205: Exam 3 Blueprint

Upper vs. Lower Respiratory Tract

Upper = nose, oropharynx (no gas exchange; protects airway & speech)
Lower = trachea → bronchi → bronchioles → alveoli (gas exchange)
Application: Only the LOWER tract participates in oxygenation.

Right vs. Left Bronchus

Right bronchus = longer, wider, more vertical
Left bronchus = shorter, narrower (use for auscultation: mid calvicular)
Clinical: Aspiration occurs more often in RIGHT lung.

Lung Lobes

Right lung = 3 lobes
Left lung = 2 lobes (space for heart)

Diaphragm & Phrenic Nerve

Main muscle of breathing; controlled by C3–C5
Clinical: Injury at C3–C5 → respiratory failure risk

Dyspnea

Shortness of breath
Seen in: COPD, heart failure, asthma

Orthopnea

Difficulty breathing when supine
Relieved by sitting up → think HEART FAILURE

Paroxysmal Nocturnal Dyspnea (PND)

Waking up suddenly gasping for air at night
Strong sign of LEFT-SIDED HEART FAILURE

Hemoptysis

Coughing up blood
Red flag → TB, lung cancer, severe infection

Productive vs. Nonproductive Cough

Productive = mucus present
Nonproductive = dry
Clinical: Productive suggests infection

Pulse Oximetry

Measures O₂ saturation in blood (normal 95–100%)
Remove nail polish → prevents false low reading

Arterial Blood Gases (ABGs)

Measure exact O₂, CO₂, and pH
Most accurate oxygenation status

Bronchoscopy

Direct visualization of the larynx, trachea, and bronchial tree using a lighted fiberoptic tube

Used to diagnose tumors, bleeding, obstruction

Thoracentesis

Removal of fluid from pleural space
Used in pleural effusion

Normal Chest Shape

AP:Transverse ratio = 1:2

The chest width is approximately twice its depth
Symmetrical, no distress

Normal Respiratory Rate

12–20 breaths/min (adult)

Tactile Fremitus (Normal)

Equal vibration bilaterally when saying “99”

• Decreased: obstructs the transmission of vibrations, such as fluid (pleural effusion) or air (pneumothorax).

• Increased: increased lung density, such as pneumonia.

Normal Breath Sounds

Bronchial = loud (trachea)
Bronchovesicular = medium (mid chest)
Vesicular = soft (peripheral lungs)

Barrel Chest

AP:Transverse = 1:1
Seen in COPD (hyperinflation)

Signs of Respiratory Distress

• Accessory muscle use

• Nasal flaring

• Tripod position
  Indicates severe breathing difficulty

Decreased Tactile Fremitus

Fluid or air blocking vibrations
Seen in pleural effusion, COPD

Increased Tactile Fremitus

Lung consolidation (filling of air-filled alveolar spaces with fluid, pus, or blood)
Seen in pneumonia

Crackles (Rales)

Fluid in lungs
Fine = sounds like hair rubbing
Coarse = sounds like Velcro
Seen in Heart Failure (HF), pneumonia

Wheezes

High-pitched from narrowed airways
Seen in asthma

Rhonchi

Low-pitched, snoring sound
Clears with cough → mucus in large airways

Pleural Friction Rub

Grating sound from inflamed pleura

Stridor

High-pitched upper airway obstruction
🚨 MEDICAL EMERGENCY

Crepitus

Crackling under skin (air in subcutaneous)
Feels like Rice Krispies

Cerebrum Function

Thinking, reasoning, emotions

Cerebellum Function

Balance, coordination, posture

Bellum = Balance

Brainstem Function

Vital functions (breathing, HR, LOC)

Broca’s vs. Wernicke’s Area

Broca (Frontal Lobe)= speech production
Wernicke (Temporal Lobe)= language comprehension
Damage → expressive vs receptive aphasia

Sympathetic vs. Parasympathetic

Sympathetic = fight or flight
Parasympathetic = rest and digest

CN I (Olfactory)

Smell

Anosmia if abnormal

CN II (Optic)

