Respiratory Exam (3)- Leah* Flashcards by Leah Stalnaker

Lung location (very general) -A & P boarders

anterior- just above clavicle; ends at sternal notch

posterior- ends below the scapula

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Lobes + Fissures:

When auscultating the anterior chest, which lobe is mostly heard? Posterior?

3 lobes on right; horizontal and oblique fissures
Left has Less Lobes- 2; oblique fissure only

anterior mostly auscultate UPPER lobe
posterior mostly LOWER lobe
(laterally lobes are equal)

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What are segments; how many does each lung have?

portion of lung associated with an individual bronchus
both lungs have 10 segments
on LEFT segments 1-2 and 7-8 are joined (leaving 8)

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Parietal vs Visceral Pleura; what is contained within the pleural space?

visceral covers the lung
parietal covers diaphragm/ mediastinum/ chest wall
pleuralspace contains small amt of fluid

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Order of respiratory tree (descending)

bronchus –> bronchiole –> t bronchiole –> respiratory bronchiole –> alveolar sac (contains alveoli + ducts, covered in capillaries)

Note: tree is the “conducting” zone until respiratory bronchioles.
RESPIRATORY bronchioles start RESPIRATORY zone.

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Anterior lung field “Lines” (3)

midsternal
midclavicular
anterior axillary

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Lateral Lung Field Lines (3)

-anterior, mid, and posterior axillary

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Posterior Lung Field Lines (3)

posterior axillary
scapular
vertebral

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Type 1 vs Type 2 pneumocytes (How do they differ in abundance, functional purpose, and shape?)

1- 95% of cells; site of gas exchange; flat

2- 5% of cells; surfactant secretion; cuboidal; proliferate in response to damage (can act as a stem cell/ become type 1 OR type 2 pneumocyte)

Type II associated with lameLLar bodies
II= lameLLar

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Layers that must be passed for gas diffusion (6)

Surfactant
Alveolar epithelium
Alveolar BM
Interstitium
Capillary BM
Capillary endothelium (This is the order for oxygen; CO2 flows in the reverse order*)

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When is alveolar maturation complete? Why is this relevant?

8 years: some people start smoking before this age

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Inhalation vs Exhalation:

Which is active? How does the diaphragm play a role in each?

Inhalation- active; requires ATP and diaphragm contraction (flattening)

Exhalation- passive; allowed by diaphragm recoil

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Describe alveolar and barometric pressures:

at equilibrium during inhalation, during exhalation

Equilibrim: Palv= 0; PB= 0…. No filling occurs because Palv = Pb
Inhalation: Palv= NEGATIVE (because diaphragm is flat); Pb= 0….. air rushes in to fill alveoli because Palv is less than Pb (continues until new Eqm reached)
Expiration: Palv»>Pb due to diaphragm relaxation; air moves out of the chest

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In the respiratory system, where (very generally) does air go?

wherever the pressure is LOWEST until equilibrium is reached!

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What do right and left shifts of the O2 sat curve mean?

Left= LESS O2 release (Left = Like O2)
Right= RELEASE of O2 (Right = Reject O2)

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Causes of right and left shift of O2 sat curve?

Causes of Right Shift: ACE BATs right handed
Acidosis; CO2; Exercise; BPG; Anxiety; Low Temp

Inverse (ie alkalosis, high temp) causes left shift;
*fetal periods and CO poisoning also = left shift**

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If a spirometry tracing is split into FOUR volumes, what are these four volumes?

LITER!!!
Lung volumes= 
I- inspiratory reserve
T-tidal volume 
E- expiratory reserve volume 
R- residual volume

LITER was genius and it blew my mind, btw

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What makes up?:

Inspiratory capacity
Functional Residual Volume
Vital Capacity
Total Capacity

Inspiratory capacity: IRV + TV
Functional Residual Volume: ERV + RV
Vital Capacity: IRV, TV, ERV
Total Capacity: Whole spirometry tracing, IRV, TV, ERV, RV

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#1 Causes chronic cough (3)
What is considered chronic?

Asthma, sinus infection, GERD

(chronic considered 8+ weeks; less than = “subacute”)

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Relevant Social Hx for Pulm (6)
**Don’t try to memorize this.
I just put it here so we would read it a few times/ be able to think of it. Most likely useful in real life as opposed to this test. –I agree; thanks, bud!

Occuptaion/ exposure details; home environment (allergens, heating system); smoking (age/ quitting attempts); regional exposures; travel; nutrition

Also, Melissa: Don’t be an asshole and always ask about old carts. Furthermore, if there’s sputum involved, follow up

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What are four causes of SOB that change with position?

CHF and pericarditis- worse when laying
Paralyzed diaphragm- worse when lifting/ on side
Liver related edema- worse when sitting

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Orthopnea vs platypnea

orthopnea= SOB when laying 
platypnea= SOB when sitting upright

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Compare kussmal breaths, tachypnea, and hyperventilation

*What is one cause of Kussmal breaths?

all defined as >20 RR BUT….
tachypnea is normal depth
Kussmal and hyperventilation are both DEEP

Kussmal is more severe/ usually assc with diabetic ketoacidosis/ metabolic acidosis– not respiratory disease

Describe Cheyenne Strokes?

What is one condition these are commonly assc with?

Crescendo/ Decrescendo followed by apnea

*Commonly assc with CENTRAL sleep apnea

Describe air trapping? | One condition to assc this with?

Harder and harder to get breath out | *See this in an acute asthma attack

What is ataxia, in terms of breathing?

