Pathway of air from nose to lungs
Nose (nares) –> Nasal cavities and paranasal sinuses –> Pharynx (adenoids & tonsils) –> Larynx (epiglottis) –> Trachea –> Bronchi –> Bronchioles –> Alveoli –> Lung capillaries (bloodstream)
Adenoids
lymphatic tissue in the nasopharynx; pharyngeal tonsils
Alveolus (pl. alveoli)
air sac in the lung
Apex of the lung
tip or uppermost portion of the lung; apical
Base of the lung
lower portion of the lung; basilar
Bronchioles
smallest branches of the bronchi, terminal bronchioles lead to alveolar ducts
Bronchus (pl. bronchi)
Branch of the trachea (windpipe) that is a passageway into the lung; bronchial tube
Carbon dioxide (CO2)
Gas produced by body cells when oxygen and carbon atoms from food combine; exhaled through lungs
Cilia
Thin hairs attached to the mucous membrane epithelium lining the respiratory tract. They clear bacteria and foreign substances from the lung.
Diaphragm
Muscle separating the chest and abdomen; it contracts to pull air into the lungs and relaxes to push air out
Epiglottis
Lid-like piece of cartilage that covers the larynx preventing food from entering the larynx and trachea during swallowing
Expiration
Breathing out (exhalation)
Glottis
Slit-like opening to the larynx
Hilum of the lung
Midline region where the bronchi, blood vessels, and nerves enter and exit the lungs; hilar
Inspiration
Breathing in (inhalation)
Larynx
Voice box; containing the vocal cords
Lobe
Division of a lung
Mediastinum
Region between the lungs in the chest cavity. It contains the trachea, heart, lymph nodes, aorta, esophagus, and bronchial tubes.
Nares
Openings through the nose carrying air into the nasal cavities
Oxygen (O2)
Gas that makes up 21 percent of air. It passes into the bloodstream at the lungs and travels to all body cells.
Palatine tonsil
One of a pair of almond-shaped masses of lymphatic tissue in the oropharynx (palatine means pertaining to the roof of the mouth)
Paranasal sinus
One of the air cavities in the bones near the nose
Parietal pleura
Outer layer of pleura lying closer to the ribs and chest wall
Pharynx
Throat; including the nasopharynx, oropharynx, and laryngopharynx
Pleura
Double-layered membrane surrounding each lung
Pleural cavity
Space between the folds of the pleura
Pulmonary parenchyma
Essential parts of the lung, responsible for respiration; bronchioles and alveoli
Respiration
Process of moving air into and out of the lungs; breathing
Trachea
Windpipe
Visceral pleura
Inner layer of pleura lying closer to the lung tissue
Adenoid/o
adenoids
Alveol/o
alveolus, air sac
Bronch/oBronchi/o
bronchial tube, bronchus
Bronchiol/o
bronchiole, small bronchus
Capn/o
carbon dioxide
Coni/o
dust
Cyan/o
blue
Epiglott/o
epiglottis
Laryng/o
larynx, voice box
Lob/o
lobe of the lung
Mediastin/o
mediastinum
Nas/o
nose
Orth/o
straight, upright
Ox/o
oxygen
Pector/o
chest
Pharyng/o
pharynx, throat
Phon/o
voice
Phren/o
diaphragm
Pleur/o
pleura
Pneum/oPneumon/o
air, lung
Pulmon/o
lung
Rhin/o
nose
Sinus/o
sinus, cavity
Spir/o
breathing
Tel/o
complete
Thorac/o
chest
Tonsill/o
tonsils
Trache/o
trachea, windpipe
-ema
condition
-osmia
smell
-pnea
breathing
-ptysis
spitting
-sphyxia
pulse
-thorax
pleural cavity, chest
Auscultation
listening to sounds within the body
Percussion
tapping on a surface to determine the difference in the density of the underlying structure
Pleural rub (friction rub)
scratchy sound produced by pleural surfaces rubbing against each other
Rales (crackles)
Fine crackling sounds heard on auscultation during inhalation when there is fluid in the alveoli
Ronchi (singular: rhonchus)
Loud rumbling sounds heard on auscultation of bronchi obstructed by sputum
Sputum
Material expelled from the bronchi, lungs, or upper respiratory tract by spitting.
Purulent
Containing pus
Stridor
Strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx
Wheezes
Continuous high-pitched whistling sounds produced during breathing
subacute viral infection of infants and children (age 1-3) with obstruction of the larynx, accompanied by barking cough and stridor. Usually lasts 5-6 days, symptoms worse at night. Commonly caused by PARAINFLUENZA VIRUS!! or respiratory syncytial virus (RSV)
Croup
Acute infection of the throat and upper respiratory tract caused by corynebacterium. Inflammation occurs w/ a leathery, opaque, adherent membrane forming in the pharynx and trachea, bleeds when removed. Sore throat, adenopathy, fever, malaise. Treated with erythromycin or penicillin. Rare in the US.