Vision

CN III, IV, VI (Oculomotor, Trochlear, Abducens)

Eye movement

Oculomotor- Eyelids, Pupils

Trochlear- Up & down

Abducens- Lateral (side-side)

CN V (Trigeminal)

Facial sensation + chewing

CN VII (Facial)

Facial expressions (Smile/Frown)
Drooping = Bell’s palsy

CN VIII (Acoustic/Vestibulocochlear)

Hearing + balance

CN IX (Glossopharyngeal) & X (Vagus)

Swallowing + gag reflex
Loss = aspiration risk

CN XI (Spinal Accessory)

Shoulder shrug, head movement

CN XII (Hypoglossal)

Tongue movement
Deviation = abnormal

Meningitis

Infection of meninges
Symptoms: fever, headache, photophobia, stiff neck

Neuropathy

Nerve damage → tingling, numbness
Causes: diabetes, ischemia

Stroke (CVA) Types

Ischemic = clot
Hemorrhagic = bleed

F.A.S.T Stroke Signs

Face = droop
Arm =weakness
Speech = slurred
Time = call 911

Dysphasia vs. Aphasia

Dysphasia = partial speech impairment
Aphasia = complete loss of speech

Hint: Relate the s in Dy(s)pha(s)ia to (s)peech

Expressive vs. Receptive Aphasia

Expressive (Broca) = understands, cannot speak/write
Receptive (Wernicke) = cannot understand spoken/written language

Dysphagia

Difficulty swallowing
⚠ Aspiration risk

Paresthesia

Pins and needles sensation

Glasgow Coma Scale

Neurological tool used to assess a person's level of consciousness, particularly after a traumatic brain injury (TBI)

<=8 means coma

EYE OPENING, VERBAL RESPONSE, MOTOR RESPONSE

3–15 scale; 15 = fully alert

Normal LOC

Alert & Oriented x4 (Name, Place, Time/date, Event- president)

A/Ox4

Hypotonia vs. Hypertonia

Hypotonia = decreased tone in muscle (flaccid/floppy muscles)

Hypertonia = increased tone in muscle (rigid/stiff muscles)

Hemiparesis

Unilateral/ one side weakness (stroke)

Paraplegia vs. Quadriplegia

Paraplegia = lower body
Quadriplegia = all limbs

Decorticate vs. Decerebrate (Rigidity) positioning

Decorticate = arms flexed (less severe) ex: like a corpse getting ready
Decerebrate = arms extended (worse → brainstem damage) ex: person goes stiff (fighter getting knocked out)

Ataxia

Unsteady gait

Dysmetria

Misses target (finger-to-nose)

Dysdiadochokinesia

Cannot do rapid alternating movements

Parkinson’s Disease

Tremor, rigidity, slow movement

Romberg Test

Patient stands with feet together, arms at sides, eyes closed for 30 seconds

Assesses balance, coordination, position sense, and cerebellar function
Positive = swaying/falling

Pronator Drift

Patient extends arms palms up, closes eyes for 20-30 seconds

Arm drifts downward
Indicates weakness

Heel-to-Shin Test

Patient runs the heel of one foot down the shin of the opposite leg

Tests coordination of lower extremities
Abnormal = cerebellar disease

Graphesthesia vs. Stereognosis

Graphesthesia = identify writing on skin
Stereognosis = identify object in hand

Babinski Reflex

Stroke the sole of foot upward.

Normal adult = toes curl DOWN
Abnormal adult = toes fan OUT
Normal in infants only

Respiratory Health Promotion

• Stop smoking

• Avoid pollutants

• Exercise

• Vaccines (Flu, Pneumovax)

Stroke Prevention Education

• Control BP

• Lower cholesterol

• Manage diabetes

• Exercise

• Healthy diet

Percussion Sounds

Resonance: Normal lung tissue

Dullness: Solid organs (liver) or fluid/masses

Tympany: Gas-filled areas (abdomen)

Flatness: High tissue density (bone)

Adventitious Breath Sounds

Crackles, Wheezes, Rhonchi