Approach to evaluation of respiratory symptoms, URTI and suppurative lung diseases Flashcards
Dyspnea
– Timing
• acute eg _______,________,_________,________
• Chronic eg _________,_________,__________,___________
asthma, pneumonia, embolism, pneumothorax
COPD, interstitial lung disease, Neuromuscular disease, heart failure
Cough : Acute versus chronic
• Acute
– ————
–___________
– __________
• Chronic
– Post nasal drip
– ______
– _________
–______________
–_______________
URTI; COPD exacerbation; Allergy
Asthma and COPD
GERD; Tuberculosis; Interstitial lung disease
Accessory muscles of ventilation include the scalene, ____________,___________,_________,_______________
the sternocleidomastoid, the pectoralis major, the trapezius, and the external intercostals.
Disease states with mucoid sputum?
Disease states with mucopurulent sputum?
Disease states with purulent sputum?
Chronic bronchitis; bronchial asthma
Acute bronchitis, chronic bronchitis, cystic fibrosis
Lung abscess, acute bronchitis, pneumonia, bromchiectasis, aspiration pneumonia
Barrel chest is a deformity in which the chest becomes ______________. Lung diseases that cause the chest to repeatedly over-expand or to remain in that position can lead to barrel chest, such as __________,___________, and __________
expanded in size
emphysema, cystic fibrosis, and asthma.
Pectus excavatum
Also called: ________ chest, _______ chest, _________ chest, Cobbler’s chest
A condition in which the _______________________
funnel chest, sunken chest, hollowed chest, Cobbler’s chest
A condition in which the breastbone sinks into the chest.
What is pectus carinatum?
Pectus carinatum is a deformity of the chest wall in which the ________________________________ . Pectus carinatum is sometimes called “ ______________ ”
breastbone and ribs are pushed outward
pigeon breast
Scoliosis
A _______________ of the ________
sideways curvature of the spine.
Signs of scoliosis
_______ shoulders
________ in spine
________ hips
Uneven
Curve
Uneven
Kyphosis
Also called: ________,________
A ________________ of the back.
hunchback, round back
forward rounding
Cheyne-Stokes breathing involves a period of _____,_______ breathing followed by ______,_______ breathing and moments ___________________________
fast, shallow
slow, heavier
without any breath at all (apneas).
The most common causes of Cheyne-Stokes respirations are __________ and ___________.
heart failure and stroke
Kussmaul breathing is an abnormal breathing pattern characterized by ____,________ breathing at a consistent pace. It’s a sign of a medical emergency — usually _________________________
rapid, deep
diabetes-related ketoacidosis (DKA),
Tracheal Alignment Abnormalities
• Pneumothorax – shifts to ___________ side
• Pleural Effusion – shifts to ___________ side
• Fibrosis or Atelectasis – shifts towards _________ side
• Pulmonary consolidation – _______ shift
unaffected; unaffected
affected; no
Causes of abnormal chest excursion
• Bilaterally decreased in both _______ and _________ lung diseases
• Reduced on the affected side in _________, lobar __________, __________ , large ____________ , and __________
restrictive and obstructive
consolidation; atelectasis; pneumothorax
pleural effusion and fractured ribs
Tactile/vocal fremitus
• Increased with __________,________,_______, or __________
• Decreased with ___________________, as seen in __________,____________,___________
alveolar consolidation, atelectasis, pulmonary edema or fibrosis
increased distance between lung and chest wall
Pneumothorax,Pleural effusion, COPD
Percussion Notes
• Dullness – ______eased density
– __________,_________,_________,________
• Hyperresonance – _____eased density
– Hyperinflation (_______), —————-
incr
Atelectasis, alveolar filling/consolidation, pleural effusion/thickening, fibrosis
decr; COPD; Pneumothorax
Auscultation in consolidation vs obstruction
Bronchial breath sound
Wheeze
Investigation
• Chest _______
• Chest _____________
• ______________ tests
• _________ tests
• ___________
• _____________
x-ray
Computed tomography scan
Pulmonary function; Sputum
Arterial blood gas
Bronchoscopy
Aetiology Of URTIs
• Often _______ in aetiology, only about 15% caused by ___________
• Diagnosis is based on symptoms: __________,________,__________ , malaise, ____ grade fever.
viral; streptococcus pyogenes.
cough, nasal, sore throat (voice), headache
low
Sputum colour is important in URTIs!
