Respiratory

Question 1

Respiration

Answer 1

process of exchanging gases (O2 and CO2) across respiratory surfaces through diffusion. Two types:

1. Internal Respiration: exchange of gases between systemic circulation and cells in tissues of body
2. External Respiration: exchange of gases between venous system and alveoli in lungs

Question 2

Ventilation

Answer 2

the movement of air into and out of the lungs

Question 3

Tracheal breath sounds

Answer 3

relatively high-pitched, harsh; heard over the trachea and neck. “darth vader”

Question 4

Bronchial breath sounds

Answer 4

relatively high pitch; heard over the manubrium, if heard at all. Abnormal anywhere else. Can indicate consolidation or compression of the lung

Question 5

Bronchovesicular breath sounds

Answer 5

heard over main bronchus area, 1st and 2nd ICS and between the scapulae; medium pitch; expiration equals inspiration

Question 6

Vesicular breath sounds

Answer 6

soft, short expirations; low-pitch, low-intensity; heard over healthy lung tissue

Question 7

Discontinuous breath sounds (fine crackles and course crackles / rales)

Answer 7

A crackle is an abnormal respiratory sound hears more often during inspiration, characterized by discrete discontinuous sounds. Caused by the disruptive passage of air through the small airways (over production of mucus/secretions)
Fine-high pitched, relativilty short duration
Course-Low-piched, longer in duration

Question 8

Rhonchi

Answer 8

Deeper, more rumbling, and more pronounced during expiration. Prolonged and continuous

Question 9

Wheezes

Answer 9

Continuous, high-pitched, musical sound (almost a whistle) heard during either inspiration or expiration. (asthma/copd) Caused by relatively high-velocity airflow through a narrowed or obstructed airway.

Question 10

Egophony

Answer 10

“voice of the goat”, bleating quality, E -> A change (emphysema)

Question 11

Whispered pectoriloquey

Answer 11

“voice of the chest”, whispered words have increased intensity and pitch (pneumonia, fibrosis)

Question 12

Tactile fremitus

Answer 12

Palpable vibrations transmitted through chest wall when patient speaks, sound waves transmit better through solid/fluid medium than gaseous medium.

Question 13

Increased tactile fremitus

Answer 13

Lung tissue density increases due to:
1. Consolidation (air space filled with fluid) - pneumonia,
pulmonary edema
2. Fibrosis (thickening of lung tissue) - pulmonary fibrosis

Question 14

Decreased tactile fremitus

Answer 14

Lung tissue replaced by fluid/air due to:
Airway obstruction - pleural effusion (fluid outside of lung),
pneumothorax (air outside of lung), emphysema/COPD,
foreign body obstruction

Question 15

Bronchophony

Answer 15

“bronchial sounds”, spoken words are louder than normal

Question 16

Diaphragmatic excursion

Answer 16

expansion of lungs, normally 3-5 cm

Question 17

What causes decreased diaphragmatic excursion when the lung is unable to expand?

Answer 17

1. Pleural effusion
2. Pneumonia
3. Atelectasis
4. Hemothorax
5. Neuromuscular disease

Question 18

What causes decreased diaphragmatic excursion when the lung is able to expand?

Answer 18

1. Emphysema

2. Asthma

Question 19

A/P diameter

Answer 19

anterior/posterior diameter, should be less than the lateral diameter, may be increased in emphysema (increased space for overinflated lungs -> barrel chest)

Question 20

What other organ systems should you examine when evaluating a respiratory complaint?

Answer 20

Musculoskeletal: Ribs, thorax symmetry, AP diameter, chest expansion, accessory muscle use
Cardiovascular: Ratio of respirations to heartbeat
HEENT: Nasal flaring, tracheal deviation
Skin and nails: cyanoisis, pursing lips, clubbing nails, diaphoresis
Abdominal: Liver enlargement

Question 21

Barrel chest

Answer 21

increase in the anterior posterior diameter of the chest (resembling a barrel) often associated with emphysema

Question 22

Flail chest

Answer 22

loss of stability of the chest wall when a segment of rib cage breaks and becomes detached from the rest of the chest wall and moves independently

Question 23

Scoliosis

Answer 23

abnormal lateral curvature of the spine

Question 24

Kyphosis

Answer 24

excessive outward curvature of the spine, causing hunching of the back

Question 25

Gibbus

Answer 25

form of structural kyphosis where one or more adjacent vertebrae become wedged

Question 26

Lordosis

Answer 26

excessive inward curvature of the spine

Question 27

Pectus carinatum

Answer 27

breast bone protrudes outward abnormally

Question 28

Pectus excavatum

Answer 28

breast bone is sunken into the chest

Question 29

Hemoptysis

Answer 29

coughing up blood

Question 30

Tachypnea

Answer 30

abnormally rapid breathing (>20 breaths/min)

Question 31

Bradypnea

Answer 31

abnormally slow breathing (

Question 32

Eupnea

Answer 32

easy, free respiration. normal breathing

Question 33

Pleural Rub

Answer 33

friction sound heard with stethoscope during inspiration and expiration due to the rubbing of the visceral and parietal pleurae

Question 34

Cyanosis

Answer 34

bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood

Question 35

Stridor

Answer 35

harsh vibrating noise when breathing, caused by obstruction of the windpipe or larynx

Question 36

Orthopnea

Answer 36

shortness of breath when laying flat

Question 37

Wheezing

Answer 37

whistling or rattling sound in the chest