Clinical Approach to Respiratory Diseases Flashcards
What is the critical first step in order to arrive at the correct diagnosis?
Obtaining a good history
(if you listen long enough the patient will tell you what is wrong with them)
What are the most common complaints for patients with pulmonary disorders (5)?
- Dyspnea (aka SOB)
- Cough with or without sputum
- Fatigue
- Exercise intolerance
- Chest tightness/pain
While dyspnea and cough are common to pulmonary disorders, what are other common causes of these symptoms?
- positional dyspnea: CHF
- cough: GERD
What follow-up questions would you ask for the complaint of dyspnea (4)?
- Impairment?
- Triggers?
- Cough? Wheezing?
- Chest pain?
Differential diagnosis for dyspnea with chest pain and sudden onset (5)
- MI
- PE
- Pulmonary edema
- Pneumothorax
- Pericardial tamponade
(these are ALL life-threatening, must rule them out)
Episodic dyspnea associated with exertion often suggests _______ (2).
- lung disease
- cardiac dysfunction
Dyspnea that is seasonal or triggered by environmental exposure suggests _______(2).
- asthma
- hypersensitivity pneumonitis
Positional dyspnea commonly occur in patients with _______ (3).
- CHF
- severe obstructive lung disease
- neuromuscular weakness
Orthopnea
Dyspnea that occurs in the Supine position
Orthopnea most commonly occurs in _______.
CHF
(also common in asthma & COPD)
Paroxysmal nocturnal dyspnea
Dyspnea that occurs several hours after lying down
Paroxysmal nocturnal dyspnea is often associated with _______ & is due to ______.
(TQ!!)
- CHF
- ⇡ venous return to heart → interstitial edema
(assoc. w/asthma also)
Most common cause of wheezing
asthma
(though not the only cause)
Causes of wheezing, other than asthma (4)
- CHF
- COPD
- bronchial obstruction (tumor, FB)
- acute bronchitis (asthmatic bronchitis)
(asthmatic bronchitis = bronchitis with wheezing)
Cough may be dry or productive (mucous) and commonly accompanies _____.
bronchitis
(may be severe enough to induce emesis or syncope)
Common cause of cough (3)
- Mild infection (i.e. bronchitis, common cold)
- croup
- pneumonia
(whooping cough/bordetella pertussis on the rise)
________ may cause a dry cough months after initiation.
ACE inhibitors
Define cough variant asthma
Cough is the only symptom of asthma
What are the most common causes of chronic cough (4)?
- Post nasal drip
- Asthma
- GERD
- Smoking
Define chronic bronchitis
persistent productive cough for 3 months out of the year, over 2 years
(can be due to asthma)
How do you clinically characterize sputum (4)?
- quantity?
- color?
- blood?
- timing/frequency?
colored sputum usually indicates _____; clear frothy sputum usually indicates _______.
- bacterial infection
- CHF
Clear sputum usually indicates _____ (2); clear and frothy usually indicates _______.
- allergic condition
- viral illness
- CHF
Hemoptysis is usually due to _____.
persistent or forceful cough (bronchitis) → irritation of bronchial lining.
(most common = infection; less common = pneumonia)
What is an important question to ask a patient who has hemoptysis?
How much blood are you producing?
(large amounts (500cc in 24 hours) could be cancer or TB)
MC causes of massive hemoptysis (4)
- lung CA
- pulmonary hemorrhage
- AV malformations
- bronchiectasis
Define Pleurisy
pleuritic chest pain during deep inspiration “sharp or stabbing pain”
(due to inflammation of pleura, lung does NOT have pain receptors)
Chest pain due to pulmonary emboli, infection and pneumothorax are usually ______ (type of pain)
pleuritic
(Pulmonary HTN usually dull & unrelated to respiration)
How can you distinguish benign chest pain?
benign is usually reproducible w/movement or palpation
(must r/o other serious causes including compression fx)
Define atelactasis
lungs not expanding fully leading to a space under lung
(one of the MC respiratory complications following surgery)
Risk of lung disease from smoking is directly related to which 2 risk factors?
- genetics
- pack/years of exposure
Histoplasmosis is endemic to ______ (2).
- Ohio
- Mississippi River valleys
(ask about travel hx)
Tuberculosis is endemic to _______.
developing countries
(ask about travel hx)
deviation of trachea may suggest _____ (2).
- lung collapse
- mass
Define fremitus
faint vibration felt when patient says “99”
Tactile fremitus is increased in areas with _______ and decreased in areas with _______ (3).
- lung consolidation (pneumonia)
- obstruction, pneumothorax, emphysema
(fluid = increase; air = decrease)
Hyperresonance on percussion of the chest usually indicates ________ (2).
pneumothorax or hyperinflation
(air increases resonance & decreases fremitus)
Which 2 breath sounds are described as loud & high pitched? Describe a tracheal breath sounds
- tracheal
- bronchial
(wheezing is also high pitched, but with a hissing)
Describe vesicular breath sounds (2).
- major normal breath sound
- soft & low pitch
(heard over most of lungs)
3 common auscultation errors to avoid
- listening over clothes
- misinterpreting hair or tubing that rubs against clothes or rails as adventitious
- patient breathing w/mouth closed
Describe crackles aka rales (on auscultation)
- velcro-like
(coarse or fine)
Crackles aka rales produce sounds due to _______.
mucous in the airways or openings
(coarse in medium or large airways, fine in alveoli)
Crackles aka rales are commonly heard in _______ (2 conditions).
- edema
- pneumonia
Describe wheezing sounds on lung auscultation (2).
- high pitched
- hissing
Wheezing is commonly heard in _____ (4).
- anaphylaxis
- Obstruction (COPD, tumor, FB)
- CHF
- PE
Describe rub sounds on lung auscultation.
pieces of leather rubbing against each other
(heard in pneumonia, PE or pleurisy)
When is a “crunching sound” heard? Dx?
(“Hamman’s Crunch)
- timed with the cardiac cycle and not with the respirations
- pneumomediastinum
4 Causes of absent breath sounds
- pneumothorax
- hydrothorax
- hemothorax
- obstruction (main stem)
Chest x-rays provide information about _______ (5).
- thoracic bones
- pleura
- lung parenchyma
- mediastinum
- cardiac silhouette
Arterial blood gas gives direct measurements of _______ (3).
- arterial oxygen
- CO2
- pH
_______ is essential for the assessment of interstitial lung diseases & masses.
CT
(with contrast is excellent for pulmonary vasculature)
Bronchoscopy allows for ______ (2)
- direct visualization of airways
- biopsy
For respiratory c/c, ask about which conditions that run in the family (5)?
- Cystic fibrosis
- alpha 1-antitrypsin deficiency
- asthma
- emphysema
- lung CA
On physical exam, check the skin for which 2 conditions?
- cyanosis
- fingernail clubbing
what do blood chemistries tell you about respiratory disease?
- hb
- electrolytes
When do you send them to the ICU?
they have a condition that may deteriorate rapidly leading to death