Diphtheria
Nosebleed. Most common cause is trauma, bleeding usually responds with pressure (sometimes needs to be packed & cauterized)
Epistaxis
Whooping cough; highly contagious bacterial infection of the pharynx, larynx, and trachea caused by Bordetella. Characterized by paroxysmal (violent, sudden) spasms of coughing ending in whooping inspiration. Transmission by direct contact, incubation period can be 3+ weeks.
Pertussis
Reversible airway disease caused by hyperresponsiveness of alveoli to a variety of stimuli. Inflammation of the airway mucosa, increased mucus production & edema obstruct airway. Associated w/ aspirin sensitivity & nasal polyps. Many causes; allergen mediated, occupational, cardiac, drug-induced, exercise-induced, cold-induced, GERD. Oftentimes eosinophils are involved. Signs/symptoms - diffuse wheezing, dry/chronic cough, tight feeling in chest, dyspnea, prolonged expiratory phase.
Asthma
Chronic, irreversible, abnormal dilation of the bronchi, usually accompanied by infection & productive cough w/ large amounts of malodorous sputum. Signs/symptoms - cough, sputum, hemoptysis, wheezing, coarse or moist rales, cyanosis, clubbing, barrel chest.
Bronchiectasis
Inflammation of bronchi persisting over a long time (excessive productive cough for 3 months over at least 2 consecutive years in the absence of any other diseases that produce similar symptoms); type of chronic obstructive pulmonary disease (COPD). Signs/symptoms - persistent productive cough, copious sputum, intermittent breathing difficulty, wheezes, pt’s usually overweight (blue bloaters). Usually occurring in pt’s over 35, smokers.
Chronic bronchitis
Autosomal recessive disorder of exocrine glands resulting in thick mucinous secretions in the respiratory tract that do not drain normally. Most common lethal genetic disease, most males are infertile. Chronic pulmonary disease, pancreatic insufficiency, abnormally high levels of electrolytes in the sweat & less frequently biliary cirrhosis & diabetes mellitus.
Cystic fibrosis (CF)
Collapsed lung; incomplete expansion of alveoli. Small ones often asymptomatic but large ones cause tachypnea, cough, hypoxia, dull to percussion, decreased chest expansion. Commonly occurs after surgery (post-op fevers). Use incentive spirometry.
Atelectasis
Hyperinflation of air sacs with destruction of alveolar walls; type of COPD. Signs/symptoms - >50yo, thin/wasted appearance (pink puffers), mild cough usually in the morning, progressive dyspnea, barrel chest, hypertrophic accessory muscles of respiration, hyper-resonant to percussion, prolonged expiratory phase. Often caused by cigarette smoking but also genetic predisposition, environmental pollution, occupational exposure, allergy, infections.
Emphysema
Malignant tumor arising from the lungs and bronchi. Leading cause of cancer death in both men & women in the US (increasing in women, decreasing in men). Smoking/2nd hand smoke, asbestos, arsenic, nickel & radon gas exposure.
Lung cancer
Occupational pulmonary fibrotic disease resulting from the inhalation of an offending agent; produces fibrotic lung changes after the inhalation of dusts. Characterized by well-defined pulmonary nodular fibrosis & in more advanced stages diffuse fibrosis of the lung & severe pulmonary impairment.
Pneumoconiosis
Black lung disease, coal dust exposure
Anthracosis
Asbestos particles in the lungs
Asbestosis
Silica or glass particles in the lungs
Silicosis
Acute inflammation and infection of alveoli (lung parenchyma), which fill up with pus or products of the inflammatory reaction. Organisms invade the lower respiratory tract via inhalation/aspiration or hematogenous spread. May be viral (more common in children) or bacterial (streptococcus is most common). Cigarette smoking/chronic bronchitis predispose pt’s to infection. Signs/symptoms - fever, productive cough, purulent sputum, dyspnea, shaking chills, wheezing, rales.
Pneumonia
Lung infection from aspirated material, usually single lung either in superior segment of a lower lobe or the posterior segment of an upper lobe. May produce a cavity filled w/ fluid/air. Associated w/ periodontal disease, foreign body obstruction & immunocompromised state. Risk factors include CNS diseases, seizures, anesthesia & LOC due to drug/alcohol abuse. Signs/symptoms - acute onset fever, malaise, anorexia, weight loss, productive cough, foul-smelling sputum, decreased breath sounds, dullness over affected area of lung.
