Unit 1 - Respiratory Exam (Heston)

what are the three parts of respiration?

ventilation

diffusion

circulation of gases

what occurs during respiration?

movement of air from inside to outside and vice versa

what occurs during diffusion?

gas exchange at the alveolar-capillarry bed

what occurs during circulation of gases?

oxygen travels to the tissues and carbon dioxide travels away from inside to out

what is the protective "shell" for the vital organs that is made up of bone and cartilage?

thorax

what are the primary muscles of respiration?

diaphragm

external intercostals

internal intercostals

what are the secondary muscles of respiration?

trapezius

SCM

scalenes

what nerves keep the diaphragm alive?

C3 C4 C5

What does the apex of the RUL and LUL lie above?

first rib

Where does gas exchange occur?

in the alveoli

T/F: it is considered a normal variant for the L lung lobe to have 3 lobes.

true

1 multiple choice option

What is the role of the conducting system (trachea, primary bronchi, smaller bronchi)?

warms, filters, and humidifies the air

What is the order of least invasive to most invasive for respiratory exam?

inspection

palpation

percussion

auscultation

What is crepitus (snap and crackling sounds) a sign for during respiratory palpation?

subcutaneous emphysema (air gets trapped in the tissues under the skin)

for patients with emphysema/COPD, how would they present during thoracic expansion?

may show no expansion due to the barrel chest already maximally enlarged

what is tactile fremitus?

palpable vibration of the chest wall

while performing tactile fremitus, if there is decreased/absent vibrations, what could be the cause?

air trapping, emphysema, COPD, or pleural effusion

while performing tactile fremitus, if there is increased vibrations, what could be the cause?

lung mass, pulmonary effusion, pneumonia, or atelectasia

How is percussion performed on a patient?

tapping on the chest wall to produce sound waves

during percussion, what is the sound of a healthy lung?

resonant

during percussion, if a dull sound is heard, what does that indicate?

hypoinflation or fluid in the lungs

during percussion, if a hyperresonance sound is heard, what does that indicate?

hyperinflation or air in the lung

why is it important to perform percussion laterally?

to assess the RML (where most pathologies love to effect)

What lobe of the lungs is where most pathologies are most commonly found?

RML

explain how to perform diaphragmatic excursion

1) ask patient to take a deep breath in and hold

2) percuss along and above the thoracolumbar junction near inferior scapula until the tone goes from resonance to dull (lungs to diaphragm muscle)

3) mark location

4) ask patient to exhale and hold

5) percuss upward until you hear resonance tone

6) mark location

TQ- what is a normal distance of marked locations after performing diaphragmatic excursion?

3-5 cm

Why does the right diaphragm sit higher than the left?

THE LIVER

is it okay if the left diaphragm sits higher than the right?

NO BIG RED FLAG

on a stethoscope, is the bell used for high or low pitch?

low

1 multiple choice option

on a stethoscope, is the diaphragm used for high or low pitch?

high

1 multiple choice option

what normal breath sound is high pitch and should be found over the trachea?

bronchial / tracheal

what normal breath sound is moderate pitch and should be found over the right/left main bronchus and proximal bronchioles?

bronchovesicular

what normal breath sound is low pitch and should be found over the healthy lung tissue?

vesicular

which of the normal breath sounds is the most common?

vesicular

2 multiple choice options

pathologic breath sounds - seen with large stiff walled pulmonary cavity, tension pneumothorax or bronchopulmonary fistula where air is "tumbling" within a confined space where it shouldn't be

- the noise made is similar to blowing air across the mouth of a bottle

amphoric

pathologic breath sounds - sounds as if air is coming from a cave and heard with pulmonary cavities in which the wall is rigid

cavernous

adventitious breath sounds - heard during INSPIRATION and characterized by discrete discontinuous sounds

caused by passage of air through small airways

crackles (aka rales)

adventitious breath sounds - deeper, rumbling, more pronounced during EXPIRATION, and continuous

caused by passage of air through an airway obstructed by thick secretions, muscle spasms, new growth, or external pressure

rhonci

adventitious breath sounds - continuous, high pitch, whistle sound heard during INSPIRATION AND OR EXPIRATION

caused by high velocity air flow through a narrow or obstructed airways from bronchospasm or bronchitis

wheezes

adventitious breath sounds - dry crackling, low-pitched sound heard during both inspiration and expiration

caused by inflamed, roughened surfaces rubbing together outside the respiratory tract

friction rub

adventitious breath sounds - air leaking into the mediastinum and can sounds like another adventitious breath sounds

mediastinal crunch (hamman sign)

which auditory change to vocal resonance is described as greater clarity and loudness of spoken words

bronchophony

2 multiple choice options

which auditory change to vocal resonance is described as extreme bronchophony (whisper sounds like a full yell)?

pectoriloquy

2 multiple choice options

which auditory change to vocal resonance is described as nasally sound but still increased intensity?

egophony

2 multiple choice options

what is a cause of decreased vocal resonance?

loss of respiratory tissue

1 multiple choice option

what would solids and fluids in the lungs increase or decrease breath sounds?

increase

1 multiple choice option

what is the normal respiration rate of infants?