T/F
F
Sputum colour not important here!
In streptococcal sore throat, URT symptoms are usually _________. Often limited to _________ and ________
absent
high grade fever and sore throat.
Important differential diagnosis for URTI is ____________________
allergic rhino sinusitis.
For step sore throat, antibiotics are indicated.
T/F
T
Indication for immediate prescribing of antibiotics in URTI
Children younger than _____ years with bilateral _____________
Children with __________ who have ____________
Patients with acute sore throat/acute pharyngitis/acute tonsillitis when __________________ are present
2; acute otitis media
otorrhoea; acute otitis media
three or more Centor criteria
Centor criteria for strep pharyngitis. Score of ≥3
_________ or _______ on __________ (+1)
Tender/swollen _____________(+1)
_______>_______(+1)
Absence of _______ (+1)
Exudate or swelling on tonsils
anterior cervical lymph nodes
Fever >38C
cough
Antibiotics choice for URTI where indicated
§ The Sinus and Allergy Health Partnership (SAHP) guidelines 1
Recommend any of the following as initial therapy in adults with mild disease who have not received antibiotics in the previous 4 to 6 weeks:
• ____________
• ____________
• ____________ axetil or other first and second generation cephalorsporins.
amoxicillin-clavulanate
• Amoxicillin
• cefuroxime
Bronchiectasis
• Abnormal (temporary or permanent?) ___________ of the _________ or ________ due to destruction of the _________ and ___________ component of the ___________.
permanent; dilatation
bronchi or bronchioles
muscular and elastic
bronchial wall.
Bronchiectasis
Presents as recurrent, (acute or chronic?) refractory infections of the airways.
Chronic
In 50% of cases in adults, _________ cause of bronchiectasis is found
No
Clinical presentation of bronchiectasis
Symptoms
• (Acute or Chronic?) cough with ______ volume sputum
• __________
• (Wheezing or Stridor?)
• __________
• Fever
• Weight loss
• Exacerbations characterized by increased sputum quantity, viscidity and odour
Chronic; large
Dyspnoea; wheezing
Haemoptysis
Physical findings of bronchiectasis
•____________
• Weight loss
•__________ and rhonchi
• Chest examination may be normal in ______ bronchiectasis
•_____________
Digital clubbing
Crepitation; dry
Cor-pulmonale
High resolution _________________ is the gold standard for diagnosis of bronchiectasis.
chest Computed tomography scan
Lung abscess
• _________ containing _________ lesions of the lung that often appears as a _________ _________ with an _________
• A similar process with _________ _________ cavities ____cm is referred to as necrotizing pneumonia
Pus ; necrotic
rounded ; opacity
air-fluid ;multiple
small ; <2cm
Diagnosis of lung abscess: Clinical features
Symptoms
• Risk factor
• Sudden expectoration of _______ volume sputum initially
• __________ sputum
• Fever and weight loss
Physical
•______________
• __________ breath sound and ___________
large; Foul smelling
Digital clubbing
Bronchial; crepitation
Empyema
• _________ in the pleural space or _________ pleural fluid
Pus ;infected
Types of empyema
– Acute or chronic (>__________)
–___________ or ________ in the pleural space
–_______ or _______ (eg _______ or ————)
3 months
Loculated or free
Closed or open
broncho-pleural fistula or sinus track
primary infective empyema without pneumonia is often due to _______
TB
Clinical features of empyema
• Depends on the underlying cause
•_______ following aerobic infections
• More _______ in anaerobic and mycobacterial infections
•_____________ following pneumonia
• _________ with ______ amounts of sputum suggests broncho-pleural fistula
• Digital clubbing
Acute; indolent
Prolonged fever
Postural cough; large
Empyema necessitans is a ____________________ of an empyema that has ______________________________,
usually into the ___________ , to form a
_________________ that eventually
may _________________
spontaneous discharge
burrowed through the parietal pleura
chest wall
subcutaneous abscess ; rupture through skin
