6 Lungs

Question 0

Sputum
Clear--
Yellow--
Green--
Brown--

Answer 0

Allergy, COPD
Infxn (live neutrophils, acute bronchitis/pneumonia)
Chronic infxn (neutrophil breakdown, chronic bronchitis, bronchiectasis, CF)
Old blood (chronic bronchitis, chronic pneumonia, TB, lung cancer)

Question 1

Cough DDX

Answer 1

URIs, rhinosinusitis, GERD, lung infxn, smoking/second hand smoke, ACE inhibitors, CF, anxiety, asthma, COPD, air pollution, CHF, cancer, postnatal drip, pulmonary edema, TB/bronchiectasis

Question 2

Hemoptysis Ddx

Answer 2

Airway inflammation, foreign body, autoimmune, cocaine induced pulmonary hemorrhage, pulmonary embolism, coagulopathy, airway trauma, bronchiogenic carcinoma, bronchiectasis/TB, pneumonia, abcess, esophageal varices

Question 3

2 questions to ask pt with respiratory issues…

Answer 3

Do you have a cough?

Do you have SOB?

Question 4

Dyspnea of Cardiac origin DDX

Answer 4

CHF, ischemic heart disease, cardiomyopathy, malignant HTN, dissecting aortic aneurysm, pericardial effusion

Question 5

Signs of cardiac originating dyspnea

Answer 5

Cheyne Stokes respiration: apnea and hyperpnea
Orthopnea: resp problems when supine (L ventricle)
Paroxysmal nocturnal dyspnea: pt awakens gasping for breath, sits up

Question 6

Chronic productive cough DDX

Answer 6

Sinusitis, smoker, allergies, chronic irritation, TB, chronic bronchitis, later stage cancer, pulmonary edema

Question 7

Chest pain and dyspnea DDX

Answer 7

MI, pleurisy, pneumonia, TB, cancer, pneumothorax, GERD, anxiety, panic attack

Question 8

physical exam

Answer 8

1. Inspection (resp rate, ss of distress, chest config, color)
2. Palpation (areas of pain, expansion, fremitis)
3. Percussion (resonant, flat, dull, hyperresonant, tympanic)
4. Auscultation (normal, changes, adventitious)

Question 9

fremitis

Answer 9

vibration transmitted through the body

Question 10

change in breath sounds

Answer 10

absent=collapsed lung
decreased=lung displaced by air (emphysema/pneumothorax) or fluid (pleural effusion)
bronchial breathing=consolidation

Question 11

Crackles

Answer 11

Adventitious/superimposed. popping upon inspiration. produced by passage of air through bronchi w/ secretions or that are constricted

Question 12

Rhonchi

Answer 12

Adventitious/superimposed. low pitched wheezes originating in upper airways. clear with coughing

Question 13

Wheezes

Answer 13

Adventitious/superimposed. high pitched, musical, or whistling sounds caused by narrowing/obstrxn of bronchi/bronchioles
Stridor when upper airway Croup

Question 14

Pleural sounds

Answer 14

Adventitious/superimposed. pleural friction rub. pleural fluid decreased or absent, dt inflammation, leather couch

Question 15

pleurisy

Answer 15

sharp, knife-like localized pain, pt may “splint”. concurrent with pleural sounds

Question 16

Bronchophony

Answer 16

vocal fremitus. “99” normally indistinct. louder, clearer sounds over area of consolidation

Question 17

Whispered Pectoriloquy

Answer 17

Pt whispers 123. “123” heard clearly over areas of consolidation

Question 18

egophany

Answer 18

Abnormal is “ee” turns to “ay”. over areas of consolidation

Question 19

Peak Flow Meter

Answer 19

~FEV1. monitors pulmonary fxn in pts w asthma

Question 20

Pulse Oximetry

Answer 20

non-invasive test of oxygen saturation in arterial blood

Question 21

Pulmonary Fxn Test

Answer 21

Spirometry. assess the functional status of the lung.
results could be decreased because of obstruction (asthma, bronchitis, mucus plug, tumor, foreign body, trauma), restricted airflow (sarcoidosis, TB, pneumonia, scoliosis, pleural effusion, tumors, obesity, myasthenia gravis, MD, ALS)

Question 22

COPD

Answer 22

Excessive airway inflammation–>abnormalities that obstruct flow
Reduced expiratory flow and slow forces emptying of lungs. Minimally reversible with bronchodilators

Question 23

COPD risk factors

Answer 23

smoking/second hand smoke, pollution, childhood URIs, occupational exposure, alpha 1 antitrypsin def, asthama

Question 24

General COPD ssx

Answer 24

dyspnea (worsens with exertion), chronic productive cough, wheezing Barrel chest, use of accessory muscles, hyperresonance, cyanosis

