Exam 2: Respiratory Flashcards
What structures define the respiratory system?
Sternum, 12 pairs of ribs, 12 pairs of thoracic vertebrae
How is the thorax divided?
Anterior thorax, posterior thorax
What are the ‘true ribs’?
Ribs 1-7, which attach directly to the sternum by costal cartilage
What are ribs 8, 9, and 10 classified as?
False ribs, as they attach to the costal cartilage above
What are ribs 11 and 12 known as?
Free floating ribs
What is the costotransverse joint?
Joint between the tubercle of the rib and the transverse costal facet of the corresponding vertebra
What is the costovertebral joint?
Joint between the head of the rib, superior costal facet of the corresponding vertebra, and the inferior costal facet of the vertebra above
Describe rib 1.
Shorter and wider than other ribs, has one facet for articulation, marked by two grooves for subclavian vessels
What is unique about rib 2?
Thinner and longer than rib 1, has two articular facets, and a roughened area for serratus anterior muscle origin
What is the significance of the suprasternal notch?
U-shaped depression above the sternum between clavicles
What is the manubriosternal angle also known as?
Angle of Louis, Sternal Angle
Where is the manubriosternal angle located?
At the articulation of manubrium and sternum, continuous with the second rib
What does the costal angle indicate?
The angle formed by the right and left costal margins meeting at the xiphoid process, usually less than 90 degrees
What is the vertebra prominens?
The seventh cervical vertebra, most prominent bony spur at the base of the neck
What is the inferior border of the scapula typically aligned with?
Usually at the 7th or 8th rib
What is the thoracic cavity also known as?
Chest cavity
What does the mediastinum contain?
Esophagus, trachea, heart, great vessels
How many lobes does the right lung have?
3 lobes
How many lobes does the left lung have?
2 lobes
What is the apex of the lung?
The highest point of lung tissue, located 3 to 4 cm above the inner 1/3 of clavicle
What is the base of the lung?
Lower border of lung, rests on diaphragm around the 6th rib, midclavicular line
What is the pleural cavity normally filled with?
A few milliliters of lubricating fluid
What is the function of the trachea and bronchi?
Transport gases between the environment and lung parenchyma
What does the term ‘dead space’ refer to?
Space filled with air but not available for gaseous exchange, approximately 150 ml in adults
What is the acinus?
Functional unit consisting of bronchioles, alveolar ducts, alveolar sacs, and alveoli
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
What impact does aging have on the respiratory system?
Decreased vital capacity and increased residual volume due to structural changes
What is the second most commonly diagnosed cancer?
Lung cancer, often related to smoking
What is the most common chronic disease in childhood?
Asthma
What should you assess in a patient with respiratory issues?
Cough, shortness of breath, chest pain with breathing, history of respiratory infections, smoking history
What is the five A’s approach to smoking cessation?
Ask, Advise, Assess, Assist, Arrange
What is important to ask about environmental exposure?
Occupational factors, protection from exposure, awareness of symptoms signaling breathing problems
What should be noted during inspection of the thoracic cage?
Shape and configuration of chest wall, position taken to breathe, skin color and condition
What is tactile fremitus?
Palpable vibrations assessed using hands during examination
What does percussion of lung fields help determine?
Predominant note over lung fields, typically low-pitched, clear, hollow sound in healthy lung tissue
What is the main purpose of auscultation in the respiratory examination?
To listen to characteristic sounds created by air passage through the tracheobronchial tree
What is the sound that predominates in healthy lung tissue in adults?
Low-pitched, clear, hollow sound
This sound is relative and has no defined standards.
What technique of measuring diaphragmatic excursion is no longer recommended?
Technique of measuring diaphragmatic excursion
This refers to the method used to assess how well the diaphragm moves during breathing.
What are the three types of breath sounds normally heard in adults and older children?
- Bronchial
- Bronchovesicular
- Vesicular
These sounds have specific characteristics and locations.
What are added sounds that are not normally heard in the lungs called?
Adventitious sounds
Common terms include crackles (or rales) and wheeze (or rhonchi).
What are fine crackles?
Short, popping, crackling sounds that sound like fine crackles but do not last beyond a few breaths
These are known as atelectatic crackles and are not pathologic.
What is stridor?
Inspiratory crowing sound, loudest in neck
It is considered an adventitious sound.
What is normal voice transmission described as?
Soft, muffled, and indistinct
Sound can be heard through a stethoscope but cannot be distinctly understood.
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
These observations are crucial for a thorough assessment.
What is tactile fremitus?
