Thorax & Lungs Flashcards by Stephanie Kovach

The thorax has an elliptical shape with an anteroposterior-to-transverse diameter of 1:2 or 5:7 in a _______ adult

Normal

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Note equal Ap to T diameter and that ribs are horizontal instead of the normal downward slope. this is associated with normal aging and also with chronic emphysema and asthma as a result of hyperinflation of lungs.

Barrel chest

appears as if held in continuous inspiration
occurs in COPD and chronic emphysema from hyperinflation of the lungs.

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A lateral S-shaped curvature of the Thoracic and lumbar spine, usually with involved vertebrae rotation. note unequal shoulder and scapular height and unequal hip level. more prevalent in adolescence esp girls.

mild deformities are asymtomatic
if severe deviation (>45) scoliosis may reduce lung volume and then person is at risk for cardiopulmonary function.

Scoliosis

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An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility.

associated with aging
severe deformities impair cardiopulmonary function
if neck muscles are strong, they compensate by hyperextension of head to maintain level of vision
people with adequate exercise habits are less likely to have this.

kyphosis

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A markedly sunken sternum and adjacent cartilages (also called funnel breast). depression begins at second intercostal space, becoming depressed most at junction of xiphoid with body of sternum.

more noticeable on inspiration
congenital, usually not symptomatic

Pectus excavatum

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A forward protrusion of the sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions (pigeon breast).

less common than pectus excavatum
no treatment required, if severe can get surgery

Pectus carinatum

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neck muscles are ________ in COPD from aiding in forced respirations. People with this often sit in a tripod position, leaning forwards with arms braced against knees, chair, or bed. this gives them leverage so that their rectus abdominis, intercostal and accessory neck muscles can all aid in expiration

Hypertrophied

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Unequal chest expansion occurs with marked _______, lobar pneumonia, pleural effusion; with thoracic _______, such as fractured ribs; or with pneumothorax.

Pain accompanies deep breathing when the ______are inflamed

atelectasis
trauma
pleurae

** check symmetric chest expansion

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______ is a course crackling sensation papable over the skin surface. occurs in subcutaneous emphysema when air escapes form the lung and enters subcutaneous tissue

crepitus

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_______ fremitus is when obstruction of transmission of vibrations such as an obstructed bronchus, plural effusion/thickening, pneumothorax, or emphysema. any barrier that comes btw the sound and your hand will decrease the fremitus

decreased

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_______ fremitus occurs with conditions that increase the density of lung tissue, thereby making a better conducting medium for vibrations (E.g. compression or consolidaton of lung tissue (lobar pneumonia). this is present only when the bronchus is patent (open) and when consolidation extends to the lung surface.

increased

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______fremitus is vibrations felt when inhaled air passes through ______ secretions in the larger bronchi. this may decrease somewhat by coughing

rhonchal

thick

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Pleural friction fremitus is produced when _________ of the parietal or visceral pleura causes a decrease in the normal lubricating fluid.

*the opposing surfaces make a coarse grating sound when rubbed together during breathing. best detected by auscultating, it may sometimes be palpable and feels like 2 pieces of leather grating together.

inflammation

*also called palpable friction rub

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_______ is the low pitches, clear, hollow sound that predominates in healthy lung tissue in adults.

resonance

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___________is a lower-pitched, booming sound found when too much air is present, such as in emphysema or pneumothorax.

hyperresonance

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A _____ note (soft, muffled thud) signals abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor

dull

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While performing diaphragmatic excursion, note an abnormally high level of _______ and absence of excursion. these occur with _____ ______ or atelectasis of the lower lobe.

dullness

pleural effusion- space btw visceral and parietal pleura)

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What are discontinuous sounds? -adventitious sounds

discrete crackling sounds

crackles (fine) formally called rales
crackles (course)
atelectatic crackles
pleural friction rub

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High pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing

Fine crackles

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Inspiratory fine crackles happens when inhaled air collides with previously ______ airways; airways suddenly pop open, creating explosive crackling sound

_______ fine crackles happen b/c of sudden airway closing

deflated

expiratory

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Late inspiratory fine crackles occur with restrictive disease: ______, heart failure and interstitial fibrosis

pneumonia

Early inspiratory fine crackles occur with obstructive disease: chronic ______, asthma, and emphysema

bronchitis

Are fine crackles that appear with a change from sitting to the supine position or with a change from supine to supine with legs elevated

