Chapter 15- General Approach Flashcards
What are the major symptoms of respiratory disease?
Cough Sputum Hemoptysis Dypsnea (acute, progressive, or paroxymal) Wheezing Chest pain Fever Hoarseness Night sweats
What are some causes of dyspnea?
Airways disease Parenchymal lung disease Pulmonary circulation Chest wall and pleura Cardiac Hemotologic Noncardiorespiratory
What are the airways disease causes of dyspnea?
Chronic obstructive lung diseases
Laryngeal disorders
Tracheal obstruction or stenosis
Tracheomalacia
What are the parenchymal lung disease causes of dyspnea?
Pneumonia Interstitial lung disease Obliterative bronchiolitis Pulmonary edema due to increased vascular permeability (ARDS) Infiltrative and metastatic malignancies
What are the pulmonary circulation causes of dyspnea?
Pulmonary thromboembolism
Pulmonary arterial hypertension
Pulmonary arteriovenous malformation
What are the chest wall and pleura causes of dysnea?
Pneumothorax Pleural effusion or massive ascites Pleural tumor Fractured ribs Chest wall deformities Neuromuscular diseases Bilateral diaphragmatic paresis
What are the cardiac causes of dyspnea?
Pulmonary edema due to left heart failure
Pericardial effusion or constrictive pericarditis
Intercardiac shunt
What are the hematologic causes of dyspnea?
Anemia
What are the noncardiorespiratory causes of dyspnea?
Psychogenic
Acidosis (w/ compensatory respiratory alkalosis)
Midbrain lesion
What should be done for PE of the chest?
Inspection
Palpation
Percussion
Ausultation
What does inspection of the chest during PE assess for?
Observation for anxiety, distress, malnutrition, somnolence Chest wall shape, deformity Respiratory rate, depth, and pattern Paradoxic respiratory motion of chest and abdomen Retractions Use of accessory muscles Pursed-lip breathing Cyanosis
What does palpation of the chest during PE assess for?
Tracheal deviation Chest expansion Vocal fremitus Lymphadenopathy Subcutaneous emphysema
What does percussion of the chest during PE assess for?
Normal
Dull
or Hyperresonant
What does auscultation of the chest during PE assess for?
Breath sounds, normal vesicular over periphery and bronchial centrally
Pleural rub
Added sounds: wheezes, crackles
stridor
What are the physical findings that are common in pulmonary disorders?
Pleural effusion Consolidation Pneumothorax Atelectasis Bronchospasm Interstitual fibrosis
What is the mediastinal displacement in pleural effusion?
Heart is displaced to opposite side
What is the chest wall movement in pleural effusion?
Reduced over affected area
What is the vocal fremitus in pleural effusion?
Absent or markedly decreased
What is the percussion note in pleural effusion?
Dull
What are the breath sounds associated with pleural effusion?
Absent over fluid; bronchial breath at upper border
What are the added sounds associated with pleural effusion?
Absent pleural rub may be found above effusion
What are the voice sounds associated with pleural effusion?
Absent over effusion
Increased with egophony at upper border
What is the mediastinal displacement in consolidation?
None
What is the chest wall movement with consolidation?
Reduced over affected area
What is the vocal fremitus associated with consolidation?
Normal or increased
What is the percussion note in consolidation?
Dull
What are the breath sounds associated with consolidation?
Bronchial
What are the added sounds associated with consilidation?
Crackles
What are the voice sounds associated with consolidation?
Increased with egobronchophony, and whispered pectoriloquy
What is the mediastinal displacement associated with a pneumothroax?
Tracheal deviation to opposite side if under pressure
What is the chest wall movement with pneumothorax?
Decreased over affected area
What is the vocal fremitus associated with pneumothorax?
Absent
What is the percussion note in pneumothorax?
Resonant
What are the breath sounds associated with pneumothorax?
absent or decreased
What are the added sounds associated with pneumothorax?
Absent
What are the voice sounds associated with pneumothorax?
Absent
What is the mediastinal displacement with atelectasis?
Ipsilateral shift
What is the chest wall movement in atelectasis?
