Thorax and Lungs

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Thorax and Lungs
2012-10-05 22:58:23
Thorax Lungs

Thorax and Lungs
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  1. The points at which the ribs join their cartilages. They are not palpable.
    Costochondral junctions
  2. Defined by the sternum, 12 pairs of ribs and 12 thoracivertebrates
    Thoracic cage
  3. U shaped depression above the sternum, in between the clavicles
    Suprasternal noch
  4. The breastbone which contains manubrium, body and xiphoid process
  5. Articulation of the manubrium and body of the sternum that is continuous with the second rib. Useful place to start counting ribs.
    Sternal angle or Angle of Louis
  6. Where the right and left costal margins form an angle where they meet at xiphoid process of 90 degrees or less. This angle increases when rib cage is chronically overinflated, as in emphysema.
    Costal angle
  7. Most prominent bonspirit protruding at base of neck is C7 and the lower nose is T1
    Vertebra Prominens
  8. Count down knobs on vertebrae which stack together to form the spinal column. They align with their same numbered ribs down to T4. After T4 they angle downward from their vertebral body and overlie vertebral body and rib below.
    Spinous processes
  9. Located symmetrically in each hemithorax. Lower tip is usually at 7th or 8th rib
    Inferior border of scapula
  10. Midway between spine and persons side
    Twelfth rib/free tip
  11. Middle section of the thoracic cavity containing esophagus, trachea, heart and great vessels.
  12. Located on either side of the mediastinum and contain the lungs
    Pleural cavities
  13. Highest point of lung tissue 3-4 cm above the inner third of the clavicles
  14. Rests on diaphragm at about 6th rib in the midclavicular line. T10!
    Base/ lower border
  15. Crosses 5th rib in midaxillary line and terminates at the 6th rib in midaxillary line
    Oblique fissure
  16. Divides the right upper and middle lobes
    Horizontal fissure
  17. Serous membranes that form an envelope between lungs and chest wall
  18. Lines the outside of the lungs, dipping down into the fissures 
    Visceral pleura
  19. Lines inside of the chest wall and diaphragm
    Parietal pleura
  20. Inside of the envelope which is a potential space filled only with a few ml of lubricating fluid.
    Pleural cavity
  21. Potential space when it fills with air or fluid, it compromises lung expansion
    Costodiaphragmatic recess
  22. Bifurcates just below sternal angle into the right and left main bronchi. At level of t4/t5
  23. Transport gases between the environment and lung parenchyma. "Dead space" that is filled with air but is not available for gas exchange
    Trachea and bronchi
  24. Protects alveoli from small particulate matter in the inhaled air
    Bronchial tree
  25. Lined wigo goblet cells that secrete mucus and cilia which sweep particles up 
  26. Functional respiratory unit that consists of bronchioles, alveolar ducts, alveolar sacs, and the alveoli
  27. Where does gaseous exchange occur?
    Across respiratory membrane in the alveolar duct and in the millions of alveoli
  28. Clustered like grapes creating a surface area for gas exchange that is as large as a tennis court
  29. What are the four major functions of  the respiratory system?
    • 1. Supply oxygen to body for energy production
    • 2. Remove carbon dioxide as waste product of energy reactions
    • 3. Maintain homeostasis of arterial blood
    • 4. Maintain heat exchange 
  30. Increase of carbon dioxide in the blood
  31. Decrease of oxygen in the blood increasing respirations
  32. Increased vertical diameter with the diaphragm descending and ribs elevating as it contracts
  33. Decrease vertical diameter when ribs depress and diaphragm domes up
    ExpirationExpiration a
  34. When does the diaphragm elevate 4 cm? 
    During pregnancy!
  35. Maximum amount of air that a person can expel from the lungs after first filling the lungs to max
    Vital capacity
  36. Amount of air remaining in lungs even after the most forceful expiration
    Residual volume
  37. Coughing up blood
  38. Difficulty breathing when supine
  39. Awakening from sleep with shortness of breath
    Paroxysmal nocturnal dyspnea 
  40. Placing hands on posterolateral chest wall with thumbs at level of T9 and T10. Pinch fold of skin and ask person to breathe. Thumbs should move apart symmetrically 
    symmetric chest expansion
  41. Ap diameter equal to transverse diameter. Ribs are horizontal with chest appearing as if held in continuous inspiration.