Posturally induced crackles

Coarse crackles are ____, low-pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration
* may decrease somewhat by sunctioning or coughing but will ______ shortly–sounds like opening velcro

loud

reappear

Coarse crackles happen when _____ air collides with secretions in the trachea and large bronchi *happens with pulmonary ______, pneumonia, and the terminally ill who have a depressed cough reflex

inhaled | edema

_______crackles sound like fine crackles but do no last and are not ______; dissapear after the first few breaths; heard in ______ and bases (usually dependent) of lungs.

atelectatic | axillae

Atelectatic crackles happen when sections of ______are not fully aerated, they deflate and accumulate _______. crackles are heard when these sections re-expland with a few deep breaths.

alveoli secretions * heard in aging adults, bedridden person, or in persons just aroused from sleep.

Pleural friction rub is a very superficial sound that is coarse and ____ pitched; grating quality, sounds is inspiratory and expiratory

low *Pleuritis, accompanied by pain with breathing (rub disappears after a few days if pleural fluid accumulates and separates pleurae

What are continuous sounds?- adventitious sounds

connected, musical sounds

A Wheeze is ____ pitched (sibiliant), musical, squeaking sounds * predominate in ________ but may occur in both

high | expiration

Wheeze happens when air is ______ or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions or tumors. * the passageways walls move btw closed and barely open positions

squeezed Example: diffuse airway obstruction from acute asthma or chronic emphysema

A wheeze is also ___ pitched; monophonic, single note, heard throughout the cycle, although more predominant on expiration, may clear somewhat by ______ *the pitch of the wheeze cannot be ______ to the size of the passageway that generates it

low coughing correlated example: bronchitis, single bronchus obstruction from airway tumor

A ______is a high pitched, mnophonic, inspiratory, crowing sound, louder in the neck than over chest wall * originates in larynx or ______, upper airway obstruction from swollen, inflamed tissues or lodged foreign body.

stridor example: croup (barking cough) and acute epiglottis in children, and foreign inhalation, obstructed airway life threatening

What are the three normal breath sounds and where can you expect to hear them?

bronchial (tracheal)-trachea and larynx (NECK area) bronchovesicular-either side of sternum over major bronchi vesicular-over lungs where air flows through smaller bronchioles and alveoli

Bronchial (tracheal) has a ____ pitch, loud ______, duration is inspiration < expiration, has a ______, hollow tubular,

high amplitude harsh

bronchovesicular has a _______ pitch & amplitude and inspiration _____ expiration, mixed quality

moderate | equals

vesicular has a ____ pitch, soft amplitude, inspiration >expiration, rustling quality like the sound of the wind in the trees.

low

Decreased or absent breath sounds occur when: *the bronchial tree is obstructed at some point by _______, mucus plug or a foreign body * in ______ as a result of elasticity in the lung fibers and decreased force of inspired air; also, the lungs are already hyper inflated so the inhaled air does not make as much noise. * when anything obstructs transmission of sound btw the lung & stethescope, such as ______ or pleural thickening, or air (pneumothroax) or fluid (pleural effusion) in the pleural space. **A _____ chest means no air is moving in or out, which is an ominous sign.

obstruction emphysema pleurisy silent

Increased breath sounds means that sounds are ______ than they should be ( bronchial sounds are abnormal when they are heard over an abnormal location, the peripheral lung fields) * they have a ____ pitch, tubular quality, with a prolonged expiratory phase and a _____ pause between inspiration and expiration. * they occur when consolidation (e.g pneumonia) or compression (eg. fluid from intrapleural space) yields a dense lung area that enhances the ________ of sound from the bronchi. * when the inspired air reaches the alveoli, it hits solid lung tissue that conducts sound more efficiently to the surface.

``` louder high distinct transmission ** sounds very close to stethescope ```

added sounds not normally heard in the lungs

adventitious (extra) -caused by moving air colliding with secretions in tracheobronchial passageways or by the popping open of previously deflated airways

for vocal resonance, consolidation (increase lung density) or compression of lung tissue will enhance the voice sounds making them sounds more ______

distinct

A ______ lung: | *Inspection:: AP

Normal

A collapsed shrunken section of alveoli or an entire lung as a result of 1. ) airway obstruction (the bronchus is completely blocked by thick exudate, aspirated foreign body or tumor), the alveolar air beyond it is gradually absorbed by the pulmonary capillaries and the alveolar walls cave in; 2. ) compression on the lung 3. ) lack of surfactant (Hyaline membrane disease) **Inspection: ______. lag on expansion on affected side, increased res rate and pulse, possible cyanosis **palpation: chest expansion _______on affected side. tactile fremitus decreased or absent over area, with large collape, ______ shift toward affected side. **percussion: _____ over area **auscultation: breath sounds ______ vesicular or absent over area. **adventitious sounds: none if _______ is obstructed. occasional fine crackles if bronchus is patent

