Exam 2: Respiratory Flashcards
1
Q
What structures define the respiratory system?
A
Sternum, 12 pairs of ribs, 12 pairs of thoracic vertebrae
2
Q
How is the thorax divided?
A
Anterior thorax, posterior thorax
3
Q
What are the ‘true ribs’?
A
Ribs 1-7, which attach directly to the sternum by costal cartilage
4
Q
What are ribs 8, 9, and 10 classified as?
A
False ribs, as they attach to the costal cartilage above
5
Q
What are ribs 11 and 12 known as?
A
Free floating ribs
6
Q
What is the costotransverse joint?
A
Joint between the tubercle of the rib and the transverse costal facet of the corresponding vertebra
7
Q
What is the costovertebral joint?
A
Joint between the head of the rib, superior costal facet of the corresponding vertebra, and the inferior costal facet of the vertebra above
8
Q
Describe rib 1.
A
Shorter and wider than other ribs, has one facet for articulation, marked by two grooves for subclavian vessels
9
Q
What is unique about rib 2?
A
Thinner and longer than rib 1, has two articular facets, and a roughened area for serratus anterior muscle origin
10
Q
What is the significance of the suprasternal notch?
A
U-shaped depression above the sternum between clavicles
11
Q
What is the manubriosternal angle also known as?
A
Angle of Louis, Sternal Angle
12
Q
Where is the manubriosternal angle located?
A
At the articulation of manubrium and sternum, continuous with the second rib
13
Q
What does the costal angle indicate?
A
The angle formed by the right and left costal margins meeting at the xiphoid process, usually less than 90 degrees
14
Q
What is the vertebra prominens?
A
The seventh cervical vertebra, most prominent bony spur at the base of the neck
15
Q
What is the inferior border of the scapula typically aligned with?
A
Usually at the 7th or 8th rib
16
Q
What is the thoracic cavity also known as?
A
Chest cavity
17
Q
What does the mediastinum contain?
A
Esophagus, trachea, heart, great vessels
18
Q
How many lobes does the right lung have?
A
3 lobes
19
Q
How many lobes does the left lung have?
A
2 lobes
20
Q
What is the apex of the lung?
A
The highest point of lung tissue, located 3 to 4 cm above the inner 1/3 of clavicle
21
Q
What is the base of the lung?
A
Lower border of lung, rests on diaphragm around the 6th rib, midclavicular line
22
Q
What is the pleural cavity normally filled with?
A
A few milliliters of lubricating fluid
23
Q
What is the function of the trachea and bronchi?
A
Transport gases between the environment and lung parenchyma
24
Q
What does the term ‘dead space’ refer to?
A
Space filled with air but not available for gaseous exchange, approximately 150 ml in adults
25
What is the acinus?
Functional unit consisting of bronchioles, alveolar ducts, alveolar sacs, and alveoli
26
What are some developmental concerns for infants and children regarding the respiratory system?
Increased vulnerability due to environmental tobacco smoke, leading to conditions like SIDS
27
What impact does aging have on the respiratory system?
Decreased vital capacity and increased residual volume due to structural changes
28
What is the second most commonly diagnosed cancer?
Lung cancer, often related to smoking
29
What is the most common chronic disease in childhood?
Asthma
30
What should you assess in a patient with respiratory issues?
Cough, shortness of breath, chest pain with breathing, history of respiratory infections, smoking history
31
What is the five A's approach to smoking cessation?
Ask, Advise, Assess, Assist, Arrange
32
What is important to ask about environmental exposure?
Occupational factors, protection from exposure, awareness of symptoms signaling breathing problems
33
What should be noted during inspection of the thoracic cage?
Shape and configuration of chest wall, position taken to breathe, skin color and condition
34
What is tactile fremitus?
Palpable vibrations assessed using hands during examination
| R to L, down then back to R, etc when assessing
35
What does percussion of lung fields help determine?
Predominant note over lung fields, typically low-pitched, clear, hollow sound in healthy lung tissue
36
What is the main purpose of auscultation in the respiratory examination?
To listen to characteristic sounds created by air passage through the tracheobronchial tree
37
What is the sound that predominates in healthy lung tissue in adults?
Low-pitched, clear, hollow sound
## Footnote
This sound is relative and has no defined standards.
38
What technique of measuring diaphragmatic excursion is no longer recommended?
Percussion Technique (?)
## Footnote
The traditional technique of measuring diaphragmatic excursion using percussion is no longer recommended due to its poor accuracy and variability
39
What are the three types of breath sounds normally heard in adults and older children?
* Bronchial
* Bronchovesicular
* Vesicular
## Footnote
These sounds have specific characteristics and locations.
40
What are added sounds that are not normally heard in the lungs called?
Adventitious sounds (crackles - rales; wheezing- rhonchi)
## Footnote
Common terms include crackles (or rales) and wheeze (or rhonchi).
41
Fine vs Coarse Crackles
Crackles are generated by small airways snapping open on inspiration.. Therefore, they are predominantly inspiratory. The difference between the course and fine crackles comes from the size of the airway snapping open (larger airways, deeper pitched, courser crackles).