    Barrel chest
  42. Palpable vibration. "Ninety Nine"
    Tactile fremitus
  43. What factors affect the normal intensity of tactile fremitus?
    • 1. Relative location of bronchi to the chest wall
    • 2. Thickness of the chest wall
    • 3. Pitch and intensity
  44. Occurs when anything obstructs transmission of vibrations (Obstructed bronchus, pleural effusion, pneumothorax and emphysema). Any barrier that gets in the way of the sound and your palpating hand
    Decreased tactile fremitus
  45. Occurs with conditions that increase density of lung tissues, thereby making a better conducting medium for vibrations (pneumonia). There must be a patent bronchus and consolidation must extend to lung surface.
    Increased tactile fremitus
  46. Vibration felt when inhaled air passes through thick secretions in the large. Bronchi. This may decrease by coughing.
    Rhonchal fremitus
  47. Produced when inflammation of parietal or visceral pleura cause a decrease in normal lubricating fluid.
    Pleural friction fremitus
  48. Coarse, crackling sensation palpable over skin surface. occurs in subcutaneous emphysema when air seascapes lung and enter subcutaneous tissue
  49. Low pitched, clear, hollow sound that predominates in healthy lung tissue 
  50. Lower pitched, booming sound found when too much air is present such as in emphysema or pneumothorax
  51. Determhow's how far diaphragm moves when breathing. 3-5 cm in adults
    Diaphragmatic excursion
  52. High pitched, loud amplitude, inspiration is less than expiration, harsh hollow tubular quality located at trachea and larynx
    Bronchial breath sounds
  53. Moderate pitch and amplitude, inspiration equals expiration, mixed quality and is located where fewer alveoli are located: posterior, between scapula, anterior
  54. Low pitch, soft amplitude, inspiration greater then expiration, rustling quality, located over peripheral lung fields where air flows through smaller bronchioles and alveoli
    Vesicular breath sounds
  55. When are their decreased or absent breath sounds?
    • 1. When bronchial tree is obstructed at some point by secretions, mucus etc
    • 2. In emphysema as result of loss of elasticity in lung fibers and decreased force of inspired air
    • 3. When anything obstructs transmission of sound between lung and stethoscope, like pleural thickening
  56. Abnormal lung sounds
    Adventitious sounds
  57. Not pathological! Short, popping, crackling sounds that sound like fine crackles but don't last beyond a few breaths. Sections of alveoli are not fully aerated and deflate slightly and accumulate secretions.
    Atelectacic crackles
  58. Purse lips in whistle position, tense, clubbing in nails
  59. Suggests obstruction of respiratory tract or increased inspiratory effort is needed, as with atelectasis
  60. Indicates trapped air as in the forced expiration associated with emphysemabout asthma
  61. Measures lung health in chronic conditions such as asthma. 75% or greater means no significant obstruction of airflow is present 
  62. Noninvasive method to assess arterial oxygen saturation. 95-100%
    Pulse oximeter
  63. A markedly sunken sternum and adjacent cartilages. Depression begins at second intercostal space, becoming depressed most at junction of zip good with body of sternum
    Pectus excavatum
  64. Forward protrusion of sternum, with ribs sloping back at either side and vertical depressions along costochondral junctions.
    Pectus carinatum
  65. S shaped curvature of thoracic and lumbar spine, usually with involved vertebrae rotation. More prevalent in girls 
  66. Exaggerated posterior curvature of thoracic spine that causes significant back pain and limited mobility. Could impair cardiopulmonary function.