Pulmonary abcess
Swelling & fluid in the air sacs and bronchioles. Often seen w/ CHF. Signs/symptoms - SOB, DOE, PND (paroxysmal nocturnal dyspnea), orthopnea, cough, pink frothy sputum, moist rales, tachycardia, air hunger, noisy respiration.
Pulmonary edema
Obstruction in pulmonary vasculature, often originating in deep venous system of legs (usually blood clot but could be air, fat, foreign bodies, amniotic fluid, or tumor cell embolisms). Risk factors - immobility, estrogen use, femoral venous catheter, obesity, polycythemia vera, lupus, malignancy, heart failure, a-fib. Signs/symptoms - anxiety, apprehension, diaphoresis, chest pain, cough, dyspnea, tachypnea, tachycardia, hemoptysis, leg pain/swelling, low grade fever, cyanosis & syncope in severe cases.
Pulmonary embolism (PE)
Formation of scar tissue in the lung that gradually replaces the normal air sacs of the lungs. Scar tissue is thicker than normal tissue resulting in an irreversible loss of oxygen exchange abilities. Results from injury to lungs; pneumonia, tuberculosis, pneumoconiosis, inhaled pollutants, certain medications & systemic diseases.
Pulmonary fibrosis
Non-infectious multisystem (liver, lungs, spleen, lymph nodes, heart, CNS) disease of unknown causes in which small nodules (granulomas) develop. More common in african americans & females. Treated w/ steroids. Presents w/ bilateral hilar adenopathy, pulmonary infiltrates, ocular & skin lesions.
Sarcoidosis
Infectious disease caused by Mycobacterium, lungs usually are involved but any organ in the body may be affected. Screen w/ PPD skin test, also should evaluate pt for HIV. Signs/symptoms - cough, sputum production, hemoptysis, fever, night sweats, weight loss, malaise, adenopathy, pleuritic chest pain.
Tuberculosis (TB)
Rare, malignant tumor arising in the pleura. Associated w/ asbestos exposure (15-40 years afterwards). Associated w/ pleural effusions.
Mesothelioma
Abnormal accumulation of fluid in the pleural space secondary to underlying disease. Signs/symptoms - pleuritic chest pain, dyspnea, decreased breath sounds & tactile fremitus, dullness to percussion, tracheal deviation toward unaffected side in severe cases.
Pleural effusion
Pleural effusion from cancer, pneumonia, PE’s
Exudative
Pleural effusion from CHF, cirrhosis, kidney dialysis, nephrotic syndrome, myxedema
Transudative
Inflammation of the pleura caused by viral infection, pneumonia, emphysema, TB, uremia, cancer, or collagen vascular disease. Signs/symptoms - sharp, localized, fleeting chest pain (may feel it in shoulders too) made worse by coughing, sneezing or deep breathing. Rapid or shallow breathing, respiratory excursion diminished on affected side, decreased breath sounds, pleural friction rub.
Pleurisy (pleuritis)
Collection of air in the pleural space caused by a break in the lung surface. Signs/symptoms (depend on size) - sudden, sharp chest pain on affected side, dyspnea. Treated w/ oxygen supplementation, needle aspiration, tube thoracostomy, & pleurodesis (surgical joining of pleural layers).
Pneumothorax
Failure of the right side of the heart to pump a sufficient amount of blood to the lungs because of underlying lung disease
Cor pulmonale
Collection of fluid in the pleural cavity
Hydrothorax
Collection of fluid or other material within the lung as seen on a chest film, CT scan, or other radiologic image
Infiltrate
Chest x-ray (CXR, chest film)
Radiographic image of the thoracic cavity (chest, lungs, heart, large arteries, ribs & diaphragm.
Computed tomography (CT) scan of the chest
Computer generated series of x-ray images show thoracic structures in cross section and other planes. Esp useful because it can simultaneously show many different types of tissues. Modern CT scans utilize spiral or helical CT process, captures pictures at many angles allowing for “slice” views.
Pulmonary angiography
X-ray pictures of pulmonary blood vessels w/ injected contrast material used to detect PE’s
Magnetic resonance imaging (MRI) of the chest
Very detailed pictures of structures of the chest from any angle. Good for cancer detection & staging. May reveal diseased heart valves. Good, non-invasive way of showing flow in lymph nodes & blood vessels.
Positron emission tomography (PET) scan of the lung
Radioactive glucose is injected and images reveal metabolic activity in the lungs. Helpful for identification of malignancies which have a higher metabolic activity.
Ventilation-perfusion (V/Q) scan
Detection device records radioactivity in the lung after injection of a radioisotope or inhalation of small amount of radioactive gas (xenon). Measures both airflow & blood-flow looking for PE’s.
