Pulmonary Exam 1 Flashcards
1
Q
anterior location of right horizontal fissure
A
between ribs 3-4
2
Q
anterior location of right oblique fissure
A
rib 6
3
Q
anterior location of lower lobe
A
lateral; this lobe is mostly posterior
4
Q
anterior location of left oblique fissure
A
about rib 6
5
Q
anterior location of lingula
A
left lobe; about ribs 4-6
6
Q
posterior location of left oblique fissure
A
about rib 4/root of spine of scapula
7
Q
posterior location of lower lobes
A
ribs 4-10
8
Q
generation at which cold; dry air fully conditioned
A
usually 12th gen; lower in subfreezing temps
9
Q
First level of respiratory division
A
respiratory bronchioles; then alveolar ducts; alveolar sacs; alveoli (generations 17-23)
10
Q
innervation of parietal pleura
A
intercostal nerves (against costal and lateral diaphragm surfaces); phrenic nerve (against superior medial diaphragm surface)
11
Q
symptom of diaphragmatic pleurisy
A
neck pain only when breathing (C3-4)
12
Q
test of pleurisy vs musculoskeletal pain
A
exhale and then move; if no movement (only breathing) produces pain; probably pleurisy
13
Q
when is pleurisy common?
A
after pnemonia
14
Q
Fissures in lungs
A
each lung has oblique fissure; only right has horizontal
15
Q
lung more likely to aspirate
A
Right; because the right mainstem bronchus is more vertical
16
Q
What is the carina
A
where trachea splits into L and R bronchi
17
Q
What defines a bronchopulomary segment
A
segmental bronchi (10 on R; 8 on L) and the lung it supplies
18
Q
Right lower lobe segments
A
LAMPS (lateral; anterior; medial; posterior; superior)
19
Q
Left lower lobe segments
A
ALPS (anterior; lateral; posterior; superior)
20
Q
Trendeleburg position
A
head below pelvis
21
Q
Lowest generation a cough can clear
A
upper 7 generations
22
Q
Collateral ventilation
A
connection formed from one bronchiole to the next; can be created by deep breathing
23
Q
Pores of Kohn
A
holes between alveoli; either for immune function or allows air to pass through
24
Q
After 12th generation
A
no cartilage (so can easily change size or collapse); mucous cells; or cillia. Increase in Elastic fibers and smooth muscle cells
25
inspiration muscles
diaphragm; external intercostals; parasternal intercostals; SCM; scalenes; serratus anterior; pecs; traps; erector spinae
26
expiration muscles
internal intercostals; abs (but mostly passive unless exercise or pathology)
27
Diaphragm % tidal volume when resting
2/3 when sitting; 3/4 when supine because more excursion
28
function of pneumotaxic center
in pons; slows inspiration by inhibiting apneustic center
29
function of apneustic center
encourage inspiration
30
fuction of vagal fibers; Hering-Breuer reflex
stretch receptors; used in fast breathing
31
Control of ventilation
CO2 level is main drive (PCO2 in CSF); central chemoreceptors in medulla. secondary drive from peripheral chemoreceptors in aortic arch which mainly monitors PO2; but if PCO2 is normal; PO2 must drop to 50mmHg before ventilation increases
32
properties of a CO2 retainer
peripheral chemoreceptors more controlling; common in COPD; depend more on PO2 level to control breathing rate; so if you give them more oxygen; their breath rate slows becuase the hypoxic drive to breathe is turned off. Treatment is to improve breathing pattern
33
autonomic input to lungs
sympathetic acts on beta 2 receptors; parasympathetic acts on cholinergic receptors
34
effect of decreased PO2 in alveoli
vasoconstriction in pulmonary capillary
35
restrictive disease hallmark
hard to get air in; comes out quickly; stiffness of lung itself or chest wall; lack of compliance; should take fast shallow breaths
36
obstructive disease hallmark
increased compliance ->increased work of breathing to overcome airflow resistance; can take big breath; hard to get all air out; should take deep slow breaths
37
surfactant functions
dec surface tension so the alveoli don't collapse; increase alveolar compliance to decrease work of breathing (produced in type 2 cells)
38
location of highest airflow resistance
beginning/larger airways; more turbulent flow; lower total cross section
39
PO2 levels (mmHg)
Environment: 160; Alveoli: 105; arteries: 100; Veins:40; mitochondria:
40
PCO2 levels (mmHg)
Environment: 0.3; alveoli: 40; arteries: 40; veins: 46
41
most diffusible gas
CO2 (more likely to be hypoxemic than hypercapnic)
42
hyper/hypoventilation determined by
PCO2 levels
43
dependent zone
lowest point in lung; dependent on body position; more compliant; Q>V; more air to dependent zone at normal tidal volumes
44
independent zone
uppermost part of lung; alveoli more expanded; V>Q; at low tidal volume more air in independent zone
45
functional residual capacity in different body postions
standing>sitting>supine (FRC is capacity when you stop breathing out at normal tidal volume)
46
equal pressure point
where pressure in airway=pressure outside of it; beyond the EPP the airway can collapse if it doesn't have carilage; huffing moves EPP more proximal compared to coughing
47
closing capacity
closing volume+residual volume; volume at which the respiratory bronchioles start to collapse
48
larynx location in neonates
high larynx; can breathe and swallow at the same time up to 3-4 months; obligitory nose breathers
49
neonate alveolar surface
1/20 adult
50
what contributes to upper airway obstruction in small infants?
