Approach to evaluation of respiratory symptoms, URTI and suppurative lung diseases Flashcards by Iseoluwa Ojo

Dyspnea

– Timing
• acute eg _______,________,_________,________
• Chronic eg _________,_________,__________,___________

asthma, pneumonia, embolism, pneumothorax

COPD, interstitial lung disease, Neuromuscular disease, heart failure

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Cough : Acute versus chronic

• Acute
– ————
–___________
– __________

• Chronic
– Post nasal drip
– ______
– _________
–______________
–_______________

URTI; COPD exacerbation; Allergy

Asthma and COPD

GERD; Tuberculosis; Interstitial lung disease

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Accessory muscles of ventilation include the scalene, ____________,___________,_________,_______________

the sternocleidomastoid, the pectoralis major, the trapezius, and the external intercostals.

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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

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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.

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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.

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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

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Scoliosis

A _______________ of the ________

sideways curvature of the spine.

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Signs of scoliosis

_______ shoulders

________ in spine

________ hips

Uneven

Curve

Uneven

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Kyphosis
Also called: ________,________

A ________________ of the back.

hunchback, round back

forward rounding

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Cheyne-Stokes breathing involves a period of _____,_______ breathing followed by ______,_______ breathing and moments ___________________________

fast, shallow

slow, heavier

without any breath at all (apneas).

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The most common causes of Cheyne-Stokes respirations are __________ and ___________.

heart failure and stroke

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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),

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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

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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

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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

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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

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

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

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 _______

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