Decreased over affected area
What is the vocal fremitus is atelectasis?
Variable
What is the percussion note in atelectasis?
Dull
What are the breath sounds associated with atelectasis?
Absent or diminished
What are the added sounds associated with atelectasis?
Crackles may be heard
What are the voice sounds associated with atelectasis?
Absent
What is the mediastinal deviation with bronchospasm?
None
What is the chest wall movement with bronchospasm?
Decreased symmetrically
What is the vocal fremitus found in bronchospasm?
Normal or decreased
What is the percussion tone in bronchospasm?
Normal or decreased
What are the breath sounds associated with bronchospasm?
Broncovesicular
What are the added sounds associated with bronchospasm?
Wheezing
What are the voice sounds associated with bronchospasm?
Normal or decreased
What is the mediastinal displacement with interstitial fibrosis?
None
What is the chest wall movement in interstitial fibrosis?
Decreased symmetrically
What is the vocal fremitus in interstitial fibrosis?
Normal or increased
What is the percussion note in interstitial fibrosis?
Normal
What are the breath sounds associated with interstitial fibrosis?
Bronchovesicular
What are the added sounds associated with interstitial fibrosis?
End-inspiratory cracked unaffected by cough or posture
What are the voice sounds associated with interstitial fibrosis?
Normal
On physical exam of a patient you find chest wall movement is reduced over the affected area, vocal fremitus is absent (or markedly decreased), percussion note is dull, bronchial breath at the upper border on auscultation, and increased egophany at the upper border. On chest xray you find the heart is displaced to the opposite side. What pulmonary disorder is the most likely diagnosis?
Pleural effusion
On physical exam you find chest wall movement is reduced over the affected area, vocal fremitus is normal (or increased), dull percussion note, bronchial breath sounds and crackles heard on auscultation, and increased voice sounds with egobronchophony and whispered pectoriloquy. On chest xray you see no mediastinal displacement. What pulmonary disorder is the most likely diagnosis?
Consolidation
On physical exam you find chest wall movement to be decreased over the affected area, vocal fremitus is absent, resonant percussion sounds, and absent or decreased breath sounds. On chest xray you find tracheal deviation to the opposite side due to tension. What pulmonary disorder is the most likely diagnosis?
Pneumothorax
On physical exam you find chest wall movement to be decreased over the affected area, vocal fremitus to be variable, dull percussion noite, absent or diminished breath sounds, crackles heard on auscultation, and absent voice sounds. Chest xray indicates an mediastinal displacement of an ipsilateral shift. What pulmonary disorder is the most likely diagnosis?
Atelectasis
On physical exam you find chest wall movements to be decreased symmetrically, normal or decreased vocal fremitus, normal or decreased percussion note, on auscultation you hear bronchovesicular breath sounds and wheezing, and voice sounds are normal or decreased. Chest xray does not show a mediastinal displacement. What pulmonary disorder is the most likely diagnosis?
Bronchospasm
On physical exam you find chest wall movements to be decreased symmetrically, normal or increased vocal fremitus, normal percussion note, auscultation results in bronchovesicular breath sounds, and end-inspiratory crackles that are unaffected by cough or posture, and normal voice sounds. Chest xray does not show a mediastinal displacement. What pulmonary disorder is the most likely diagnosis?
Interstitial fibrosis
What is paraoxysmal nocturnal dyspnea usually associated with?
CHF
What is the most common causes of cough? (there are 3)
postnasal drip
asthma
GERD
What are 3 lung issues that can cause chest pain?
pleural disease
pulmonary vascular disease
musculoskeletal pain precipitated by coughin
what are the 2 categories of breath sounds?
Bronchial
Vesicular
What are bronchial breath sounds?
heard over central airways and are louder and coarser than vesicular, longer inhaled component
What are vesicular breath sounds?
heard at the periphery and base of lungs, longer expiratory component and are much softer
What is a Hamman crunch?
crunching sound timed with cardiac cycle; heard with pneumomediastinum
What does an ABG give info about?
oxygenation and acid-base status