## Footnote
These are known as atelectatic crackles and are not pathologic.
42
What is stridor?
Inspiratory crowing sound, loudest in neck
Sounds like a cough or bark, originating from the upper airway and occurring on inspiration
## Footnote
It is considered an adventitious sound.
43
What is normal voice transmission described as?
Soft, muffled, and indistinct
## Footnote
Sound can be heard through a stethoscope but cannot be distinctly understood.
44
What should be assessed during the inspection of the anterior chest?
* Shape and configuration of chest wall
* Patient’s facial expression
* Level of consciousness
* Skin color and condition
* Quality of respirations
* Symmetry
* Accessory muscles usage
## Footnote
These observations are crucial for a thorough assessment.
45
What is tactile fremitus?
Vibrations felt on the chest wall when a person speaks
## Footnote
This is assessed by comparing vibrations from one side to the other.
46
What is the normal range for a healthy person's SpO2?
97% to 98%
## Footnote
This assessment must consider the person’s Hb level, acid-base balance, and ventilatory status.
47
What is the Apgar scoring system used for?
Newborn’s first respiratory assessment to measure successful transition to extrauterine life
## Footnote
It evaluates the health of newborns immediately after birth.
48
What is the normal respiratory rate for newborns?
30 to 40 breaths per minute
## Footnote
This rate may spike up to 60 breaths per minute.
49
What is the primary concern in patients with COPD during surgery?
Postoperative pulmonary complications
## Footnote
Patients with COPD are twice as likely to experience these complications.
50
What characterizes chronic bronchitis?
Productive cough for greater than 3 months for 2 successive years
## Footnote
It is not attributed to another cause.
51
What is the GOLD Classification of COPD used for?
Assess the severity of COPD and evaluate perioperative pulmonary risks
GOLD 1–4 staging is based on post-bronchodilator FEV₁ % predicted:
GOLD 1 (Mild): ≥80%
GOLD 2 (Moderate): 50-79%
GOLD 3 (Severe): 30-49%
GOLD 4 (Very Severe): <30%
52
What is the primary symptom of asthma?
Bronchoconstriction leading to intermittent cough, wheezing, chest tightness, and shortness of breath
## Footnote
These symptoms typically present before age 20.
53
What is cystic fibrosis?
An autosomal disorder caused by a mutation in CFTR found on epithelial cells most exocrine glands
Mutation causes:
- Abnormal / thickened secretions
- Abnormalities of other systems
Chronic and progressive
Causes luminal obstruction
-Obstructive lung disorder
## Footnote
It leads to abnormal, thickened secretions and causes luminal obstruction.
54
What are common physical findings in interstitial lung diseases?
* Fine crackles
* Clubbing of fingers
## Footnote
These findings are often present in patients with a history of occupational exposure.
55
What is the purpose of pulmonary function tests?
Diagnose lung diseases such as asthma and cystic fibrosis
## Footnote
They assess lung capacity and airflow.
56
What is the significance of the 6-minute walk test (6 MWT)?
A safer, simple, inexpensive clinical measure of functional status in aging adults
## Footnote
It helps assess physical endurance and health.
57
What are Interstitial Lung Diseases?
A group of restrictive lung diseases characterized by inflammation and fibrosis of the lung parenchyma
## Footnote
Interstitial Lung Diseases lead to decreased lung distensibility and increased recoil.
58
What are common symptoms of Interstitial Lung Diseases?
* Progressive dyspnea on exertion
* Non-productive cough
## Footnote
These symptoms often point to lung parenchyma involvement.
59
What physical finding is commonly associated with Interstitial Lung Diseases?
Fine crackles in lung sounds
## Footnote
Clubbing of fingers may also be observed.
60
What diagnostic methods are used for Interstitial Lung Diseases?
* Clinical evaluation
* Radiographs
* CT scans
* Surgical lung biopsy
## Footnote
These methods help in confirming the diagnosis.
61
What is the role of consultation with Pulmonology in Interstitial Lung Diseases?
To optimize medical management and monitor for exacerbations
## Footnote
Pulmonologists specialize in lung diseases.
62
How can some Interstitial Lung Diseases affect other body systems?
They can involve cardiac, renal, and hepatic systems
## Footnote
Examples include sarcoidosis and systemic lupus.
63
What is Obstructive Sleep Apnea (OSA)?
A condition characterized by repetitive upper airway collapse leading to apnea lasting 10 seconds or longer
Decrease in saturation by 3-4%
Affects 9-25% of the general population.
64
What is the standard screening method for OSA pre-operatively?
Overnight polysomnography (PSG)
## Footnote
This determines the Apnea-hypopnea index (AHI).
65
What are the AHI ranges for different severities of OSA?
* Mild OSA: 5-14
* Moderate OSA: 15-30
* Severe OSA: >30
## Footnote
AHI indicates the number of abnormal respiratory events in an hour.