40-60 per minute

what is the normal respiration rate of adults?

12-16 per minute

what age does a child's respiration rate reach 12-16 bpm?

17 yrs old

T/F: is it considered normal for infants to have periodic breathing?

true

1 multiple choice option

what is paradoxical brerathing?

a breathing pattern where the chest or abdomen moves in the opposite direction of a normal breath

T/F: paradoxical breathing is common during sleeping for infants?

true

1 multiple choice option

What is a high pitched, piercing sound most often heard during inspiration that is due to an obstruction high in the respiratory tree?

stridor

what is the mechanism a baby can "clear out" the lungs of trapped fetal lung fluid while retaining air and increases oxygen levels?

respiratory grunting

what is a sign of respiratory distress in infants?

flaring of the nostrils

higher levels of progesterone during pregnancy can lead to what respiratory pattern?

hyperventilation

what affect does costcochondral cartilage calcification have on older aduls?

decrease in chest expansion

abnormalities- reversible small airway obstruction caused by airway inflammation, increased mucus production, and bronchial smooth muscle contraction secondary to a trigger

symptoms: dyspnea, chest pain, coughing, tachypnea, wheezing

asthma

how does asthma appear on an xray NOT during an asthma attack?

normal

TQ: how does asthma appear on an xray during an acute asthma attack?

identical to emphysema

list some asthma triggers

allergens

anxiety

cold air

exercise

upper respiratory infections

cigarette smoking

environmental agents

abnormalities- incomplete expansion/collapse of the lobes of the lung

symptoms- decreased chest wall movement, tachypnea, dyspnea

atelectasis

the clinical findings of atelectasis: _ fremitus (vibrations felt on chest wall), _ percussion, _ breath sounds

decrease

dull

decrease

during atelectasis, are structures in the thorax pulled towards or away from the collapsed side?

towards

1 multiple choice option

abnormalities- inflammation of large airways resulting in increased mucus secretion (acute or chronic)

bronchitis

what is the MC factor for developing chronic bronchitis?

smoking

at what age does acute bronchitis occur?

any age

at what age does chronic bronchitis occur?

>40

what is the color of mucus for acute bronchitis?

colorful - rusty

abnormalities- inflammation of the pleura visceral and or parietal)

pleurisy

what is the MC cause of pleurisy?

pulmonary infection

does respiration relieve or worsen chest pain with pleurisy?

worsen

1 multiple choice option

pleurisy can lead to pleural effusion... if that becomes infected, what will that result in?

empyema - a collection of pus in the pleural space

abnormalities - collection of fluid within the pleural space that occurs from back up somewhere in the lymphatic or cardiopulmonary system

pleural effusion

what are the clinical findings of pleural effusion: _ fremitus, _ percussion, _ breath sounds, _ tracheal position

decrease

dull

decrease

depends but MC no change

which clinical finding of pleural effusion is the most helpful?

dull percussion

how much fluid is needed to be seen on an chest x-ray?

250-600mL

TQ: what x-ray view is the most sensitive for pleural effusion and pneumothorax?

lateral decubitus (patient laying on their side)

TQ: what x-ray view is the least sensitive for pleural effusion and pneumothorax?

PA chestt

abnormalities - infection of the pleural space (pus forming)

empyema

what is the MC cause of empyema?

adjacent infection or trauma

what are the clinical findings of empyema: _ fremitus, _ percussion, _ breath sounds

decrease

dull

decrease

what is the biggest risk factor for patients with empyema?

pneumonia

abnormalities - well defined mass within the lung that mimics TB or SCC; very foul smelly sputum

lung abscess

what are the MC of lung abscess?

aspiration pneumonia (frielander's)

dentat infection

pulmonary infection

if you have an alcoholic or debilitated patient who presents with a lung abscess, what is important to for screen?

klebsiella (currant jelly)

what are the key differences between empyema and lung abscess?

empyema- well defined, smooth wall, vessels displaced

lung abscess- poorly defined, irregular wall, vessels not displaced

abnormalities - infection of the lower respiratory tract (bronchioles and alveoli) from viral, bacterial, or fungal origin that allows serious fluid within the alveolar sack

pneumonia

clinical findings of pneumonia: _ breath sounds, _ percussion, _ fremitus

decrease or increase

dull

decrease or increase

abnormalities - viral infection of the lung that weakens the immune system making the host more likely to get another bacterial infection

influenza

abnormalities - chronic, infectious disease that begins in the lungs causing multiple cavities lesions in the upper lung field but can spread to other organs

tuberculosis

what is TB in the spine called?

Pott's disease

TB lab results: -PPD and -QG

never been exposed

TB lab results: -PPD and +QG

post-primary/latentt

TB lab results: +PPD and +QG

reactivation TB / contagious

miliary TB is caused by the spread of TB through what?

the bloodstream

what stage of TB is non-specific pneumonia s/s and the TB can hide in a granuloma or lymph node?

primary TB

2 multiple choice options

what stage of TB is asymptomatic and reactivation only occurs when the body's immune system is compromised?

latent

2 multiple choice options

what stage of TB is "full blown infections TB"?

reactivation

2 multiple choice options

abnormalities - presence of air within the pleural space

pneumothorax