes pathologies

A

asthma (reactive airway disease)
acute/chronic bronchitis
foreign body (very localized)

81
Q

Friction rub

A

Dry crackly grating (“machine-like quality”), low pitched sound, “leather-on-leather” sound.
Heard in both inspiration and expiration.
Suggests pleurisy

82
Q

Stridor

A

High-pitched, piercing sound
Heard during inspiration
Due to obstruction high in the respiratory tree

83
Q

Bronchophony

A

Have patient say 99»positive = increased sound

84
Q

Egophony

A

Have patient say “E, E, E”&raquo_space;positive = “A, A, A”

85
Q

Whispered pectoriloquy

A

Have patient whisper “1, 2 3”&raquo_space; positive - increased sound

86
Q

Retropharyngeal abscess

A

a life-threatening deep neck space infection that has the potential to occlude the airway; occurs in the potential space extending from the base of the skull to the posterior mediastinum between the posterior pharyngeal wall and prevertebral fascia

87
Q

Peritonsillar abscess

A

infection of space between the palatine tonsil capsule and pharyngeal muscles
differentiate between branchial cleft cyst and thyroglossal duct cyst

88
Q

Branchial cleft cyst

A

type of birth defect in which a lump develops on both sides of a child’s neck or below the collarbone; incomplete involution of branchial cleft

89
Q

Thyroglossal duct cyst

A

fluid-filled pocket in front of neck, just above voice box; forms in tissue sometimes leftover from development of thyroid gland.

90
Q

Epstein’s pearls

A

small cysts that appear in a baby’s mouth that look like tiny white bumps; present in many babies and completely harmless unless they’re showing signs of pain

91
Q

Oral thrush

A

fungal infection caused by Candida albicans where it accumulates inside the lining of your mouth (candida is normal, but can overgrow in case of thrush); causes creamy white lesions on tongue or inner cheeks that can spread to the roof of your mouth, gums, tonsils, or back of throat

92
Q

Tooth eruption 7+4 rule

A 
7 months - teething
11 mo - 4 teeth
15 mo - 8
19 mo - 12
23 mo - 16
27 mo - 20
93
Q

Conductive hearing loss

A

Reduced transmission of sound to middle ear (problem in auditory canal, tympanic membrane, middle ear)

94
Q

Causes of conductive hearing loss

A

Cerumen impaction, otitis media with effuction, acutre otitis media, otitis externa, foreign body, cholesteatoma, stiffening of ossicles, otosclerosis

95
Q

Indications of hearing loss

A

Turns TV loud, hears better in noisy environment, asks for things to be repeated, speaks softly, bone conduction>air conduction with Rinne, lateralization to affected ear with Weber

96
Q

Sensorineural hearing loss

A

Reduced transmission of sound to inner ear (cochlea, associated structures, CN VIII)

97
Q

Causes of sensorineural hearing loss

A

damage to CN VIII, congenital infection, genetic hearing impairment, genetic syndromes, systemic disease, ototoxic medications, trauma, tumors, or prolonged exposure to loud occupational and recreational noise

98
Q

Indications of sensorineural hearing loss

A

Complains that people mumble, has difficulty understanding speech, speaks loud, air conduction>bone conduction but less than 2:1 with Rinne, lateralization to unaffected ear with Weber

respiratory (9 decks)

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