M1 Review

Question 1

Contrast the localization of wheezing or rhonchi vs. crackles.

Answer 1

wheezing or rhonchi are in the airway (non-alveoli)

crackles are in the lung parenchyma (alveoli)

Question 2

What are wheezes and how are they created?

Answer 2

a polyphonic whistling sound made by the high-velocity flow of air through a narrowed bronchial tube

Question 3

What are rhonchi and how are they created?

Answer 3

a coarse rattling sound somewhat like snoring, usually caused by secretions in the bronchial tube

Question 4

What are rales and how are they created?

Answer 4

rales are also called crackles, a small clicking, bubbling or rattling sound in the lung believed to occur when air opens closed air spaces (can be further described as moist, dry, fine and coarse)

Question 5

What are adventious breath sounds?

Answer 5

arising form an external source or occurring in an unusual place or manner

Question 6

LIst the different parts of the cartilaginous, non cartilaginous and gas exchange portions of the lower airway.

Answer 6

cartilaginous airways: trachea, main, lobar, segmental bronchi
noncartilagenious airways: bronchioles and terminal bronchioles
gas exchange: respiratory bronchioles, alveolar ducts, alveolar sacs

Question 7

What differential diagnosis would you consider for wheezing?

Answer 7

uncontrolled asthma
COPD
cystic fibrosis
bronchiectasis
(acute pulmonary edema)

Question 8

What is hypersensitivity pneumonitis?

Answer 8

inflammation of the alveoli due to hypersensitivity to inhaled organic dust

tx. with supplemental oxygen and prednisone for (3) months with taper

Question 9

At what point is there no more cartilage in the airways?

Answer 9

at the level of the bronchiole

Question 10

What can be included in the differential diagnosis for crackles?

Answer 10

interstitial lung disorders: pneumonitis, sarcodosis, hypersensitivity pneumonitis, asbestosis

also with pneumonia or pulmonary edema

Question 11

Which type of pneumocyte is involved in gas exchange?

Answer 11

type I, type II produces surfactant and is proliferative

Question 12

What are factors that shift the oxygen saturation curve to the right?

Answer 12

acidosis, increased temperature, increased 2,3 DPG (think of an exercising muscle)

Question 13

Name 3 conditions that result in decreased breath sounds (focal).

Answer 13

Mucous plug with atelectasis
pleural effusion
pneumothorax