Vibrations felt on the chest wall when a person speaks
This is assessed by comparing vibrations from one side to the other.
What is the normal range for a healthy person’s SpO2?
97% to 98%
This assessment must consider the person’s Hb level, acid-base balance, and ventilatory status.
What is the Apgar scoring system used for?
Newborn’s first respiratory assessment to measure successful transition to extrauterine life
It evaluates the health of newborns immediately after birth.
What is the normal respiratory rate for newborns?
30 to 40 breaths per minute
This rate may spike up to 60 breaths per minute.
What is the primary concern in patients with COPD during surgery?
Postoperative pulmonary complications
Patients with COPD are twice as likely to experience these complications.
What characterizes chronic bronchitis?
Productive cough for greater than 3 months for 2 successive years
It is not attributed to another cause.
What is the GOLD Classification of COPD used for?
Assess the severity of COPD and evaluate perioperative pulmonary risks
It aids in optimizing medical management before surgery.
What is the primary symptom of asthma?
Bronchoconstriction leading to intermittent cough, wheezing, chest tightness, and shortness of breath
These symptoms typically present before age 20.
What is cystic fibrosis?
An autosomal disorder caused by a mutation in CFTR found on epithelial cells
It leads to abnormal, thickened secretions and causes luminal obstruction.
What are common physical findings in interstitial lung diseases?
- Fine crackles
- Clubbing of fingers
These findings are often present in patients with a history of occupational exposure.
What is the purpose of pulmonary function tests?
Diagnose lung diseases such as asthma and cystic fibrosis
They assess lung capacity and airflow.
What is the significance of the 6-minute walk test (6 MWT)?
A safer, simple, inexpensive clinical measure of functional status in aging adults
It helps assess physical endurance and health.
What are Interstitial Lung Diseases?
A group of restrictive lung diseases characterized by inflammation and fibrosis of the lung parenchyma
Interstitial Lung Diseases lead to decreased lung distensibility and increased recoil.
What are common symptoms of Interstitial Lung Diseases?
- Progressive dyspnea on exertion
- Non-productive cough
These symptoms often point to lung parenchyma involvement.
What physical finding is commonly associated with Interstitial Lung Diseases?
Fine crackles in lung sounds
Clubbing of fingers may also be observed.
What diagnostic methods are used for Interstitial Lung Diseases?
- Clinical evaluation
- Radiographs
- CT scans
- Surgical lung biopsy
These methods help in confirming the diagnosis.
What is the role of consultation with Pulmonology in Interstitial Lung Diseases?
To optimize medical management and monitor for exacerbations
Pulmonologists specialize in lung diseases.
How can some Interstitial Lung Diseases affect other body systems?
They can involve cardiac, renal, and hepatic systems
Examples include sarcoidosis and systemic lupus.
What is Obstructive Sleep Apnea (OSA)?
A condition characterized by repetitive upper airway collapse leading to apnea lasting 10 seconds or longer
Affects 9-25% of the general population.
What is the standard screening method for OSA pre-operatively?
Overnight polysomnography (PSG)
This determines the Apnea-hypopnea index (AHI).
What are the AHI ranges for different severities of OSA?
- Mild OSA: 5-14
- Moderate OSA: 15-30
- Severe OSA: >30
AHI indicates the number of abnormal respiratory events in an hour.
List some screening tools for OSA.
- STOP-Bang
- P-SAP
- Berlin
- ASA Checklist
These tools help in identifying patients at risk for OSA.
True or False: Insufficient evidence exists to cancel surgery when OSA is identified.
True
This applies as long as other co-morbidities are not present.
What is the leading cause of preventable morbidity and mortality?
Smoking
Long-term exposure leads to numerous health complications.
What are some complications associated with tobacco use?
- Reduced tissue perfusion
- Impaired immune function
- Increased mucus production
- Delayed wound healing
These factors contribute to increased surgical risks.
What is the benefit of smoking cessation 3-4 weeks before surgery?
Reduced surgical infections
This time frame also decreases respiratory complications.
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
This can motivate patients to engage in smoking cessation efforts.
What is the recommended approach for smoking cessation discussions?
Ask, Advise, Connect
This includes referral and follow-up to improve treatment enrollment.
What is the ARISCAT score used for?
To predict overall risk of post-operative pulmonary complications (PPC)
It categorizes risk into low, intermediate, and high.
What are some post-operative respiratory complications?
- Atelectasis
- Respiratory infections
- Hypoxemia
These complications can arise from various perioperative events.
