Chapter 19: Thorax and Lungs Flashcards
Alveoli
Functional units of the lung; the thin-walled chambers surrounded by networks of capillaries that are the site of respiratory exchange of carbon dioxide and oxygen
Angle of Louis
Manubriosternal angle, the articulation of the manubrium and body of the sternum, continuous with the second rib
Apnea
Cessation of breathing
Asthma
An abnormal respiratory condition associated with allergic hypersensitivity to certain inhaled allergens, characterized by inflammation, bronchospasm, wheezing, and dyspnea
Atelectasis
An abnormal respiratory condition characterized by collapsed, shrunken, deflated sections of alveoli
Bradypnea
Slow breathing, fewer than 10 breaths per minute, regular rate
Bronchiole
One of the smaller respiratory passageways into which the segmental bronchi divide
Bronchitis
Inflammation of the bronchi with partial obstruction of bronchi due to excessive mucus secretion
Bronchophony
The spoken voice sound hear through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue
Bronchovesicular
The normal breath sound heard over major bronchi, characterized by moderate pitch and an equal duration of inspiration and expiration
Chronic obstructive pulmonary disease (COPD)
A functional category of abnormal respiratory conditions characterized by airflow obstruction (e.g. emphysema, chronic bronchitis_
Cilia
Millions of hairlike cells lining the tracheobronchial tree
Consolidation
The solidification of portions of lung tissue as it fills up with infectious exudate, as in pneumonia
Crackles
(Rales) abnormal, discontinuous, adventitious lung sounds heard on inspiration
Crepitus
Coarse, crackling sensation palpable over the skin when air abnormally escapes from the lungs and enters the subcutaneous tissue
Dead space
Passageways that transport air but are not available for gaseous exchange (e.g. trachea, bronchi)
Dyspnea
Difficult, labored breathing
Emphysema
Chronic obstructive pulmonary disease characterized by enlargement of alveoli distal to terminal bronchioles
Fissure
The narrow crack dividing the lobes of the lungs
Fremitus
A palpable vibration from the spoken voice felt over the chest wal
Friction rub
A coarse, grating, adventitious lung sound heard when the pleurae are inflamed
Hypercapnia
(Hypercarbia) increased levels of carbon dioxide in the blood
Hyperventilation
Increased rate and depth of breathing
Hypoxia
Decreased level of oxygen in the blood
Intercostal space
Space between ribs
Kussmaul respiration
Type of hyperventilation that occurs with diabetic ketoacidosis
Orthopnea
Ability to breathe easily only in an upright position
Paroxysmal nocturnal dyspnea
Sudden awakening from sleeping, with shortness of breath
Percussion
Striking over the chest wall with short, sharp blows of the fingers to determine the size and density of the underlying organ
Pleural effusion
Abnormal fluid between the layers of the pleura
Rhonchi
Low-pitched, musical, snoring, adventitious lung sounds caused by airflow obstruction from secretions
Tachypnea
Rapid, shallow breathing; more than 24 breaths per minute
Vesicular
Refers to soft, low-pitched, normal breath sounds heard over peripheral lung fields
Wheeze
High-pitched, musical, squeaking adventitious lung sound
Xiphoid process
Sword-shaped lower tip of the sternum
Describe the most important points about the health history for the respiratory system
j
Describe the pleura and its function
k
List the structures that compose the respiratory dead space.
h
Summarize the mechanics of respiration
j
List the elements included in the inspection of the respiratory system
h
Discuss the significance of a barrel chest
k
List and describe common thoracic deformities
k
List and describe 3 types of normal breath sounds
k
Define 2 types of adventitious breath sounds
k
The manubriosternal angle is also called ____. Why is it a useful landmark?
k
How many degrees is the normal costal angle?
k
When comparing the anteroposterior diameter of the chest with the transverse diameter, what is the expected ratio? What is the significance of this?
k
What is the tripod position?
j
List 3 factors that affect the normal intensity of tactile fremitus
k
During percussion, which sound would you expect to predominate over normal lung tissue?
k
List 5 factors that can cause extraneous noise during auscultation
k
Describe the 3 types of normal breath sounds (name, location, description)
d
Identify label “a”
Clavicle
Identify label “b”
2nd intercostal space
Identify label “c”
Costal cartilage
Identify label “d”
Dome of the diaphragm
Identify label “e”
7th intercostal space
Identify label “f”
Costal margin
Identify label “g”
Suprasternal notch
Identify label “h”
Manubrium of sternum
Identify label “i”
Manubriosternal angle (angle of Louis)
Identify label “j”
Costochondral junction
Identify label “k”
Body of sternum
Identify lable “l”
Xiphoid process
Identify label “m”
Costal angle
Identify label A
4th rib
Identify label B
Horizontal fissue
Identify label C
5th rib; midaxillary line
Identify label D
Right oblique fissure
Identify label E
Left oblique fissure
Identify label F
6th rib; midclavicular line
Identify label A
Oblique fissure
Identify label B
T3
Identify label C
T10
Identify label D
T12
Identify label E
Inspiration
Identify label F
Expiration
Identify label A
Vesicular
Identify label B
Bronchovesicular
Identify label A
Bronchial (tracheal)
Identify label B
Vesicular
Identify label C
Bronchovesicular
The manubriosternal angle is:
a. The articulation of the manubrium and the body of the sternum
b. A hollow, U-shaped depression just above the sternum
c. Also known as the breastbone
d. A term synonymous with chostochondral junction
k
Select the correct description of the left lung
a. Narrower than the right lung with three lobes
b. Narrower than the left lung with two lobes
c. Wider than the right lung with two lobes
d. Shorter than the right lung with three lobes
k
You assess a patient who reports a cough. The characteristic timing of the cough of chronic bronchitis is described as:
a. Continuous throughout the day
b. Productive for at least 3 months of the year for 2 consecutive years
c. Occuring in the afternoon or evening because of exposure to irritants at work
d. Occurring in the early morning
.