Significantly disorganized breaths; less apnea than you may see in biot

What is biot? | What condition is it assc with?

disorganized (irregular) breaths + periods of apnea | CODING!!

Define bradypenia? | Common cause of this?

RR less than 12 | Drug OD

Pursed Lips are assc with what kind of disease?

obstructive: ie COPD/emphysema | patients contentiously try to slow expiration in order to expire through collapsing airway

First year flashback: What is emphysema exactly? So how is it classified?

It is just COPD WITH chronic bronchitis | ....so its obstructive.

How are normal breaths described? | What is the RR and describe the sound:

"vesicular breathing" - RR =regular and comfortable 12-20 breaths per minute - Auscultaiton=sounds soft low pitched and rustling w/ inspiration and expiration

Rhonchi: physiologic cause sound assc conditions

- secretions or transudates - LOW pitched wheeze - see in acute CHF or diffuse disease causing transudate (ie diffuse COPD) *Note CRACKLES= chronic CHF, but rhonci may be seen in acute due to ^^^ PHTN/ P edema

Crackles: physiologic cause sounds assc conditions (4)

- alveoli being collapsed/ reinflated due to pressure/ scarring - sounds like burning fire/ velcrow - assc with chronic CHF, atelectasis, bronchitis, pneumonia

Crackles are aka? | Describe fine vs. Coarse crackles:

Aka: "rales" Fine Crackles: heard at END of inspiration ONLY Coarse crackles: heard during EARLYinspiration and eludes to secretions in the bronchi

Friction rub- pericarditis vs pleuritic? How can you tell?

They sound the same! | **Have the patient hold their breath to determine if sound continues with only the heart beating**

What is wheezing? With what respiratory disease is wheezing commonly associated? What is stridor?

- Both caused by swelling --> obstruction - Wheezing is common in asthma - WHEEZING occurs in lungs - STRIDOR occurs in upper airway **Both caused by obstruction but STRIDOR is due to a mass/ lesion of the UPPER airways**

Intra vs extra thoracic lesions of the upper airway: How do they differ on exam? What happens if your patient has a fixed lesion?

- INTRAthoracic lesions cause stridor on EXpiration - EXTRAthoracic lesiosn cause stridor on INhalation * Note: fixed lesions cause stridor during all respiration

What are some examples of intrathroacic (2)/ extrathoracic (2) and fixed (2) lesions of the upper airways?

- intra: trachea, bronchus - extra: lesions of larynx, vocal cords - fixed: coup, paralysis of both vocal cords

Common cause of inspiratory stridor in the ICU?

extubation --> inflammation of larynx and vocal cords --> extrathoracic lesion --> inspiratory stridor

What pulmonary conditions should be considered in the case of cachexia (3)? Obesity (2)?

cachexia: TB, malignancy, pulmonary cachexia syndrome Obesity: sleep apnea/ general restriction of lung filling

What is clubbing? | When might are some potential causes (4)?

Angle >180 between skin and finger nail | May be congenital OR caused by malignancy, IPF, suppurative disease if acquired

When is barrel chest seen?

emphysema/ COPD | OR... its normal in kids.

Pectus excavatum/ carinatum: | What do these words mean?

``` ExCAVatum= chest CAVed in Carinatum= chest sticks out ```

Whats a blue bloater? A pink puffer?

Blue bloater describes cor pulmonale- severe edema + cyanosis Pink puffer- emphysema/ COPD- breathing through pursed lips in tripod position!

Three conditions that may cause the trachea to be shifted?

- pneumothorax - pleural effusion - atelectasis * Trachea will shift towards NORMAL/ unaffected side.

What does a finding of "decreased fremitus" mean? | When might it be seen?

- means ^^ space between lung and chest wall. | - one example of pneumothorax

What do findings of HYPO/HYPER-resonance mean?

hypo: more dense/ fluid hyper: more air (sound travels through air better)

Conditions that might cause HYPO/HYPER resonance? (3 each)

hypo: effusion, fibrosis, phrenic paralysis hyper: pneumothorax, COPD, emphysema

When percussing the lungs, how many sites on the front, side and back should you percuss? When do you mostly hear the LOWER lung lobes?

- front: 8 - side: 4 - back: 10 *Hear the lower lobes here!!

Pulmonary Function Tests: | What are four things they tell you?

spirometry; FV loops; Lung volume; DLCO

First year flashback: | What CANT spirometry tell you?

Residual volume OR any combined volume that includes RV SO... It cannot tell you the TLC or the FRC

What is a normal FEV1/ FVC value?

80%

Which disease decrease FEV1/FVC ratio? | Which do not?

Both obstructive and restrictive disease DECREASE FEV1 and FVC. -Obstructive disease decreases FEV1 MORE than FVC, thereby DECREASING THIS RATIO! -Restrictive diseases decrease FEV1 and FVC the same amount, leaving their ratio relatively NORMAL

How is the severity of an OBSTRUCTIVEdisease ranked according to PFT results? Define mild, moderate, severe, and very severe disesase:

``` FEV1: FVC ratio mild- normal ratio 80% or better moderate-50-80% severe- 30-50 very severe- less than 30% ```

What are PFT results for RESTRICTIVEdisease? How is the severity determined? Define mild, moderate, and severe disease:

PFT disease shows NORMAL FEV1: FVC but decreased TLC and DLCO. Severity ranked by TLC: 70-80% of normal- mild; 60-70 moderate; 50-60 severe

What are the epithelial cells of the lung?

The pneumocytes!! | pneumos= epithelial!