  67. Rapid, shallow breathing that's more than 20 a min. Normal response to fever, fear, exercise. Rate increases with respiratory insufficiency, pneumonia, alkalosis, pleurisy, and lesions in the pons
  68. Slow breathing. Decreased by regular rate under 12 breaths per min. Drug induced depression of respiratory center in medulla, increased intracraniapresided and diabetic coma
  69. Increase in both breathing rate and depth. Blows off carbon dioxide causing a decreased level in the blood. Occurs with exertion, fear or anxiety
  70. Irregular shallow pattern caused by overdose of narcotics or anesthetics. Can also occur with prolonged bed rest or conscious splinting of chest to avoid respiratory pain
  71. Cycle in which respirations gradually wax and wane in a regular pattern, increasing in rate and depth and then decreasing. Breathing period lasts 30-45 seconds with periods of apnea alternating. Most common cause is heart failure
    Cheyne-stokes respiration 
  72. Similar to cheyne-stokes except that the pattern is irregular. Seen with head trauma.
    Biots respiration
  73. Discontinuous, high pitched, short crackling, popping sounds heard during inspiration that aren't cleared by coughing
    Fine crackles
  74. Inhaled air collides with previously deflated airways
    Inspiratory crackles
  75. Sudden airway closing
    Expiratory crackles
  76. Loud, low pitched, bubbling and gurgling sounds that start in early inspiration and may be present in expiration. Inhaled air collides with secretions in trachea and large bronchi. Pulmonary edema, pneumonia.
    Coarse crackles
  77. Superficial sound that is coarse and low pitched that is caused when pleural become inflamed and lose their normal lubricating fluid. Roughened surfaces rub together during respiration.
    Pleural friction rub
  78. High pitched, musical sounds that predominate in expiration. Air is squeezed through passageways narrowed almost to closure by collapsing, swelling, secretions or tumors
    High pitched wheeze
  79. Low pitched, single note, prominent on expiration. Airflow obstruction as described by vibrating reed mechanism
    Low pitched wheeze
  80. High pitched, monophonic, inspiratorty crowing sound that originates in larynx or trachea. Upper airway I obstruction from swollen, inflamed tissues.
  81. Ask person to repeat 99. Normal voice transmission is soft, muffled and indistinct
  82. You should hear "eeeee" not "aaaaaa" through stethoscope 
  83. "1,2,3"
    normal response is faint, muffled and almost inaudible
    Whispered pectoriloquoy
  84. Collapsed shrunken section of alveoli or an entire Lunt as result of airway obstruction, the alveolar air beyond it is absorbed into pulmonary capillaries and alveolar walls cave in, compression on lung, lack of surfactant
    Atelcectasis (collapse)
  85. Infection in lung parenchyma leaves alveolar membrane edematous and porous, so rbc's and wbc's pass from blood to alveoli. Alveoli fill up decreasing surface area of respiratory membrane causing hypoxemia.
    Lobar pneumonia
  86. Proliferation of mucus glands in the passageways, resulting in excessive mucus secretion. Inflammation of bronchi with partiaobstruction of bronchi by secretions
  87. Caused by destruction of pulmonary connective tissue characterized by permanent enlargements of air sacs distal to terminal bronchioles and rupture of interalveolar walls. Increases airway resistance especially with expiration producing hyper inflated lungs
  88. An allergic hypersensitivity to certain inhaled allergens, irritata, microbes, stress or exercise that produces a complex response characterized by bronchi spasm and inflammation, edema in walls of bronchioles and secretion of may us into airways
  89. Collection of excess fluids in the infra pleural space with compression or overlying lug tissue. Effusion may contain watery capillary fluid, protein, purulent matter, or milky lymphatic fluid
    Pleural effusion or thickening
  90. Pump failure with incpressure pressure of cardiac overload causes pulmonary congestion or an increased amount of blood present in pulmonary capillaries. Dependent air sacs deflate, pulmonary capillaries engorged.
    Heart failure
  91. Free air in pleural space causes partial or complete lung collapse. Air in pleural space neutralizea the usual negative pressure present
  92. Inhalation of tubercular bacilli into the alveolar wall starts
  93. Undos solved materials originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels 
    Pulmonary embolism
  94. Acute, pulmonary insult damages alveolar capillary membrane, leading to increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema. Trauma, gastric acid aspirations, shock, sepsis.collapsed alveoli!
    Acute respiratory distress syndrome