Question 25

Gold Scale

Answer 25

``` severity of COPD. FEV1 normal: >85% mild: >80% moderate: 50-79% severe: 30-49% very severe: <30% ```

Question 26

Emphysema

Answer 26

permanent enlargement of alveolar ducts and air spaces distal to terminal bronchioles, loss of elastic recoil, fibrosis, scarring. Pink puffers. cough is rare. Barrel chest, cachectic, purse-lipped breathing. sleep upright

Question 27

Hoover sign

Answer 27

lower ribs pull together with deep inhalation. sign in emphysema.

Question 28

Chronic Bronchitis

Answer 28

mucus hyper-secretion secondary to hypertrophy of glands of bronchial mucosa, producing a cough most days of month, 3 month for a yr for 2 yrs Blue bloaters (cyanosis, polycythemia, fluid retention) dyspnea/wheezing

Question 29

Chronic bronchitis risk factors

Answer 29

smoking *a lot*, pollutants, dust, microbes.

Question 30

COPD DDX

Answer 30

central airway stenosis, bronchiectasis, heart failure, CF, constrictive bronchiolitis, bronchopulmonay mycosis

Question 31

Asthma

Answer 31

REVERSIBLE obstructive lung disorder with increased reactivity of airways * airway obstruction * inflammation * airway irritability

Question 32

Common triggers for attack

Answer 32

URI, allergens, meds, food, exercise, irritants, weather, stress, GERD

Question 33

Asthma PE findings

Answer 33

w attack: increased resp rate/HR, diaphoresis, use of accessory muscles, can't.speak.in.full.sentences. chest hyperinflation, expiratory wheezing/polyphonic erythamatous/boggy turbinates/polyps, allergic rhinitis skin---atopic derm, eczema, etc

Question 34

Pulsus paradoxus

Answer 34

slowing of pulse during inspiration. could be pe finding of asthmatic

Question 35

Stratus Asthmaticus

Answer 35

*red flag in asthma attack* | unresponsive to bronchodilation. may be fatal

Question 36

Tests for asthma

Answer 36

labs not routine. chest radiography, sinus CT. allergy skin testing; 24 hour gastric pH (if sxs of GERD), spirometry

Question 37

Bronchiectasis

Answer 37

ifnxs-->mucus accumulates in airways-->inflammation-->weak/dilated airway wall muscles thickening, herniation, dilation

Question 38

Bronchiectasis etiology

Answer 38

bronchial cyst, bronchomalacia, immunodef, CF, infections (H flu, staph, klebsiella, TB), virus, fungal (pseudomonas, aspergillus)

Question 39

Bronchiectasis SSxs

Answer 39

chronic daily (productive) cough, mucipurulent/tenacious sputum

Question 40

Bronchiectasis PE

Answer 40

nonspecific. fever w acute exacerbations, wt loss, crackles, wheezes/rhonchi, cyanosis, plethora, nasal polyps, * if advanced--cor pulmonale, peripheral edema, hepatomegaly, hypoxia

Question 41

Cystic Fibrosis

Answer 41

defect in CFTR--> deranged transport of chloride, sodium, bicarb and thick secretions in lungs.

Question 42

CF SSxs

Answer 42

lungs: persistent, productive cough; barrel chest, obstructive findings on PFTs. chronic bronchitis develops sinuses: panopacification of paranasal sinuses, nasal polyposis, chronic rhinosinusitis pancreas: insufficient production of digestive enzymes distal intestinal obstructive syndrome infertility Musc-Skel: reduced bone density, clubbing of fingers and toes kidney stones salty taste on skin *often first sign*

Question 43

CF PE findings

Answer 43

rhinitis pulmonary: tachypnea, wheeze/crackles, cough (usu productive), increased AP diameter, hyperresonant, respiratory distress with retractions, cyanosis GI: abdominal distension, hepatosplenomegaly, rectal prolapse dry skin, scoliosis, swelling of salivary ducts, cheilosis, kyphosis

Question 44

CF dx test

Answer 44

Sweat chloride test. Results confirmed with DNA genetic screen.

Question 45

CF prognosis and treatment

Answer 45

survival~37.4 years chest percussion and postural drainage. high cal, high protein diet, fat soluble vitamins, pancreativ enzymes, NAC, mucolytics, anti-inflammatories

Question 46

Dyspnea not of cardiac origin DDX

Answer 46

Physiologic (broken ribs, obesity, chest deformities, high altitude), restrictive lung disease, obstructive lung disease (asthma, CF, COPD, upper airway edema), pneumonia, SARS, lung ca, sarcoidosis, atelectasis Chemical, neuromuscular (MS, ALS, myasthenia gravis), anxiety/panic attack

Question 47

Asthma ddx

Answer 47

Vocal cord paralysis, angioedema,aspiration, COPD, bronchiectasis, eosinophilic pneumonia, CHF, bronchopulmonary aspergillosis

Question 48

Wheezing DDX

Answer 48

Asthma, bronchitis, pulmonary edema, foreign object/tumor, infection (eg croup), COPD

Question 49

Classifications of asthma

Answer 49

Extrinsic: allergies Intrinsic: infxn, irritants, emotions, cold weather

Question 50

Chest pain DDX

Answer 50

Cardiac: Angina, MI Pulmonary pain: pleurisy, TB, cancer, atelectasis, thromboembolism, pleural effusion, pneumothorax GI: swallowing, large meals, foods, body position, GERD MuscSkel: fractured rib, herpes zoster CNS: anxiety/panic attack

Question 51

Flexible bronchoscopy

Answer 51

Special test to examine airways