components of the upper respiratory tract
- nasal cavity
- pharynx
- larynx
components of the lower respiratory tract
- trachea
- primary bronchi
- lungs
what does white sputum indicate
viral respiratory tract infections
what does yellow/green blood streaked sputum indicate
bacterial infection (not exclusively)
bloody or blood-stained sputum coughed up from the pharynx, trachea, larynx, bronchi or lungs
hemoptysis
rusty sputum is associated with
pneumococcal pneumonia
what would cause pink and frothy sputum
Air mixing with blood not as deep as in airways may cause pink frothy sputum
what is the pain sensitive part of the lungs
pleura
The trachea bifurcates topographically into the main bronchi at what level
2nd ICS anteriorly and at T3 posteriorly
the apex of each lung projects where
1” above the clavicle
where is the base of the lungs anteriorly
6th rib
where is the base of the lungs posteriorly
T10
how many lobes does the right lung have
3 lobes
What are the traditional lung physical exam procedures?
- inspection
- palpation
- fremitus
- percussion
- auscultation
which of the traditional lung physical exam procedures is the most effective and efficient
auscultation
abnormally slow breathing
bradypnea
abnormally fast breathing
tachypnea
rapid, deep breathing; as in hyperventilation
hyperpnea (kussmaul)
shallow breaths; as in pleurisy
hypopnea
Dyspnea initiated or aggravated when lying down
orthopnea
Dyspnea initiated or aggravated when in the upright position
platypnea
prolonged periods between breaths
apnea
Dyspnea provoked by minimal exertion such as climbing a few stairs
exertional dyspnea
Alternating crescendo- decrescendo breathing & apnea
cheyne-stokes breathing
A few deep breaths followed by a period of apnea
biot respiration
patient placement for posterior-lateral chest
seated with arms crossed, hands on shoulders and leaning forward
With multiple unilateral rib fractures the fractured rib cage moves downward with inspiration instead of upward like the other side
flail chest
The patient holds their chest in an attempt to limit movement as in pleurisy, bruised or cracked rib
respiratory splinting
structural abnormalities that could be found during inspection
- hyperkyphosis
- pectus excavatum
- pectus carinatum
- barrel chest
- ICS retraction
- ICS bulging
congenitally depressed sternum
pectus excavatum
abnormally prominent sternum
pectus carinatum
what is palpation assessing during a traditional lung examination
- symmetrical elevation of the rib cage
- no structural and functional abnormalities of skin and musculoskeletal system
Voice induced vibrations transmitted from the larynx through the tracheobronchial tree & palpated on the surface of the chest
fremitus
which side paraspinal area has more pronounced vibrations
right side; presence of heart on left
during pneumothorax are the vibrations louder or diminished
diminished
during pleural effusion are the vibrations louder or diminished
diminished
during lung consolidation are the vibrations louder or diminished
louder
during lobar pneumonia are the vibrations louder or diminished
louder
what are the five clinically useful percussion sounds
- resonant
- flat
- dull
- tympanic
- hyperresonant
what is the sound normally heard over the lung fields during percussion
resonant
sound normally heard over larger bones like the sternum and scapulae during percussion
flat
sound normally heard over the heart, liver and diaphragm during percussion
dull
sound normally heard in the abdomen over the gastric air bubble and intestines during percussion
tympanic
sound only heard over hyperinflated alveoli as in advanced emphysema during percussion
hyperresonant
what do dull or flat percussion sounds indicate
- consolidation
- pleural effusion
- large tumor
what do hyperresonant percussion sounds indicate?
hyperinflated alveoli as in advance emphysema
what do tympanic percussion sounds indicate
spontaneous or traumatic pneumothorax
what are you listening for during auscultation?
- breath sounds
- added sounds
- voice sounds
what are the breath sounds?
- bronchial
- bronchovesicular
- vesicular
what are the added sounds?
- crackles
- weezes
- friction rubs
what are the voice sounds?
ABC, “EEE”, and whispered “ABC”
TRUE or FALSE: breath sounds are the loudest and longest over the large airways
TRUE; breath sounds are soft and short over small airways
where are the breath sounds for the main bronchi heard
2nd intercostal space
where are the breath sounds for the bronchovesicular/large bronchials
3rd and 4th intercostal space
gurgling, popping sounds due to agitation of excess mucous in the airways or the inflation of multiple collapsed alveoli
crackles
squeaky, musical, whistling sounds usually heard during expiration due to narrowed airways
weezes
grating, rubbing, crackling sounds heard on inspiration & expiration due to inflammation of the pleura
friction rub
what often accompanies friction rub
pleural pain
what would cause increased breath sounds
- consolidating pneumonia (lobar or lobular)
- atelectasis
- large tumor
Why does consolidating pneumonia cause increased intensity of breath sounds and a longer expiratory phase?
solids &/or fluid media conduct sound vibrations better than air, therefore if consolidation is continuous filling the airways from the bronchi/bronchioles to the alveoli it will conduct the louder, longer bronchial breath sound into the vesicular areas
What could cause diminished or absent breath sounds at a contralateral point?
- blocked airway
- significant pneumothorax
- significant pleural effusion
- significant pleural thickening
Increased intensity & clarity of the whispered word (“ABC”)
Whispered pectoiloquy
Increased intensity & clarity of the spoken word (“ABC”)
bronchophony
Increased intensity & clarity of the spoken “EEE”
egophony
chest cold
acute bronchitis
Viral irritation causes inflammation of the mucous lining of the bronchi & perhaps some bronchioles resulting in symptoms of fever, cough with clear or white sputum & back pain.
acute bronchitis
percussion produced during acute bronchitis
resonant over lung fields
what are the notes on added sounds during acute bronchitis
large airway crackles & wheezes may clear with coughing
Usually it’s a bacterial infection involving the distal airways & alveoli causing small patchy areas of consolidation
bronchopneumonia
what are the symptoms of bronchopneumonia
fever, dyspnea & a productive cough
percussion produced during bronchopneumonia
resonant over the lung fields
added sounds during bronchopneumonia
scattered crackles and weezes
Usually it’s a bacterial infection involving an entire lobe(s) of a lung
lobar pneumonia
symptoms of lobar pneumonia
fever, dyspnea & cough with rusty sputum
ribcage movements during lobar pneumonia
rapid and shallow
fremitus intensity over lobe affected during lobar pneumonia
increased over consolidated area
percussion produced during lobar pneumonia
dull over consolidated lobe
ribcage movements during pleural effusion
rapid and shallow
percussion produced during pleural effusion
dull over pleural fluid