Which of the following assessments best confrims symmetric chest expansion?
a. Placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch a small fold of skin between the thumbs
b. Inspection of the shape and configuration of the chest wall
c. Placing the palmar surface of the fingers of one hand against the chest and having the person repeat the words “ninety-nine”
d. Percussion of the posterior chest
j
You are auscultating breath sounds on a patient. Which of the folloiwng best describes how to proceed?
a. Hold the bell of the stethoscope against the chest wall; listen to the entire right field and then the entire left field
b. Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side-to-side comparisons
c. Listen from the apices to the bases of each lung field using the bell of the stethoscope
d. Select the bell or diaphragm depending on the quality of sounds heard; listen for one respiration in each location, moving from side to side
,
Select the best description of bronchovesicular breath sounds.
a. High-pitched, of longer duration on inspiration than expiration
b. Moderate-pitched, inspiration equal to expiration
c. Low-pitched, inspiration grater than expiration
d. Rustling sound, like the wind in the trees.
.
After examining a patient, you not: fever, increased respiratoty rate, chest expansion decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with:
a. Bronchitis
b. Asthma
c. Pleural effusion
d. Lobar pneumonia
,
On examining a patient’s nails, you not that the angle of the nail base is > 160 degrees and that the nail base feels spongy to palpation. These findings are consistent with:
a. Acute respiratory distress syndrome
b. Normal findings for the nails
c. Congenital heart disease and COPD
d. Atelectasis
,
On ausculating a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient reports pain with breathing. These findings are consistent with:
a. Fine crackles
b. Wheezes
c. Atelectatic crackles
d. Pleural friction rub
,
To use the technique of egophony, ask the patient to:
a. Take several deep breaths and then hold for 5 seconds
b. Say “eeeee” each time the stethoscope is moved
c. Repeat the phrase “nintety-nine” each time the stethoscope is moved
d. Whisper a phrase as auscultation is performed
,
When examining for tactile fremitus, it is important to:
a. Ask the patient to breathe quickly
b. Ask the patient to cough
c. Palpate the chest symmetrically
d. Use the bell of the stethoscope
k
Pulse oximetry measures:
a. Arterial oxygen saturation of hemoglobin
b. Venous oxygen saturation of hemoglobin
c. Combined saturation of arterial and venous blood
d. Carboxyhemoglobin levels
,
A pleural friction rub is best detected by:
a. Observation
b. Palpation
c. Auscultation
d. Percussion
n
A patient has a barrel-shaped chest, characterized by:
a. Equal anteroposterior transverse diameterand ribs being horizontal
b. Anteroposterior transverse diameter of 1:2 and an elliptic shape
c. Anteroposterior transverse diameter of 2:1 and ribs being elevated
d. Anteroposterior transverse diameter of 3:7 and ribs sloping back
k
Apex:
a. Rests on the diaphragm
b. C7
c. Sixth rib, midclavicular line
d. Fifth intercostal
e. 3 to 4 cm above the inner third of the clavicles
g
Base:
a. Rests on the diaphragm
b. C7
c. Sixth rib, midclavicular line
d. Fifth intercostal
e. 3 to 4 cm above the inner third of the clavicles
v
Lateral left:
a. Rests on the diaphragm
b. C7
c. Sixth rib, midclavicular line
d. Fifth intercostal
e. 3 to 4 cm above the inner third of the clavicles
v
Lateral right:
a. Rests on the diaphragm
b. C7
c. Sixth rib, midclavicular line
d. Fifth intercostal
e. 3 to 4 cm above the inner third of the clavicles
h
Posterior apex
a. Rests on the diaphragm
b. C7
c. Sixth rib, midclavicular line
d. Fifth intercostal
e. 3 to 4 cm above the inner third of the clavicles
g
Normal chest:
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
k
Barrel chest
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
h
Pectus excavatum
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
j
Pectus carinatum
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
d
Scoliosis:
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
d
Kyphosis:
a. Anteroposterior = transverse diameter
b. Exaggerated posterior curvature of thoracic spine
c. Lateral S-shaped curvature of the thoracic and lumbar spine
d. Sunken sternum and adjacent cartilages
e. Elliptic shape with an anteroposterior to transverse diameter in the ratio of 1:2
f. Forward protrusion of the sternum with ribs sloping back at either side
d