``` Atelectasis (collapse) cough decreased tracheal Dull decreased bronchus ```

_____ ______ is an infection in lung parenchyma leaves alveolar membrane edematous and porous, so RBC & WBC pass from blood to alveoli. * alveoli progressively fill up (become consolidated) with bacteria, solid cellular _____, fluid, blood cells, which replace alveoli air. this _______surface area of the res. membrane causing hypoxemia. ** inspection: ______ res rate, guarding and lag on ______ on affected side. children-sternal retraction, nasal flaring. **palpation: chest _______ decreased on affected side, tactile fremitis ______if bronchus is patent (open), decreased if bronchus _______. **percussion: ____ over lobar pnemonia **auscultation: breath sounds louder with open bronchus, as if coming directly from larynx. voice sounds have ______ clarity; bronchophony,egophony, and whispered pectoriloquy present. **adventious sounds: crackles, fine to medium

``` Lobar pneumonia debris decreases increases expansion expansion increases obstructed dull increased ```

proliferation of mucus glands in the passageways, resulting of excessive mucus secreation. Inflammation of bronchi with partial obstruction of bronchi by secretions or constrictions. *secretions of lung _____to obstruction may be deflated. This may be acute or chronic with a recurrent productive cough. caused by cigs **inspection: ______, rasping cough productive of thick mucoid sputum. if chronic--______, fatigue, cyanosis, possible clubbing of fingers **palpation: tactile fremitus _______ **Percussion is _________ ** auscultation: Normal vesicular. voice sounds normal. chronic--prolonged _________ **adventious sounds: _______ over deflated areas. may have wheeze

``` Bronchitis distal hacking SOB normal resonant expiration crackles ```

______ is caused by destruction of pulmonary connective tissue (elastin, collagen); characterized by permanent ________ of air sacs distal to terminal bronchioles and rupture of interalveolar walls. This increases airway resistance, esp on _________--producting a hyperinflated lung and an increase in lung volume **caused 80-90% of time by cigs **inspection: increased AP diameter. barrel chest. use of______ muscles to aid respiration. tripod position. SOB, esp on exertion, res. distress, tachypnea **palpation: ______ tactile fremitus and chest expansion **percussion: ___________. decreased diaphragmatic excursion. **auscultation: _______ breath sounds. may have prolonged expiration. muffled heart sounds resulting from ___________ of lungs. **adventious sounds: usually none; occasionaly wheeze.

``` emphysema enlargement expiration accessory decreased hyperresonant decreased overdistension ```

An allergic ____________to certain inhaled allergins (pollen), irritants (tobacco, ozone), microbes, stress, exercise that produces a complex response characterized by _________and inflammation, edema in walls of bronchioles, and secretion of highly viscous mucus in airways. *these factors greatly _______ airway resistance, esp during expiration, and produce symptoms of _______, dyspnea and chest tightness

hypersensitivity bronchospasm increase Wheezing

Pump failure with increasing pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in the pumonary capillaries. _______air sacs are deflated, pulmonary capillaries engorged. bronchial mucosa may be swollen

heart failure dependent **inspection: increased res rate, SOB on exertion, orthopnea, paroxysmal nocturnal dypnea, nocturia, ankle edema, pallor in light skinned people. **palpation: skin moist, clammy, tactile fremitus normal **percussion: resonant **aucultation: normal vesicular. heart sounds include s3 gallop **adentious sounds: crackles at lung bases.

free air in pleural space causes partial or complete lung collapse. can be spontaneous, traumatic and tension

pneumothroax

Pneumocystis jiroveci is a virulent form of ______ and a protozoal infection associated with aids.

pneumonia