6 Lungs Flashcards
Sputum Clear-- Yellow-- Green-- Brown--
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)
Cough DDX
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
Hemoptysis Ddx
Airway inflammation, foreign body, autoimmune, cocaine induced pulmonary hemorrhage, pulmonary embolism, coagulopathy, airway trauma, bronchiogenic carcinoma, bronchiectasis/TB, pneumonia, abcess, esophageal varices
2 questions to ask pt with respiratory issues…
Do you have a cough?
Do you have SOB?
Dyspnea of Cardiac origin DDX
CHF, ischemic heart disease, cardiomyopathy, malignant HTN, dissecting aortic aneurysm, pericardial effusion
Signs of cardiac originating dyspnea
Cheyne Stokes respiration: apnea and hyperpnea
Orthopnea: resp problems when supine (L ventricle)
Paroxysmal nocturnal dyspnea: pt awakens gasping for breath, sits up
Chronic productive cough DDX
Sinusitis, smoker, allergies, chronic irritation, TB, chronic bronchitis, later stage cancer, pulmonary edema
Chest pain and dyspnea DDX
MI, pleurisy, pneumonia, TB, cancer, pneumothorax, GERD, anxiety, panic attack
physical exam
- Inspection (resp rate, ss of distress, chest config, color)
- Palpation (areas of pain, expansion, fremitis)
- Percussion (resonant, flat, dull, hyperresonant, tympanic)
- Auscultation (normal, changes, adventitious)
fremitis
vibration transmitted through the body
change in breath sounds
absent=collapsed lung
decreased=lung displaced by air (emphysema/pneumothorax) or fluid (pleural effusion)
bronchial breathing=consolidation
Crackles
Adventitious/superimposed. popping upon inspiration. produced by passage of air through bronchi w/ secretions or that are constricted
Rhonchi
Adventitious/superimposed. low pitched wheezes originating in upper airways. clear with coughing
Wheezes
Adventitious/superimposed. high pitched, musical, or whistling sounds caused by narrowing/obstrxn of bronchi/bronchioles
Stridor when upper airway Croup
Pleural sounds
Adventitious/superimposed. pleural friction rub. pleural fluid decreased or absent, dt inflammation, leather couch
pleurisy
sharp, knife-like localized pain, pt may “splint”. concurrent with pleural sounds
Bronchophony
vocal fremitus. “99” normally indistinct. louder, clearer sounds over area of consolidation
Whispered Pectoriloquy
Pt whispers 123. “123” heard clearly over areas of consolidation
egophany
Abnormal is “ee” turns to “ay”. over areas of consolidation
Peak Flow Meter
~FEV1. monitors pulmonary fxn in pts w asthma
Pulse Oximetry
non-invasive test of oxygen saturation in arterial blood
Pulmonary Fxn Test
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)
COPD
Excessive airway inflammation–>abnormalities that obstruct flow
Reduced expiratory flow and slow forces emptying of lungs. Minimally reversible with bronchodilators
COPD risk factors
smoking/second hand smoke, pollution, childhood URIs, occupational exposure, alpha 1 antitrypsin def, asthama
General COPD ssx
dyspnea (worsens with exertion), chronic productive cough, wheezing
Barrel chest, use of accessory muscles, hyperresonance, cyanosis
Gold Scale
severity of COPD. FEV1 normal: >85% mild: >80% moderate: 50-79% severe: 30-49% very severe: <30%
Emphysema
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
Hoover sign
lower ribs pull together with deep inhalation. sign in emphysema.
Chronic Bronchitis
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
Chronic bronchitis risk factors
smoking a lot, pollutants, dust, microbes.
COPD DDX
central airway stenosis, bronchiectasis, heart failure, CF, constrictive bronchiolitis, bronchopulmonay mycosis
Asthma
REVERSIBLE obstructive lung disorder with increased reactivity of airways
- airway obstruction
- inflammation
- airway irritability
Common triggers for attack
URI, allergens, meds, food, exercise, irritants, weather, stress, GERD
Asthma PE findings
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
Pulsus paradoxus
slowing of pulse during inspiration. could be pe finding of asthmatic
Stratus Asthmaticus
red flag in asthma attack
unresponsive to bronchodilation. may be fatal
Tests for asthma
labs not routine.
chest radiography, sinus CT.
allergy skin testing; 24 hour gastric pH (if sxs of GERD), spirometry
Bronchiectasis
ifnxs–>mucus accumulates in airways–>inflammation–>weak/dilated airway wall muscles
thickening, herniation, dilation
Bronchiectasis etiology
bronchial cyst, bronchomalacia, immunodef, CF, infections (H flu, staph, klebsiella, TB), virus, fungal (pseudomonas, aspergillus)
Bronchiectasis SSxs
chronic daily (productive) cough, mucipurulent/tenacious sputum
Bronchiectasis PE
nonspecific. fever w acute exacerbations, wt loss, crackles, wheezes/rhonchi, cyanosis, plethora, nasal polyps,
* if advanced–cor pulmonale, peripheral edema, hepatomegaly, hypoxia
Cystic Fibrosis
defect in CFTR–> deranged transport of chloride, sodium, bicarb and thick secretions in lungs.
CF SSxs
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
CF PE findings
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
CF dx test
Sweat chloride test. Results confirmed with DNA genetic screen.
CF prognosis and treatment
survival~37.4 years
chest percussion and postural drainage.
high cal, high protein diet, fat soluble vitamins, pancreativ enzymes, NAC, mucolytics, anti-inflammatories
Dyspnea not of cardiac origin DDX
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
Asthma ddx
Vocal cord paralysis, angioedema,aspiration, COPD, bronchiectasis, eosinophilic pneumonia, CHF, bronchopulmonary aspergillosis
Wheezing DDX
Asthma, bronchitis, pulmonary edema, foreign object/tumor, infection (eg croup), COPD
Classifications of asthma
Extrinsic: allergies
Intrinsic: infxn, irritants, emotions, cold weather
Chest pain DDX
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
Flexible bronchoscopy
Special test to examine airways