Bronchoscopy
Fiberoptic endoscope examination of the lower airways including larynx, trachea, bronchi & bronchioles. Also used to collect specimens for culture.
Bronchoalveolar lavage
Bronchial washing; fluid is injected and withdrawn
Bronchial brushing
A brush is inserted through a bronchoscope and is used to scrape off tissue
Endobronchial ultrasound (EBUS)
Performed during bronchoscopy to diagnose and stage lung cancer, can be used to guide a forceps biopsy
Endotracheal intubation
Placement of a tube through the mouth into the pharynx, larynx, and trachea to establish an airway or administer oxygen, gaseous medication or anesthetics. May also be done to remove blockages, view the interior walls, or place pt on a mechanical ventilator
Laryngoscopy
Visual examination of the voice box
Lung biopsy
Removal of lung tissue followed by microscopic examination
Mediastinoscopy
Endoscopic visual examination of the mediastinum using a mediastinoscope. Used to visualize, examine & biopsy lymph nodes (particularly in lung cancer diagnosis/staging).
Pulmonary function tests (PFTs)
Tests that measure the ventilation mechanics of the lungs; airway function, lung volume, and the capacity of the lungs to exchange oxygen and carbon dioxide efficiently.
Thoracentesis
Surgical puncture to remove fluid from the pleural space. May be diagnostic to determine the etiology of a pleural effusion or therapeutic to relieve respiratory insufficiency due to a large pleural effusion.
Thoracotomy
Large surgical incision of the chest usually done as a last resort in pt’s w/ pulmonary problems of unknown etiology in order to diagnose focal or diffuse issues.
Thoracoscopy (thorascopy)
Visual examination of the chest via small incisions and use of an endoscope. VATS = video=assisted thorascopy
Tracheostomy
Surgical creation of a temporary or permanent opening into the trachea through the neck; tracheotomy is the incision necessary to create a tracheostomy. The hole is called a stoma.
Tuberculin test
Determines past or present tuberculosis infection based on positive skin reaction. Small amount of TB protein (called PPD, purified protein derivative) put under top layer of skin, if pt has been exposed they develop firm red bump within 2 days. Called mantoux skin test, cannot tell if infection is active or latent.
Tube thoracostomy
A flexible, plastic chest tube is passed into the pleural space through the ribs to continuously remove air (pneumothorax), fluid (pleural effusion), or pus (empyema)
The removal of a small, localized area of diseased tissue near the surface of the lung; pulmonary structure and function are relatively unchanged after healing
Wedge resection
The removal of a bronchiole and its alveoli (one or more lung segments). The remaining lung tissue expands to fill the previously occupied space.
Segmental resection
The removal of an entire lobe of the lung. Afterwards, the remaining lung increases in size to fill the space in the thoracic cavity.
Lobectomy
The removal of an entire lung, techniques such as removal of ribs and elevation of the diaphragm are used to reduce the size of the empty thoracic space.
Pneumonectomy
Nasal CPAP
Continuous positive airway pressure mask; the pressure applied by air coming from the compressor opens the oropharynx and nasopharynx
Spirometer
Measures the volume and rate of air passing into and out of the lung
Airways are narrowed resulting in resistance to air flow during breathing. Examples include asthma, COPD, bronchiectasis, CF, and bronchiolitis
Obstructive lung disease
Expansion of the lung is limited by disease that affects the chest wall, pleura, or lung tissue itself. Decreased total lung capacity (TLC). Examples include pulmonary fibrosis, radiation damage to the lung, pneumoconiosis, myasthenia gravis, muscular dystrophy, and diaphragmatic weakness/paralysis.
Restrictive lung disease
Acute, progressive inflammation of the bronchiole walls, usually seen in children
Bronchiolitis
Central location malignancy that is sensitive to chemotherapy. Surgery is not indicated. Poor prognosis (2-4 months from diagnosis to death).
Small cell lung cancer
90% of lung cancers including squamous, large cell & adenocarcinoma. Poor response to chemotherapy but surgery if early stage. Prognosis varies w/ stage.
Non-small cell lung cancer
Pneumothorax that occurs most commonly in tall, thin, young males w/ no underlying lung disease.
Primary spontaneous pneumothorax
Pneumothorax that occurs w/ diminished breath sounds, decreased tactile fremitus & hyporesonance.
Large pneumothorax
Pneumothorax resulting from major trauma presenting w/ tachycardia, hypotension, mediastinal or tracheal deviation.
Tension pneumothorax
Magnetic resonance angiography
Special MRI used to demonstrate narrowing of coronary arteries or actual blockage by fatty deposits. May also show aneurysms or a torn inner lining of an artery (dissection).