Ch 18 Throax & Lungs

Question 0

Pleural cavities

Answer 0

On either side of the mediastinum contain the lungs

Question 1

Mediastinum

Answer 1

Middle section of the thoracic cavity containing the esophagus trachea heart and great vessels

Question 2

Lobes of the lungs of

Answer 2

Right lung has 3 lobes and left lung has 2

lobes

Question 3

Pleurae

Answer 3

Thin slippery, forms an envelope between the lungs and the chest wall

Question 4

Visceral pleura

Answer 4

Lines the outside of the lungs dipping down into the tissues it is continuous with the parietal pleura lining the inside of the chest wall and diaphragm

Question 5

Costodiaphragmatic recess

Answer 5

The pleural extend about 3cm below the level of the lungs forming . This is the potential space; when it abnormally fills with air or fluid it compromises lung expansion

Question 6

Acinus

Answer 6

Functional respiratory unit consist of bronchioles, alveolar ducts, alveolar sacs, and the alveoli. Gas exchange occurs across the respiratory membrane in alveoli ducts.

Question 7

Mechanics of Respirations

Answer 7

(1) supply oxygen to the body for energy production (2) removing carbon dioxide as a waste product for energy reaction (3) maintain homeostasis (acid-base balance) of Arterial blood (4) maintain heat exchange

Question 8

Hypercapnia

Answer 8

Increase of carbon dioxide in the blood

The normal stimulus for us to breathe

Question 9

Hypoxemia

Answer 9

A decrease of oxygen in the blood

Also increases Respirations but is less effective

Question 10

Surfactant

Answer 10

The complex lipid substance needed for sustained inflation of the air sacs

Question 11

Characteristics timing of a cough

Answer 11

Continuous throughout the day– acute illness (ex respiratory infection)

Afternoon/evening– may reflect exposure to irritants at work

Night– postnatal drip, sinusitis

Early morning – chronic bronchial inflammation of smokers

Question 12

Hemoptysis

Answer 12

The act of coughing up blood

Question 13

Chronic bronchitis characterized

Answer 13

History of productive cough for 3 months out of a year for 2years in a row

Question 14

Characteristic sputum production :

White or clear mucoid

Answer 14

Colds , bronchitis, viral infections,

Question 15

Characteristic sputum production :

Yellow or green mucoid

Answer 15

Bacterial infection

Question 16

Characteristic sputum production :

Rust colored mucoid

Answer 16

Tuberculosis pneumococcal pneumonia

Question 17

Characteristic sputum production :

Pink frothy mucoid

Answer 17

Pulmonary edema some sympathomimetic medication have side effect pink tinged mucus

Question 18

Conditions of Characteristics cough sound

Answer 18

Mycoplasma pneumonia = hacking

Early heart failure= dry

Croup= Barking

colds, bronchitis, pneumonia = congested

Question 19

Orthopnea

Answer 19

Difficulty breathing when supine need pillows to fine a comfort zone to breath

Question 20

Paroxysmal nocturnal dyspnea

Answer 20

Awakening from sleep with a shortness of breath (SOB) and needing to be upright to achieve comfort

Question 21

Emphysema

Answer 21

A type of COPD damaging the air sac alveoli in the lungs

Question 22

Histoplasmosis

Answer 22

A fungus that can effect the lungs once inhaled typical seen with farmers the fungus is found in soil

Question 23

Coccidioidomycosis

Answer 23

A fungus Found in the soil of south western United States and Mexico

Question 24

Pneumoconiosis

Answer 24

Lung disease cause by inhaling dust and coal mines

Question 25

Atelectasis

Answer 25

collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung.

Question 26

Symmetric chest expansion

Answer 26

You place your hand on the back of pt. as they inhale your thumbs slide apart evenly

Unequal chest expansion occur with atelectasis or pneumonia

Question 27

Tactile (vocal) Fremitus

Answer 27

Fremitus is a palpable vibration sound is generated from larynx are transmitted through patent bronchi and lung parenchyma to the chest wall where you feel the vibration

Have pt. repeat 99 or blue moon they generate strong vibrations

Question 28

Tactile Fremitus can be heard:

Answer 28

More prominent between the scapulae and around the sternum,

Affects the normal intensity: Thick chest wall , obese or muscular chest , pitch and intensity: a loud, low-pitch voice generates more than soft, high-pitched sound.

