Ch 19 Lungs

Question 1

Angle of Louis marks 3 things:

• trachea ______
• upper border of ______
• lies above __thoracic vertebra on the back

Answer 1

Angle of Louis

• trachea bifurcates into L and R bronchi
• upper border of atria
• lies above 4th thoracic vertebra

Question 2

Lung landmarks:

Anterior:
-base of lung: ___ rib at midclavicular line
Laterally:
-lung extends from __ of axilla to ____ rib
Posterior:
-__ marks apex, ___ marks base, ____ with deep inspiration

Answer 2

Anterior:
-base of lung: 6th rib midclavicular
Laterally:
-apex of axilla to 7/8 rib
Posterior
-C7 apex, T10 base --> T12 with deep breath

Question 3

Left lung does not have _____ lobe
Anterior chest contains mostly ____ and _____ lobes
Posterior chest almost all ____ lobe

Answer 3

Left: no middle lobe
Anterior: upper and middle
Posterior: lower

Question 4

Visceral pleura encloses _____
Parietal pleura lines ____

Costodiaphragmatic recess is ____

Answer 4

Visceral: encloses lung
Parietal: lines chest cavity

Costodiaphragmatic recess: pleurae extend 3 cm below lungs (potential space for air/fluid to fill)

Question 5

Involuntary control of respiration is mediated by respiratory centre in ______
Normal stimulus to breath is ______

Answer 5

brain stem (pons and medulla)

hypercapnia (build up of CO2)
-hypoxemia is less effective drive to increase respirations

Question 6

Forced inspiration (with heavy exercise/resp distress): accessory neck muscles ______ (3) are used

Answer 6

• sternomastoid (elevate sternum)
• scalene (elevate upper ribs)
• trapezius

Question 7

Acute cough lasts _____
Chronic cough lasts ____
Chronic bronchitis is cough that lasts ______

Answer 7

Acute: less than 2-3 weeks
Chronic: >2 months
Chronic bronchitis: productive cough x 3 months x 2 years in a row

Question 8

Define orthopnea

Answer 8

difficulty breathing in supine position (state # of pillows needed to sleep)

Question 9

Define paroxysmal nocturnal dyspnea

Answer 9

wakening from sleep with SOB, need to be upright

Question 10

Chest expansion is unequal with ______ (3 example of conditions)

Answer 10

pneumonia, thoracic trauma (fractured ribs), pneumothorax

Question 11

Tactile fremitus
-most prominent _________
decreased fremitus with ______
increased fremitus with _____

Answer 11

most prominent between scapulae and around sternum - think where bronchi are close to chest wall

decreased fremitus with pleural effusion, pneumothorax, emphysema
increased fremitus with consolidation (pneumonia)

Question 12

Percussion
-normal in healthy lung tissue is _____

_______ with too much air (emphysema, pneumothorax)
_______ with density (pneumonia, pleural effusion, tumour)

Answer 12

resonance = normal

hyperresonance = too much air

dull = consolidation

Question 13

Increased breath sounds can occur with ____ and _____

Answer 13

consolidation (pneumonia) or compression (pleural effusion) –> increases density –> enhances transmission of sound

Question 14

Describe

• bronchophony
• egophony
• whispered pectoriloquy

Answer 14

Bronchophony: say 99 (normal = muffled, abnormal = clear with increased lung density)
Egophony = eeeee sounds like aaaaa
Whispered pectoriloquy: whispered is very clear and distinct with small consolidation (normally faint, muffled)

Question 15

Define FVC and FEV1

Normal finding FEV1: FVC

Answer 15

FVC: total volume exhaled (inhale deeply and do a full exhale)

FEV1: volume exhaled in first second

Normal FEV1: FEV: 75-80%

Question 16

Define hyperventilation and tachypnea

Answer 16

Hyperventilation: increase in rate and depth of respirations
Tachypnea: rapid and shallow, increased rate >24/min

Question 17

Define bradypnea and hypoventilation

Answer 17

Bradypnea: slow RR<10
Hypoventilation: irregular and shallow breathing

Question 18

What are 2 conditions that must be present for tactile fremitus to be apparent?

Answer 18

• at least one patent bronchus

- consolidation must be close to surface