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DT3- EXAM 2 > Respiratory Exam (3)- Leah* > Flashcards

Respiratory Exam (3)- Leah* Flashcards

1
Q

Lung location (very general) -A & P boarders

A

anterior- just above clavicle; ends at sternal notch

posterior- ends below the scapula

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2
Q

Lobes + Fissures:

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

A

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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3
Q

What are segments; how many does each lung have?

A
  • 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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4
Q

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

A
  • visceral covers the lung
  • parietal covers diaphragm/ mediastinum/ chest wall
  • pleuralspace contains small amt of fluid
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5
Q

Order of respiratory tree (descending)

A

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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6
Q

Anterior lung field “Lines” (3)

A
  • midsternal
  • midclavicular
  • anterior axillary
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7
Q

Lateral Lung Field Lines (3)

A

-anterior, mid, and posterior axillary

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8
Q

Posterior Lung Field Lines (3)

A
  • posterior axillary
  • scapular
  • vertebral
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9
Q

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

A

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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10
Q

Layers that must be passed for gas diffusion (6)

A
  1. Surfactant
  2. Alveolar epithelium
  3. Alveolar BM
  4. Interstitium
  5. Capillary BM
  6. Capillary endothelium (This is the order for oxygen; CO2 flows in the reverse order*)
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11
Q

When is alveolar maturation complete? Why is this relevant?

A

8 years: some people start smoking before this age

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12
Q

Inhalation vs Exhalation:

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

A

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

Exhalation- passive; allowed by diaphragm recoil

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13
Q

Describe alveolar and barometric pressures:

at equilibrium during inhalation, during exhalation

A
  • 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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14
Q

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

A

wherever the pressure is LOWEST until equilibrium is reached!

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15
Q

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

A 
Left= LESS O2 release (Left = Like O2)
Right= RELEASE of O2 (Right = Reject O2)
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16
Q

Causes of right and left shift of O2 sat curve?

A

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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17
Q

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

A 
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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18
Q

What makes up?:

  1. Inspiratory capacity
  2. Functional Residual Volume
  3. Vital Capacity
  4. Total Capacity
A

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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19
Q 
#1 Causes chronic cough (3)
What is considered chronic?
A

Asthma, sinus infection, GERD

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

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20
Q

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!

A

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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21
Q

What are four causes of SOB that change with position?

A

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

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22
Q

Orthopnea vs platypnea

A 
orthopnea= SOB when laying 
platypnea= SOB when sitting upright
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23
Q

Compare kussmal breaths, tachypnea, and hyperventilation

*What is one cause of Kussmal breaths?

A
  • 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

24
Q

Describe Cheyenne Strokes?

What is one condition these are commonly assc with?

A

Crescendo/ Decrescendo followed by apnea

*Commonly assc with CENTRAL sleep apnea

25
Q

Describe air trapping?

One condition to assc this with?

A

Harder and harder to get breath out

*See this in an acute asthma attack

26
Q

What is ataxia, in terms of breathing?

A

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

27
Q

What is biot?

What condition is it assc with?

A

disorganized (irregular) breaths + periods of apnea

CODING!!

28
Q

Define bradypenia?

Common cause of this?

A

RR less than 12

Drug OD

29
Q

Pursed Lips are assc with what kind of disease?

A

obstructive: ie COPD/emphysema

patients contentiously try to slow expiration in order to expire through collapsing airway

30
Q

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

A

It is just COPD WITH chronic bronchitis

….so its obstructive.

31
Q

How are normal breaths described?

What is the RR and describe the sound:

A

“vesicular breathing”

  • RR =regular and comfortable 12-20 breaths per minute
  • Auscultaiton=sounds soft low pitched and rustling w/ inspiration and expiration
32
Q

Rhonchi:
physiologic cause
sound
assc conditions

A
  • 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

33
Q

Crackles:
physiologic cause
sounds
assc conditions (4)

A
  • alveoli being collapsed/ reinflated due to pressure/ scarring
  • sounds like burning fire/ velcrow
  • assc with chronic CHF, atelectasis, bronchitis, pneumonia
34
Q

Crackles are aka?

Describe fine vs. Coarse crackles:

A

Aka: “rales”

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

35
Q

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

A

They sound the same!

Have the patient hold their breath to determine if sound continues with only the heart beating

36
Q

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

A
  • 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

37
Q

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

A
  • INTRAthoracic lesions cause stridor on EXpiration
  • EXTRAthoracic lesiosn cause stridor on INhalation
  • Note: fixed lesions cause stridor during all respiration
38
Q

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

A
  • intra: trachea, bronchus
  • extra: lesions of larynx, vocal cords
  • fixed: coup, paralysis of both vocal cords
39
Q

Common cause of inspiratory stridor in the ICU?

A

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

40
Q

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

A

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

41
Q

What is clubbing?

When might are some potential causes (4)?

A

Angle >180 between skin and finger nail

May be congenital OR caused by malignancy, IPF, suppurative disease if acquired

42
Q

When is barrel chest seen?

A

emphysema/ COPD

OR… its normal in kids.

43
Q

Pectus excavatum/ carinatum:

What do these words mean?

A 
ExCAVatum= chest CAVed in
Carinatum= chest sticks out
44
Q

Whats a blue bloater? A pink puffer?

A

Blue bloater describes cor pulmonale- severe edema + cyanosis

Pink puffer- emphysema/ COPD- breathing through pursed lips in tripod position!

45
Q

Three conditions that may cause the trachea to be shifted?

A
  • pneumothorax
  • pleural effusion
  • atelectasis
  • Trachea will shift towards NORMAL/ unaffected side.
46
Q

What does a finding of “decreased fremitus” mean?

When might it be seen?

A
  • means ^^ space between lung and chest wall.

- one example of pneumothorax

47
Q

What do findings of HYPO/HYPER-resonance mean?

A

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

48
Q

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

A

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

49
Q

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?

A
  • front: 8
  • side: 4
  • back: 10 *Hear the lower lobes here!!
50
Q

Pulmonary Function Tests:

What are four things they tell you?

A

spirometry; FV loops; Lung volume; DLCO

51
Q

First year flashback:

What CANT spirometry tell you?

A

Residual volume OR any combined volume that includes RV

SO… It cannot tell you the TLC or the FRC

52
Q

What is a normal FEV1/ FVC value?

A

80%

53
Q

Which disease decrease FEV1/FVC ratio?

Which do not?

A

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

54
Q

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

A 
FEV1: FVC ratio
mild- normal ratio 80% or better 
moderate-50-80% 
severe- 30-50
very severe- less than 30%
55
Q

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

A

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

56
Q

What are the epithelial cells of the lung?

A

The pneumocytes!!

pneumos= epithelial!

DT3- EXAM 2 (19 decks)

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