enlarged lymphatic tissue
51
effect of neonates having less collateral ventilation
more prone to atelectasis and infection
52
neonate chest wall anatomy
circular rib cage (gravity pulls them down when they start to sit) and horizontal diaphragmatic angle of insertion; neonates are belly breathers but have low percent of type 1 fibers (25% in infant; 50% in adult); rib cage more cartilaginous so less efficient ventilation and more chest wall distortion
53
Severity of obstructive disease in infants and young children
worse due to greater density of mucous glands vs the size of their bronchial surface
54
age at which bronchiole smooth muscle develops
3-4 years
55
air conductance increases at what age?
about 5 years
56
pulmonary reserve in infants and children
less reserve to rely on when ill due to smaller lung volumes
57
compliance in infants
decreased compliance in lungs and increased compliance in chest wall->increased work of breathing
58
infant respiratory patterns
irregular
59
neonate compensation for repiratory difficulties
increase rate rather than increasing depth
60
change in work of breathing during REM
increased due to increased intercostal muscle tone
61
cough reflex in infants
weak or absent
62
PaO2 level at which cyanosis occurs
about 50 mmHg
63
Apneustic breathing
slow rate; deep prolonged inspiration followed by apnea; associated with brainstem disorders
64
kussmal's breathing
fast rate; increased depth; regular rhythm; associated with metabolic acidosis; trying to blow off CO2; common in diabetes
65
cheyne-stokes breathing
increasing then decreasing depth followed by apnea; very irregular pattern; associated with critical illness
66
respiratory alternans
cyclic pattern of breathing alternating between abdominal and upper rib cage movement patterns; often sign of ventilatory muscle fatigue
67
abdominal paradox; strong diaphragm with weak abdominals
abdomen rises excessively during inspiration and thorax is pulled inward; during exhalation abdomen falls and thorax moves outward
68
abdominal paradox: weak or paralyzed diaphragm and normal upper accessory muscles
during inspiration abdominals pull inward and chest rises; during expiration abdomen rises and chest falls
69
fremitus
vibrations normally felt over upper lobe when humming; if you feel it lower it suggests more solid less air, increased fremitus usually means solid, decreased is more air (pneumothorax)
70
percussion
more air gives a more resonant tone
71
inspiration/expiration time ratio
normal 1/2; when listening to breath sounds inspiration is louder and longer
72
adventitious breath sounds
added sounds that may be due to airway narrowing; fluid in airway; secretions; atelectasis; or consolidation
73
early inspiratory crackles
usually COPD; hearing larger airways snapping open
74
late inspiratory crackles
restrictive disease (CHF or pulmonary fibrosis)
75
wheezes
usually heard during expiration; sound produced by air passing through narrowed airway
76
whispered pectoriloquy
spoken word muffled; will increase when fremitus increases
77
bronchophany
spoken voice; should be muffled, voice sounds louder and more distinct with consolidation or increased density
78
egophany
say E E E E; if it sounds like A A A A positive test; usually pleural effusion
79
pulmonary function tests with "forced" in the name
people with obstructive disease will usually do poorly
80
normal FEV1% (forced expiratory volume)
percent of total FVC (forced vital capacity) you can expel in 1sec; normal 75-85%; lower in obstructive disease; higher in restrictive
81
forced expiratory flow (FEF)
average flow rate for 1L gas expired after the first 200 (or 500 or 1000 ml) during a FVC test; normal is about 5L/sec
82
peak expiratory flow
pts with asthma may have home monitors; may be >10L/s in healthy males
83
dead space definitions
anatomic: volume of air in conducting airways; physiologic: alveolar volume with poor V/Q; total dead space 1/3 of tidal volume
84
MIP
max inspiratory pressure; greatest negative pressure that can be generated during inspiration against an occluded airway; usually 70-100 cm H2O; lower MIP means more ventilatory fatigue; drops in hyperinflated lungs; Higher MIP less breathlessness
85
DLCO
diffusion of lung carbon monoxide;
86
acid base status flowchart
first look at pH; then PaCO2 (acid) to determine if primary imbalance is respiratory; third look at HCO3- (base); lungs can compensate fast; kidneys slower
87
normal pH
7.35-7.45
88
normal PaO2
80-100 (lower for older adults; never
89
normal PaCO2
35-45 mmHg (lower is hyperventilation; higher is hypo)
90
normal HCO3-
22-26 mEq/L
91
normal SaO2 (oxygen saturation of Hb)
95-98%; clinically want pts >90%; pulmonary pts >88%
92
hyperventilation
lower PaCO2
93
hypoventilation
high PaCO2
94
approx FiO2 in nasal cannula
room air: 21%; 1L 24%; 4% increase for each L after (2L 28%)
95
home oxygen concentrator
single unit with enough tubes to reach throughout house; probably a fall risk for some
96
calculating PAO2
(713*FiO2)-PaCO2
97
a/A ratio
PaO2/PAO2; percent of O2 getting across alveolar membrane into blood
98
vesicular breath sounds
longer, louder inspiratory phase, expiration almost silent, normal for most of lung field
99
bronchial breath sounds
short inspiratory phase, longer and louder expiration, loud and harsh, normally heard over trachea and manubrium, also heard over tumor, consolidation, or pleural effusion
100
exam signs of emphysema
hyperresonant percussion, decreased fremitus, decreased breath sounds, early inspiratory crackles
101
exam signs of pneumonia and atelectisis
increased fremitus, more clear/distinct voice sounds, E to A egophany, (atelectasis only will have tracheal shift)
