CVR 1 SOL Flashcards by Maggie Yu

What is auscultation?

process of listening and interpreting the sounds produced within the thorax

part of full respiratory Ax

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How breath sounds are generated:

By_____ air flow

As the air passes through progressively ____ airways during _____, turbulence and sound is generated

Breath sounds are composed of ___(3) frequencies

During expiration air moves from ___ to ___ airways so sound is only generated at the ____. The rest of _____ being quiet

turbulent;
progressively smaller; during inspiration;

high, medium and low

smaller to larger; initial phase of expiration; expiration

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most of the air circulate in the ___ respiratory tract (thus louder)

upper

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another name for normal breath sound

vesicular sounds

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Normal breath sound:

The higher frequencies are attenuated by the ______

Normal breath sounds are heard during what phases?

There will be variation in normal breath sounds depending on (2)

normal aerated/inflated lung tissue

throughout inspiration and during the initial part of expiration

the thickness of the chest wall or body size

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Attenuated =?

filtered out

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Normal breath sounds is like?

Soft and low pitched

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Bronchial breath sounds are normal in ____ (2)
abnormal when heard ____

tracheal and large airways only;
heard over areas of consolidated lungs

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Bronchial breath sounds is?

It is the sound transmitted through airless lung, which then cannot attenuate the higher frequencies

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Bronchial breath sounds: The sound heard is therefore much ___ in frequency, __ and ___

higher; loud; high pitched

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Bronchial breath sounds: Heard throughout ___, with a short pause ___

both inspiration and expiration equally; between the two

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bronchial breathing Vs
vesicular breathing

bronchial breathing: heard over the tracheobronchial tree

vesicular breathing: heard over the lung tissue

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Reasons for Reduced breath sounds: (5)

Reduction in the _____ Either can’t or won’t take a deep breath

When there is an increase in ___ i.e. emphysematous lungs

Localised reduced breath sounds may be due to _____ by tumour or sputum/mucus plugs

_____(2) in the pleural space will block sound transmission

____ barrier i.e. obese

Initial generation of the sound;
sound attenuation;
an obstructed bronchus;
Air or fluid;
Acoustic

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types of abnormal/added lung sounds (4)

wheeze
crackles
pleural rub
stridor

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describe wheeze

blowing a musical horn

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describe crackles

shoveling rocks/ small rocks popping

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describe pleural rub

walking w a suitcase on old wooden floor

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describe stridor

move a straw up and down; windshield wipers w/o rain

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Wheezes:
Generated by _____

They are normally heard on ___, and when it is more severe it will be heard during ____

airflow vibrating within a narrowed or compressed airway

expiration first; inspiration

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_____ wheeze is caused by single obstructed airways

Polyphonic wheeze is caused by widespread disease

Monophonic; Polyphonic wheezes

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Wheezes are common in what population (2)

Asthma & COPD

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Crackles are caused by

(popping) opening of previously closed (collapsed) alveoli and small airways

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2 types of Crackles

fine/rales
coarse/ rhonchi

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_____ crackle tend to be loud, low pitched, tend to be heard during EARLY INSP and possibly exp. Fluid or sputum in the larger airways. Will often clear post cough or physio

Coarse

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____Crackle tend to be high pitched and heard at END INSP. Pulmonary oedema, pulmonary fibrosis, bronchiectasis.

Fine

walking on fresh snow Could be confused with crackles It occurs with each breath During inspiration and expiration Caused by inflammation, infection or a neoplasm

Pleural Rub

how to diff Pleural Rub and Crackle

ask pt to cough

can hear w or w/o stethoscope extremely loud sound during INSP and EXP

Stridor

Stridor Suggests ___ obstruction

tracheal or laryngeal obstruction (upper airway narrowing)

Where to begin with auscultation (anything)

Listen to external noise first Correct insertion of ear tips into your ear canal! Turn stethoscope on! Good positioning of patient if possible Stethoscope to touch bare skin Auscultate with the diaphragm of the stethoscope Ask the patient to breathe in and out through their mouth Listen to equal position on each side to allow you to compare the two Pick up on something? Listen to multiple cycles to identify wt you are hearing

why ask pt to breath via mouth than nose?

generate less turbulence

sound from apex vs base L vs R same or diff

diff same

Def ventilation

mvmt of air in and out of the lungs

Def respiration

occurrence of gas exchange

ventilation and respiration involve which 2 systems?

CVS and neurological system

Def external respiration

gas exchange b//w env and bloodstream

Def gas transport

transportation of O2 and CO2 to/form the lungs in the blood

Def internal respiration

mvmt of O2 from the blood to the cells and CO2 from the cells to the blood

Factors affecting ventilation

weak muscles of ventilation neurological problem - messages not getting to muscles from brain. skeletal problem. pain. blockage in the main airway.

Factors affecting external respiration (4)

air getting into the lungs but not where it needs to be for gas exchange. partial lung collapse. atelectasis (lungs not expanding) bronchospasm

Factors affecting Gas Transport (3)

blood clots in the pulmonary circulation. low levels of Hb. consolidated lung - dense lung tissue due to pneumonia.

Factors affecting internal respiration (3)

reduced circulation. blood clots in the peripheral circulation. narrowed arteries

functions of nasal cavity (7)

1st line of defence - protect the LRT. moistens/humidifies filters. slow breath warm airs increase turbulence produce mucus

cilia is on what cells

mucosal epithelial cells

function of goblet cells

mucus production

why nasal cavity is highly vascularized?

warms the air

function of conchae in nasal cavity

increase SA, turbulence, help ensure most of air comes into contact with mucus membrane

sinuses function

resonation for vocalisation

pharynx function

passageway for air and food/drink

larynx contain (2)

epiglottis vocal folds & voice box

function of epiglottis

prevents aspiration/food from entering airways

vocal folds and voice box function

voice and cough

trachea bifurcates at ?

t4/5 right is more acute - increased risk aspiration

function of C shaped cartilage rings

stability and prevent trachea from collapsing

CXR: sputum is not ___?

radio opaque

lv of absorption of x-ray (high/low) blackest = whitest =

low high

CXR: PA vs AP imaging meaning?

PA - x-ray go from posterior to anterior (closest to detection plate)

CXR: why PA imaging gold standard?

scapular is out of the way PA - true representation of heart AP - enlarged heart (when pt can't stand erect)

CXR: what is silhouette sign?

loss of the expected interface normally created by 2 structures of different density. no boundary can be seen b//w 2 structures of similar density

CXR: 3 borders where silhouette sign can occur

heart borders costophrenic angles diaphragms

CXR: RIP =?

rotation inspiration penetration

CXR: Penetration/ Exposure? Under or over exposed? How to identify this?

underexposed = white overexposed = black

ABCDE

airway breathing circulation disability exposure

CXR: what indicate good exposure

see spine through the heart

CXR: indication of good penetration

rib 6-7 ant dissect w diaphragm at mid-clavicular line

CXR: indication of sufficient inflation (ant/post view)

ant 6-7 ribs dissect the diaphragm post 9-10 ribs > = hyperinflation < = insufficient inflation

CXR: how to determine if there's rotation

check if the clavicle ends equal distance from the spinous processes