OHCEPS - Respiratory System Flashcards
Lower respiratory tract?
Larynx and below.
Trachea divides to left and right main bronchi - where?
At the “carina” level with the sternal angle.
Further divisions before reaching alveoli - number?
About 25.
Bronchioles?
Last 16 orders are termed bronchioles:
- No cartilage
- Fewer goblet cells
- Progressively less muscular walls
Anterior chest exam - which lobes?
Upper and middle (right) - lower lobes from behind.
Horizontal fissure?
Separates upper from middle lobe (right).
Corresponds to 4th and 6th ribs anteriorly - EASILY MISSED.
Inferior border of the lung - anteriorly/posteriorly?
Anteriorly –> 6th rib.
Posteriorly –> 12th rib.
Mechanism of cough?
Cough receptors in the pharynx and lower airways initiate mechanisms resulting in deep inspiration followed by expiration against a closed glottis and a sudden glottal opening –> rapid, forceful expulsion of air which we know as a cough.
Dyspnea - what is it?
Shortness of breath - the sensation that one has to use an abnormal amount of effort in breathing.
Patients say –> “breathlessness”, “inability to get their breath”, “shortwinded”, “tightness” (may actually mean asthma, or may be chest pain).
Pleuritic pain and dyspnea?
Pleuritic pain is worse at the height of deep inspiration –> patients may say they are NOT ABLE TO GET MY BREATH.
Dyspnea - Sudden onset?
- Pulmonary embolus
- Pneumothorax
- Asthmatic attacks
Dyspnea - onset over days/weeks?
- Pneumonia
- HF
- Anemia
Dyspnea - severity?
Quantify by asking “How many flight of stairs?” etc.
BE SURE that activities are restricted by shortness of breath (SOB) as opposed to arthritic hips, knees, chest pain, or some other ailment.
Hyperventilation syndrome?
Decr. in blood CO2 will cause paresthesia in the lips and fingers along with light headedness and, in severe cases, tetany.
Cough may be the ONLY symptom of what?
Childhood asthma.
Chronic cough - def?
Lasting >3weeks.
Chronic cough - etiology?
- Asthma
- Carcinoma
- Interstitial disease
- Bronchiectasis
- GERD
- Post-nasal drip
- Smokers - particularly in the morning.
Character of cough - cough with a hoarse voice?
Laryngitis
Character of cough - dry and painful?
Tracheitis
Character of cough - sharp pain (chest wall)?
Pleurisy
Character of cough - tickly?
Post-nasal drip.
Character of cough - chronic, paroxysmal, worse after exercise and at night?
Asthma
Character of cough - dry and nauseating. Often first thing in the morning.
GERD
Character of cough - nauseating and worse after eating?
Tracheo-esophageal fistula (rare).
Character of cough - “barking”?
Epiglottitis
Character of cough - “bovine” hollow, brassy?
Laryngeal nerve palsy.
Character of cough - productive and worse on lying flat?
LHF.
Cough - NON pulmonary etiology?
- Post-nasal drip
- GERD
- Pharyngeal pouch or tracheo-esophageal pouch
- ACE inhibitors
Sputum - features to clarify?
- How often?
- How much?
- How difficult is to cough up?
- Colour?
- Consistency?
- Smell?
Green-colored sputum may ALSO be what?
Eosinophils in the sputum of asthmatics.
Miniature tree-like bronchial casts (sputum)?
Bronchopulmonary aspergillosis
Hemoptysis - must clarify?
- Amount
- Color
- Frequency
- Nature of any associated sputum
- Easily CONFUSED with blood originating in the nose, mouth, and GI tract (hematemesis)
Massive hemoptysis?
> 500mL in 24hr.
Hemoptysis - etiology?
- Bronchitis
- Carcinoma
- Pulmonary embolus
- Infarction
- TB
- CF
- Lung abscesses
Infectious causes of hemoptysis?
Usually produce blood-stained SPUTUM as opposed to pure hemoptysis.
Hemoptysis - be alert for what?
Other potential sites of bleeding: 1. Skin 2. GI tract 3. Mouth which could point to a coagulation disorder.
White/grey sputum?
Asthma - smoking.
Green/yellow sputum?
- Bronchitis
2. Bronchiectasis
Green and offensive sputum?
- Bronchiectasis
2. Abscesses
Sticky/rusty sputum?
Lobar pneumonia
Frothy/pink sputum?
CHF
Separates to 3 layers sputum?
SEVERE bronchiectasis –> mucoid, watery, rusty.
Very sticky, often green sputum?
Asthma
Sticky, with plugs?
Allergic aspergillosis (complication of asthma).
Wheeze - what is it?
High-pitched whistling “musical” sound produced by narrowing of airways, large or small.
Wheeze - when?
On inspiration + expiration - usually more prominent in EXpiration.
Wheeze due to small airway narrowing - as in asthma?
Will be accompanied by a prolonged expiratory phase.
Wheeze - etiology?
- Asthma
- Smoking related lung disease
- Mucosal edema
- Airway obstruction
- Airway collapse
- Pulmonary edema (‘cardiac asthma’)
Stridor?
A harsh “crowing” inspiratory + expiratory sound with a CONSTANT pitch.
Stridor - cause?
LARGE airway narrowing usually at the LARYNX/TRACHEA.
Can precede complete airway obstruction so is treated as a medical emergency.
Pleuritic pain - features?
- Arises from the pleura or mediastinum - LUNGS DO NOT HAVE PAIN FIBERS.
- Severe, sharp pain at the height of inspiration OR on coughing.
- Usually localized to a small area of chest
- Patient will avoid DEEP BREATHING and may complain of breathlessness.
Pain from lung parenchymal lesions?
May be dull and constant - usually a sign of direct spread into the chest wall.