66
List some screening tools for OSA.
* STOP-Bang
* P-SAP
* Berlin
* ASA Checklist
## Footnote
These tools help in identifying patients at risk for OSA.
67
True or False: Insufficient evidence exists to cancel surgery when OSA is identified.
True
## Footnote
This applies as long as other co-morbidities are not present.
68
What is the leading cause of preventable morbidity and mortality?
Smoking
## Footnote
Long-term exposure leads to numerous health complications.
69
What are some complications associated with tobacco use?
* Reduced tissue perfusion
* Impaired immune function
* Increased mucus production
* Delayed wound healing
## Footnote
These factors contribute to increased surgical risks.
70
What is the benefit of smoking cessation 3-4 weeks before surgery?
Reduced surgical infections
## Footnote
This time frame also decreases respiratory complications.
71
What is a 'Teachable Moment' in smoking cessation?
A time when patients are more likely to quit due to increased surgical risks and poor healing
## Footnote
This can motivate patients to engage in smoking cessation efforts.
72
What is the recommended approach for smoking cessation discussions?
Ask, Advise, Connect
## Footnote
This includes referral and follow-up to improve treatment enrollment.
73
What is the ARISCAT score used for?
To predict overall risk of post-operative pulmonary complications (PPC)
## Footnote
It categorizes risk into low, intermediate, and high.
74
What are some post-operative respiratory complications?
Ranges from 3 – 6 %
-Atelectasis
-respiratory infections
-exacerbation of underlying pulmonary diseases
-Hypoxemia
- need for noninvasive mechanical ventilation
Post op Respiratory Complications
Other Causes --> Perioperative events
* Micro aspirations
* excessive administration of fluids and blood products
* Systemic inflammatory response
* Immunosuppression
75
How to identify Manubriosternal angle: Angle of Louis
Palpate 2nd rib and slide down to 2nd intercostal space
76
Importance of Manubriosternal angle: Angle of Louis
-Marks site of tracheal bifurcation into R and L main bronchi
-Corresponds with upper border of atria of the heart, and it lies above 4th thoracic vertebra on back
77
How to assess breath sounds?
-Both anterior and posterior.
-Use flat diaphragm of stethoscope and listen to at least one full respiration in each location.
-Perform bilateral comparison.
78
Bronchial Breath Sounds
-Location: Normal over the trachea
-Character: Loud, harsh, and high-pitched (also known as tubular or tracheal breath sounds)
-Predominance: Expiration is longer and louder than inspiration
-Normal Finding: These sounds are expected only over the trachea and major bronchi.
Bronchial sounds outside the trachea → May indicate lung consolidation (pneumonia).
79
Vesicular Breath Sounds
-Normally arise from the finer lung parenchyma (alveoli and smaller airways).
-Location: Heard best over the posterior lung bases but present throughout most lung fields.
-Character: Soft and low-pitched breath sounds. Predominantly inspiratory
Diminished or absent vesicular sounds → May suggest air trapping (emphysema), pleural effusion, or pneumothorax.
80
Bronchovesicular Breath Sounds
-Location: Normally heard over the upper third of the anterior chest (around the sternal borders)
-Character: Intermediate (mid-range) pitch and intensity—between bronchial and vesicular sounds.
-Heard equally during inspiration and expiration.
-Normal Finding: These sounds are expected over the large central airways (mainstem bronchi).
Bronchovesicular sounds in peripheral lung fields → May suggest early consolidation or partial atelectasis.
81
Atelectatic crackles
-Type of adventitious sound that is not pathologic
-Short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths
82
Wheezes (Rhonchi)
-Rhonchi are continuous sounds. Produced by the fluttering of narrowed airways and the air that flows through them
-Wheezes are high pitched
83
Borders of cardiac dullness normally found on anterior chest
-In R hemithorax, upper border of liver dullness is located in 5th intercostal space in right midclavicular line.
-Left, tympany is evident over gastric space.
84
Forced expiratory time
-# of seconds it takes to exhale from total lung capacity to residual volume.
-a screening measure of airflow obstruction.
85
Diagnosis of Asthma
Spirometry = diagnosis
Bronchoprovocation testing may be needed
Differentials
- other obstructive pulmonary conditions
- cystic fibrosis
- heart failure
- tracheal stenosis
86
Pathology of Asthma
chronic inflammatory disease affecting the
Airways
Bronchial hyperresponsiveness
airflow obstruction
Pathology
* chronic airway inflammation
* increased bronchial smooth muscle mass
* mucus hypersecretion
* luminal narrowing
87
CFTR functions as a chloride channel
- epithelial cells lining most exocrine glands.
- mutation causes changes in cellular electrolytes and water transport --> in abnormal and thickened secretions affecting multiple organs including sinuses, lungs, pancreas, hepatobiliary system, GI tract, and reproductive organs
88
PFT in CF
Decreased FEV1
Decreased FEV1 to FVC ratio
Increased residual volume
89
Lung Sounds in CF
Wheezing
Sounds consistent with upper airway secretions