Question 29

Decreased Fremitus (vibration)

Answer 29

Occurs when anything obstructs transmission of vibrations (ex. Obstructed bronchus, pleural effusion or thickening, pneumothorax, or emphysema

Question 30

Increased Fremitus

Answer 30

Occurs with compression or consolidation of lung tissue (ex. Lobar pneumonia)

Question 31

Rhonchal Fremitus

Answer 31

Is palpable with thick bronchial secretions. vibration felt when inhaled air passes through thick secretion in the larger bronchi

Question 32

Pleural friction Fremitus

Answer 32

Is palpable with inflammation of the pleura produced when inflammation of the parietal or visceral pleura causes a decrease in the normal lubricating fluid

Question 33

Crepitus

Answer 33

Is a coarse crackling sensation palpable over the skin surface. Occurs in subcutaneous emphysema when air escapes from the lung and enters the subcutaneous tissue.

Question 34

Resonance

Answer 34

Is the low-pitched , clear, hollow sound that predominates in healthy lung tissue in the adult. However it has not constant standard

Question 35

Hyperresonance

Answer 35

Is a low-pitched booming sound found when too much air is present as in emphysema or pneumothorax

Question 36

Dull

Answer 36

Soft muffled thud signals abnormals density in the lungs as with pneumonia , pleural effusion atelectasis or tumor

Question 37

Diaphragmatic excursion

Answer 37

“Exhale and hold it” briefly while you press down the scapular line until sound changes from resonant to dull (on ea. side) this estimates the level of diaphragm separating the lungs from the abdominal viscera mark that spot “take a deep breath and hold it” continue précis sing down from 1st mark and mark the level where the sound changes to dull. Measure the difference this is the diaphragmatic excursion Should be equal bilaterally and measure about 3 to 5 cm in adults

Question 38

Pleural effusion

Answer 38

is excess fluid that accumulates in the pleural cavity. This excess can impair breathing by limiting the expansion of the lungs.

Question 39

Types of Normal breath sounds

Answer 39

Bronchial (tracheal) , bronchovesicular , vesicular

Question 40

Bronchial (tracheal)

Answer 40

High pitched loud amplitude sound quality is harsh, hollow tubular in the trachea and larynx

Question 41

Bronchovesicular

Answer 41

Moderate pitch and amplitude sound quality is mixed heard over the bronchi where fewer alveoli are located around the sternum

Question 42

Vesicular

Answer 42

Low pitch soft amplitude sound rustling like the sound of wind in trees heard over the peripheral lungs fields where air flows through

Question 43

Adventitious sounds

Answer 43

The added sounds that are not normally heard in the lungs. Crackles/rales, wheeze/rhonchi, or stridor

Question 44

Crackles (fine)

Answer 44

Sounds like rolling hair between the fingers occurs with obstructive disease (emphysema, chronic bronchitis) or restrictive diseases (pneumonia, heart failure)

Question 45

Crackles (coarse)

Answer 45

Loud low pitch bubbling gurgling sound sounds like opening Velcro occurs with pulmonary edema , pneumonia, pulmonary fibrosis

Question 46

Wheeze (sibilant) high pitched

Answer 46

High pitched musical squeaking sounds that sound polyphonic occurs diffuse airway obstruction from acute asthma or chronic emphysema

Question 47

Wheeze low pitched (sonorous rhonchi)

Answer 47

Low pitched monophonic single note musical snoring moaning sounds they are heard throughout the cycle occurs Bronchitis, single bronchus obstruction , Tumor

Question 48

Voice sounds

Answer 48

Ask a person to repeat a phrase such as 99 while you listen normal voice transmission is soft muffled and indistinct. Usually not done in the routine examination. Performed if suspected lung pathology on the basis of earlier data

Testing for bronchophony, egophony, or whispered pectoriloquy

Question 49

Bronchophony

Answer 49

Person repeats 99 listen with stethoscope Normally: is soft muffled and indistinct Abnormal : you auscultate a clear 99 pathology that increases lung density will enhance transmission of voice sounds

Question 50

Egophony

Answer 50

Listen while person says long “ee-ee-eee-ee” Normally: you hear eeeeeee
Abnormal: you hear a bleating long aaaaa sound

Question 51

Whispered Pectoriloquy

Answer 51

Auscultate ask pt. whispers one-two-three
Normally: faint muffled almost inaudible
Abnormal: with only small consolidation the whisper is very clearly

Question 52

Apgar scoring system

Answer 52

Scores the baby on its ability to extrauterine life it scores heart rate respiratory effort, muscle tone, reflex irritability and color

Question 53

Barrel chest

Answer 53

Equal anteroposterior-to-transverse Ribs are horizontal instead of normal downward slope An increased anteroposterior chest diameter.

Question 54

Scoliosis

Answer 54

A lateral S-shaped curvature of the thoracic and lumbar spine usually involved vertebrae rotation unequal shoulder and scapular height and unequal hip levels

Question 55

Kyphosis

Answer 55

An exaggerated posterior curvature of thoracic spine (humpback) that causes significant back pain and limited mobility

Question 56

Phrenic Nerve

Answer 56

When breathing is initiated messages are sent from the medulla’s respiratory center by way of this nerve to the primary respiratory muscles.