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Three parts of sternum
- 1. Manubrium
- 2. Body
- 3. Xiphoid process
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Costochondral junction
Where rib attaches to cartilage
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Costal angle
Nml less than or equal to 90 degrees
Abn when angle increases. Hyperinflation (e.g. emphysema)
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Vertebral Prominences
C7. Palpate with head flexed. If two bumps then C7 and T1
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Location of lower tip of scapula
inferior border at 7th-8th rib
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What is contained in the mediastinum
- heart
- great vessels
- esophagus
- trachea
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Location of anterior apex (top) of lung border
3-4cm above 1st rib
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Location of anterior base (bottom) of lung border
- Right: at 5th ICS, MCL
- Left: at 6th ICS, MCL
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Location of lateral lung border
From apex of axilla to 7th-8th ribs
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Location of posterior upper lobes
T1 to T3/4
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Location of posterior lower lobe of lung borders
T3 to T10 (expiration) or T12 (inspiration)
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How many lobes does the right lung have
- 3 (upper, middle, lower)
- Shorter d/t liver
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How many lobes does the left lung have
2 (upper and lower). Narrower d/t heart border
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Location of horizontal fissures (right side of heart)
- 4th rib right sternal border to 5th rib MAL.
- Separates upper and middle lobe
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Location of anterior oblique fissues (bilateral)
5th rib MAL to 6th rib MCL
- Right: separates middle and lower lobes
- Left: separates upper and lower lobes
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Visceral layer of pleura
Lines lung surface
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Parietal layer of pleura
Lines chest wall and diaphragm
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Pleural cavity
Negative pressure holds lungs against chest wall
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Costodiaphragmatic recess
Pleura extend 3cm below level of lung. Potential space for fluid and air which may compress lung
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Span of trachea
- Anterior to esophagus
- Starts at cricoid (10-11cm long)
- Bifurcates at manubriosternal angle (anteriorly)
- Bifurcates at T4 (posteriorly)
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Right main stem of bronchus
Shorter and straighter. Increased risk of aspiration
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Dead Space
Trachea and bronchi. Filled with air, but no gas exchange
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Bronchial tree lined with goblet cells (function) and cilia (function)
- Goblet: Secrete mucus that entrap particles
- Cilia: Sweep particles upward
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Acinus (functional resp unit)
Bronchioles, alveolar ducts, alveolar sacs and alveoli
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How many alveoli do we have
300 million
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Resp acidosis
Retained CO2
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Resp alkalosis
Excessive excretion of CO2 through resp
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Resp center
Brain stem. Pons and medulla
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Scoliosis
- Lateral curve
- More common in girls, adolescents
- Assess uneven shoulder, scapular, hip height
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Crackles
Produced when there is a fluid inside a bronchus causing a collapse of the distal (smaller) airways and alveoli. Crackles occur when there is a sudden equalization of pressure causing some of the airways to pop open. Heard on inspiration, doesn't clear with coughing
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Fine crackles
High pitched, short duration, cracking and popping sounds
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Coarse crackles
Low pitched, longer duration, bubbling and gurgling sounds
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Tachypnea
- Rapid, shallow, breathing >20/min.
- Fear, anxiety, fever, exercise, resp insufficiency, PNA, alkalosis, pleurisy, lesions in the pons
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Bradypnea
- Regular, show, brathing <10/min
- depressant drugs, increased ICP, DM coma
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Hyperventilation
- Rapid, deep breathing
- Extreme exertion, fear, anxiety, DKA
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Cheyne-Stokes
- Regular, cyclic.
- Breathe 30-40sec then apnea for 20 sec
- CHF and other causes
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Biots (ataxic)
Irregular, deep, slow with periods of apnea (preceeds Cheyne Stokes)
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Stridor
Croup, foreign body, growht on vocal cords, high pitched on inspiration
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PEFR
- Peak Expiratory Flow Rate
- Max flow of air during a forced expiration
- Useful surrogate measure of VC
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Atelectasis
Collapsed alveoli. Predisposes to PNA
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Emphysema
- Destruction of alveoli
- Decreased gas exchange
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Asthma
Intermittment bronchospasm and constriction.
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Pleural effusion
Fluid in pleural space
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Pneumothroax
- Air in pleural space
- Collapsed lung
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Hemothroax
Blood in pleural space
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Emphyema
Purulent exudate in pleural space
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Cystic Fibrosis
Autosomal recessive disorder of exocrine glands affecting lungs, pancrease, sweat glands
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Bronchiectasis
- Chronic condition of bronchi and bronchioles caused by repeated infections
- Serious
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Corpulmonale
Lung disease that cuases hypertrophy of right ventricle and progresses to heart failure
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