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Questions and Answers
What can trigger localized pain in the chest wall?
Which shape change of the chest wall indicates chronic lung disease?
What is the typical AP:T ratio of a normal chest wall?
Which of the following is a sign of airway constriction?
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What do fine crackles signify about fluid in the airways?
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What condition is most likely to cause acute cough?
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What characteristic distinguishes coarse crackles from fine crackles?
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Which of the following options relates to chronic cough pathology?
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What does rhonchi indicate regarding airway conditions?
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Which symptom is most indicative of central cyanosis?
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What is the significance of diminished breath sounds?
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Which symptom is NOT typically associated with hypoxemia?
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What characterizes stridor in patients with upper airway issues?
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How is peripheral cyanosis typically identified?
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What can prolonged hypoxemia lead to in patients over time?
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Which is the primary cause of stridor?
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Which of the following conditions can lead to hemoptysis?
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What is dyspnea commonly associated with?
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What characterizes the sputum during a viral acute upper respiratory infection?
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What physical response might be observed in a person experiencing dyspnea?
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Which statement about retractions is true?
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What causes pleural pain experienced during deep inspiration?
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What technique is used to assist with air trapping during exhalation?
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What type of sputum is typically associated with pulmonary edema?
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Study Notes
Chest Wall Pain
- Costochondritis, inflammation of one or more costal cartilages, is characterized by anterior chest wall pain.
- Coughing can trigger costochondritis.
- Inflammation of the airways, intercostal muscles, or accessory muscles can also cause localized pain.
- Coughing can trigger inflammation.
- Chest pain can originate in the lungs, but must be differentiated from cardiac pain to rule out a myocardial infarction.
Barrel Chest
- The chest wall is typically oval-shaped, with the anterior-posterior (AP) plane narrower than the transverse (T) plane (AP:T ratio of approximately 1:2).
- Chronic dilation and distention of the alveoli, as seen in emphysema, can lead to a barrel chest appearance, where the AP:T ratio becomes 1:1.
Breath Sounds
- Adventitious breath sounds are altered lung sounds caused by airway constriction or fluid accumulation.
- Wheezing breath sounds are caused by airway constriction.
- Crackles, a snapping, popping, or bubbling sound, are caused by fluid accumulation in the airways.
- Fine crackles are high-pitched and short, signifying fluid in smaller airways.
- Coarse crackles are louder and lower-pitched, indicating fluid in larger airways.
- Rhonchi, low-pitched wheezing sounds with a snoring quality, occur when the airway narrowing is in the larger airways.
- Rhonchi, high-pitched wheezing sounds with a squeaking quality, occur when the airway narrowing is in the smaller airways.
- Rhonchi are caused by thick mucus partially blocking the airways.
- Stridor, a harsh, high-pitched, creaking sound, is indicative of upper airway obstruction, particularly in the trachea or larynx.
- Diminished breath sounds indicate quieter, barely audible breath sounds, suggesting complete obstruction in one or more airways.
- Absent breath sounds indicate no air movement through the lungs.
Systemic Manifestations of Altered Ventilation
- Hypoxemia, hypoxia, and hypercapnia can cause systemic manifestations.
- Fever, malaise, leukocytosis, and higher levels of circulating plasma proteins can occur with inflammation and issues with altered ventilation and diffusion.
- The intensity of hypoxic or hypercapnic responses varies depending on the severity of oxygen deprivation and carbon dioxide retention.
- Manifestations may include dusky or cyanotic mucous membrane color, changes in arterial blood gases, mental status changes, and finger clubbing.
Cyanosis
- Cyanosis is caused by a high proportion of desaturated hemoglobin in the blood, giving the blood a bluish hue.
- Central cyanosis, a problem of low oxygen saturation in arterial blood, can cause color changes in the skin and mucous membranes.
- In individuals with dark skin, color changes are often described as ashen or dusky.
- In light skin, color changes are often described as pale or bluish.
- The most reliable indicator of central cyanosis is a bluish color in the mucous membranes.
- Peripheral cyanosis, caused by sluggish blood flow in the fingers and toes, often presents with slow capillary refill and a pale or bluish hue in the nail beds.
Finger Clubbing
- Chronic problems with ventilation and diffusion may lead to clubbing of the fingers.
Sputum
- A viral acute upper respiratory infection (common cold) often begins with clear, thin mucus.
- As phagocytes move into the area of inflammation and die, they are shed off as yellow or green mucus.
- Hemoptysis, coughing up blood from the respiratory tract, is caused by the presence of red blood cells in the sputum.
- Hemoptysis in the sputum can be caused by heavy exertion during coughing, tuberculosis, a tumor, or trauma.
- In the presence of pulmonary edema, the sputum can become blood-tinged, frothy, or foamy.
Dyspnea
- Dyspnea, the subjective feeling of shortness of breath or the inability to get enough air, is common in individuals with altered ventilation or diffusion.
- Dyspnea is stimulated by hypoxemia, hypercapnia, and the subsequent reduction in pH, but the exact mechanism is often unknown.
- Lung receptors or chemoreceptors may stimulate the brain and breathing muscles to induce this sensation.
- Dyspnea often leads to physical and emotional responses, such as the need to sit upright or stand to maximize lung expansion (orthopnea).
- Individuals with dyspnea may use accessory muscles and demonstrate nasal flaring to assist with breathing.
- Retractions, pulling in of accessory muscles in the intercostal, substernal, and supraclavicular spaces, can promote more effective inspiration.
- Individuals experiencing air trapping may perform pursed lip breathing to maintain positive airway pressure in the alveoli, minimize air trapping, and promote carbon dioxide expiration.
- Emotional manifestations of dyspnea include anxiety, panic, frustration, and anger.
Pleural Pain
- Inflammatory processes within the pleura can lead to pleural pain, which is often described as sharp or stabbing and increases with deep inspiration.
- Auscultation reveals a grating, scratching sound (pleural friction rub) with inspiration.
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