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Questions and Answers
Which structure is part of the upper airway in the respiratory system?
What percentage of the total surface area available for gas exchange is contained in the left lung?
Which of the following is not considered one of the six cardinal symptoms of chest diseases?
What defines a chronic cough according to the respiratory examination criteria?
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In which situation would expectoration most likely be considered productive?
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Which imaginary line is located at the mid-clavicular region?
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Which symptom is characterized by coughing up blood?
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What is the total approximate surface area available for gas exchange in the two lungs combined?
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Which of the following is NOT a common cause of hemoptysis?
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Wheezing is best described as occurring due to which condition?
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What is the recommended position for a patient during a chest examination?
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What symptom is typically associated with mitral stenosis?
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Which of the following is NOT a recommended step when preparing to examine a patient's chest?
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What type of breath sound is associated with stridor?
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Which finding in the neck examination could indicate potential issues related to bronchial carcinoma?
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Which sign may indicate moderate to massive pleural effusion?
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What is the normal respiratory rate for adults?
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What is a typical symptom of pneumothorax?
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When inspecting the anterior chest wall, what is recommended?
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Which finding would you expect when inspecting a patient with a tension pneumothorax?
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What indicates the use of accessory muscles during respiration?
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What would likely be seen during the inspection of a patient with significant chest deformity?
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Which of the following does NOT suggest respiratory distress in a patient?
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What symptom might suggest the presence of pleural effusion?
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Study Notes
Anatomy of Respiratory System
- The respiratory system includes the upper airway (nose, mouth, oropharynx, and larynx) and the lower airway (trachea and lungs).
- Each lung contains approximately 300 million alveoli, providing a total air exchange surface area of 40-80m2.
- The left lung has 45% of the total surface area available for gas exchange due to the location of the heart within the left side of the chest.
Chest Landmarks
- Anterior Landmarks: Suprasternal notch, Supraclavicular fossa, Infraclavicular fossa, Sternal line, Sternal angle, Parasternal line, Anterior midline, Midclavicular line, Epigastric angle
- Lateral Landmarks: Posterior axillary line, Anterior axillary line, Midaxillary line
- Posterior Landmarks: Suprascapular region, Scapular region, Interscapular region, Infrascapular region, Scapular line, Posterior midline
Respiratory System Examination
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History of Present Illness:
- Six cardinal symptoms of chest diseases: cough, expectoration (sputum), hemoptysis, chest pain, dyspnea, wheezes.
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Cough:
- Dry or productive.
- Persistent or episodic.
- Acute (lasting less than 3 weeks) or chronic (lasting longer).
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Expectoration (Sputum):
- Important to note color, consistency, volume, and odor.
- Can be mucoid, purulent, or blood-tinged.
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Hemoptysis:
- Differentiate from hematemesis (vomiting blood).
- Causes: Mitral stenosis, Pulmonary tuberculosis, Pulmonary infarction, Bronchiectasis, Bronchogenic carcinoma, Bronchial adenoma, Bleeding tendency.
- Ask about preceding events (e.g., deep vein thrombosis, chest infection).
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Chest pain:
- Common and the location and character of pain can indicate specific diseases.
- Retrosternal pain: acute tracheitis.
- Mediastinal pain: emphysema or mediastinitis.
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Dyspnea:
- Difficulty or labored breathing.
- Causes: Emphysema, Asthma, Pneumonia, Pneumothorax, Pleural effusion.
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Wheezes:
- Differentiate between wheezes and stridor.
- Wheezes occur due to narrowing of small airways.
- Stridor occurs due to obstruction of major airways and is audible only during inspiration.
- Wheezing can be intermittent (asthma) or persistent (chronic bronchitis).
- Wheezing can be diffuse (asthma, chronic bronchitis) or localized (bronchogenic carcinoma).
Examination Techniques
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Inspection:
- Observe from the end of the bed:
- Respiratory rate, chest shape, oxygen, inhalers/nebulisers, sputum pot, cigarettes, stridor, cachexia, accessory muscle use, pursed lip breathing.
- Examine Hands:
- Clubbing, tar staining, tremor, asterixis, steroidal skin, wasting of small muscles, pulse, hypertrophic pulmonary osteoarthropathy (HPOA).
- Examine Face:
- Pallor, dilated pupils, central cyanosis, Horner’s syndrome, Cushingoid appearance, hoarse voice.
- Examine Neck:
- Trachea, crico-sternal distance, jugular venous pressure (JVP), lymphadenopathy.
- Examine Anterior Chest:
- Inspect for: prominent veins, pulsations, scars, respiratory rate, type of respiration, shape of the chest, any chest deformities, symmetry of chest movement.
- Observe from the end of the bed:
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Palpation:
- Palpate for: vocal fremitus, tenderness, crepitations, palpable lung edge.
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Percussion:
- Done to assess the density of underlying lung tissue.
- Normal percussion sounds: resonant or hyperresonant. Abnormal percussion sounds: dullness, tympany, flatness.
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Auscultation:
- Listen to breath sounds, adventitious sounds, and vocal resonance.
Respiratory Diseases
-
Pleural Effusion:
- A buildup of fluid in the space between the lungs and the chest wall (pleural space).
- Symptoms: Dyspnea, orthopnea, palpitation.
- Signs (Moderate to massive effusion): tachypnea, limited movement of affected side, wider costal interspaces on affected side, trachea shifts to opposite side, decreased vocal fremitus, dullness or flatness, decreased or disappeared vesicular breath sound, decreased or disappeared vocal resonance, pleural friction rub, abnormal bronchial breath sound in the upper area of the fluid.
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Pneumothorax:
- A collapsed lung.
- Symptoms: Sudden chest pain, dyspnea, forced sitting position, unaffected side lying, dry cough.
- Signs: Wider costal interspaces on affected side, limited movement of affected side, decreased or disappeared vocal fremitus, trachea and heart shift to opposite side, tympany, vesicular breath sound.
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Description
Test your knowledge on the anatomy and landmarks of the respiratory system. This quiz covers important aspects of the upper and lower airway, as well as key chest landmarks used in respiratory examinations. Challenge yourself to recall the details of each region and their functions.
