Respiratory tract Flashcards
What does physical examination of the respiratory tract consist of?
- inspection of respiratory rate
- palpation of tracheal position
- tactile fremitus
- auscultation
- percussion
What are extrapulmonary manifestations of pulmonary disease? (3)
- acute findings such as cyanosis and altered mental status and signs of chronic respiratory insufficiency such as growth failure, clubbing, and osteoarthropathy
- evidence of cor pulmonale (loud pulmonic component of the second heart sound, hepatomegaly, elevated neck veins, and rarely, peripheral edema)
- Respiratory disorders - secondary to disease in other systems (metabolic acidosis, congenital heart disease, neuromuscular disease, immunodeficiency, autoimmune disease, and occult malignancy arthritis or hepatosplenomegaly).
When do we do pulmonary function tests?
to evaluate obstructive, restrictive lung diseases
Measure disease severity, measure disease progression, and evaluate response to therapy.
The Expert Panel Report recommends pulmonary function testing be performed routinely for …
for evaluation and management of asthmatic children age 5 and older.
Obstructive processes include … (3)
asthma, bronchopulmonary dysplasia (BPD), and cystic fibrosis (CF).
Restrictive lung disease can be caused by … (3)
chest wall deformities that limit lung expansion, muscle weakness, and
interstitial lung diseases such as collagenvascular diseases, hypersensitivity pneumonitis, and interstitial fibrosis.
Confirmation of restrictive lung or chest wall physiology requires …
lung volume measurements (total lung capacity, residual volume, and functional residualcapacity) because poor effort can mimic restrictive physiology).
Blood gas measurements are used to evaluate … (3)
hypoxemia, acidosis, hypercarbia
Blood gas measurements can be used to categorize acid-base disturbances as … (3)
respiratory, metabolic, mixed
Blood gas measurements are affected by … (4)
abnormalities of respiratory control,
gas exchange,
respiratory mechanics, and
the circulation.
Causes of hypoxemia (3)
hypoventilation, shunts, and diffusion barrier for oxygen.
Hypercapnia results from … (3)
hypoventilation due to:
decreased central respiratory drive,
respiratory muscle weakness, and
low-tidal-volume breathing as seen in restrictive lung diseases, severe scoliosis, or chest wall trauma
Venous blood gas analysis or capillary blood gas analysis can be useful for the assessment of … but not …
Venous blood gas analysis or capillary blood gas analysis can be useful for the assessment of Pco2 and pH, but not Po2 or saturation.
The pulse oximeter has reduced reliability during conditions causing reduced arterial pulsation such as … 3
hypothermia, hypotension, or infusion of vasoconstrictor drugs.
Sources of respiratory tract secretions for diagnostic testing include: (5)
nasopharyngeal and oropharyngeal swabs; expectorated and induced sputum;
tracheal aspirates;
direct lung or pleural fluid sampling; bronchoalveolar lavage fluid;
and gastric aspirates, for M tuberculosis.
imaging of the respiratory tract
- radiograph for chest wall abnormalities, heart, diaphram, lung parenchyma
- lateral neck radiograph +/- barium swallowing
- airway fluroscopy to asses both fixed airway obstruction and dynamic airway obstruction
- chest CT
- MRI
- laryngoscopy and bronchoscopy
what is oxygen therapy for
to relive hypoxemia: supplemental oxygen can reduce the work of breathing, relax pulmonary vasculature
describe the therapy with inhalation of medications
used routinely with chronic disease such as CF, bronchopulmonary dysplasia, asthma, acute illnesses
SABA and anticholinergics for acute bronchodilation
inhaled corticosteroids and cromones : antiinflammatory effects (controllers)
nebulized antibiotics
what is airway clearance therapy
chest physical therapy with postural drainage, percussion and forced expiratory maneuvers for clearance of lower airway secretions in children with CF, bronchiectasis and neuromuscular disorders
Extrathoracic or upper airway obstruction disrupts the _____ phase of respiration and is often manifest by _____.
inspiratory phase; stridor or noisy breathing
intrathoracic obstruction disrupts the ____ phase of respiration and is often manifest by ____
expiratory phase
wheezing and rpoongation of the expiratory phase
after assessing whether the obstruction is extrathoracic or intrathoracic, the next challange is ….
to determine if the obstruction is fixed or variable
sounds in variable obstruction:
dofter or absent with normal quiet breathing and sound different with hevery breath
clinical indication that teh obstruction is severe:
hig-pitched stridor or wheezing, biphasic stridor, dorroling or dysphagia, poor intensity breath sounds, severe retractions and poor color or cynosis
How do we most successfully remove foreign body?
using a rigid bronchoscopy under general anaesthesia
