Respiratory System Flashcards
(144 cards)
What are things to evaluate in relation to the hands when doing a respiratory exam?
Pallor-
Flapping tremour- Carbon dioxide retention (impacts muscle contraction)
Blueing- peripheral cyanosis
What are things to evaluate in relation to the face when doing a respiratory exam?
Pallor of conjunctive- anaemia
Mucous Membrane blueing- central cyanosis
What are things to evaluate in relation to the neck when doing a respiratory exam?
Trachea- should feel central
Lymph nodes- looks for lymphatanotomy (neck masses), and palpate (patient sits up and you go behind to feel)
What are things to evaluate in relation to the chest when doing a respiratory exam?
Barrel chest- COPD, emphysema (prominent chest cavity)
Pectus excavatum/ carinatum- inward/outward sternum
Symmetry
Apex beat
Percussion- Should sound hollow
Chest expansion- place hands on chest wall with fingers meeting in middle, laying over, not on. Front and back
Tactile vocal phremitis- say 1-1-1 and listen for vibrations (pleural effusion, pneumothorax, pneumonia)
What are things to evaluate in relation to the auscultations when doing a respiratory exam?
Starting at apex of lungs, and moving side to side as you move down the chest wall.
3 on front, 4 on back, and in apex
Crackling course- noisy, sounds like crunchy leaves, found at base
Fine crackles- pulmonary fibrosis, found at base
Wheezing- all throughout chest- caused by narrowed airways (COPD, asthma)
Strider- upper airway obstruction, severe
Vocal phremitis- vibrations
What do you do at the end of respiratory exam?
Summarize and thank patient
What is chylothorax?
Chyle (lipid rich fluid) in thorax
Commonly found in paediatric oncology patients
What is empyema?
Collection of pus in pleural sac
What atelectasis?
Inability to expand
Can occur due to obstruction, i.e. chocking
Where does looping of the vagus nerve occur?
Left: Arch of aorta (giving off the left recurrent laryngeal branch)
Right: Level of right subclavian artery
How do you differentiate the phrenic and vagus nerves when examining the thorax?
Vagus travels in thoracic cavity posterior to the hilum, phrenic travels anteriorly
What is effusion?
Accumulation of fluid in a space (i.e. the pericardial cavity)
What physiological changes are associated with asthma?
Loss of normally functioning of airway epithelium, thickening of basement membrane, hypertrophy of smooth muscle layer.
What impact does the pathophysiology of asthma have?
Causes hyper-responsiveness to normal triggers of contraction (histamine and/or acetylcholine).
Abnormal contraction in response to usually benign triggers.
What are possible triggers for asthma?
Acute Inflammation: Allergy, Viral/bacterial infection, exercise
Drugs (that interfere with normal regulation of airway): beta-blockers, non-steroidal anti-inflammatory drugs
Cold air and scents
How are asthma symptoms managed?
Bronchospasm- treated with bronchorelaxation (beta 2 agonists like salbutamol)
Inflammation- treated with anti-inflammatories (corticosteroids, leukotriene receptor blockade, monoclonal antibodies)
What is the typical presentation of asthma?
Bronchospasm (causes wheeze, dyspnoea, exercise intolerance), and Inflammation (cough)
What limits ability to take a breathe?
Breathing is a single orifice system, so need for oxygen is balanced with need to eliminate waste
What are the 2 different types of airway narrowing, explain each briefly?
Dynamic- Rapid muscle contraction (due to histamine or acetylcholine), medium-secretions
Fixed (stiff airway wall)- smooth muscle bulking, thickened basement membrane
How do the pathophysiological changes associated with asthma impact the physiological response?
Increased smooth muscle: increased force of contraction
Mast cells in smooth muscle: Twitchy smooth muscle with variable airway calibre (big changes in sensitivity and activity of muscle impacting radius)
Increased basement membrane: loss of relaxation following contraction (loss of elasticity, chronic reduction in airway calibre leading to damage of airways)
What is diurnal variability?
Variability in smooth muscle contraction throughout the day.
Usually worse at night.
What type of inflammation is seen in physiological response of asthma, and how is it mearsured?
Eosinophilic inflammation
It causes increase in production of exhaled nitric oxide which can be measures (30ppb is normal).
What is reversible airflow and how is its measure related to asthma?
Asthma should always have reversible airflow obstruction.
Asthmatic patients should experience bronchodilation following use of nebulised salbutamol, whereas someone with chronic destructive lung disease would not have any dilation. Confirmatory test
What are the 3 phases needed for diagnosing asthma?
Smooth muscle only- trigger by direct mediator release (histamine) causing rare wheezy episodes
Chronic Inflammation- irritates smooth muscle, causes regular wheezy episodes
Acute inflammation- viral infection, ‘clinical exacerbations’