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Pulmonology - OMS 2 > Clinical Approach to Respiratory Diseases > Flashcards

Clinical Approach to Respiratory Diseases Flashcards

1
Q

What is the critical first step in order to arrive at the correct diagnosis?

A

Obtaining a good history

(if you listen long enough the patient will tell you what is wrong with them)

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2
Q

What are the most common complaints for patients with pulmonary disorders (5)?

A
  1. Dyspnea (aka SOB)
  2. Cough with or without sputum
  3. Fatigue
  4. Exercise intolerance
  5. Chest tightness/pain
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3
Q

While dyspnea and cough are common to pulmonary disorders, what are other common causes of these symptoms?

A
  1. positional dyspnea: CHF
  2. cough: GERD
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4
Q

What follow-up questions would you ask for the complaint of dyspnea (4)?

A
  1. Impairment?
  2. Triggers?
  3. Cough? Wheezing?
  4. Chest pain?
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5
Q

Differential diagnosis for dyspnea with chest pain and sudden onset (5)

A
  1. MI
  2. PE
  3. Pulmonary edema
  4. Pneumothorax
  5. Pericardial tamponade

(these are ALL life-threatening, must rule them out)

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6
Q

Episodic dyspnea associated with exertion often suggests _______ (2).

A
  1. lung disease
  2. cardiac dysfunction
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7
Q

Dyspnea that is seasonal or triggered by environmental exposure suggests _______(2).

A
  1. asthma
  2. hypersensitivity pneumonitis
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8
Q

Positional dyspnea commonly occur in patients with _______ (3).

A
  1. CHF
  2. severe obstructive lung disease
  3. neuromuscular weakness
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9
Q

Orthopnea

A

Dyspnea that occurs in the Supine position

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10
Q

Orthopnea most commonly occurs in _______.

A

CHF

(also common in asthma & COPD)

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11
Q

Paroxysmal nocturnal dyspnea

A

Dyspnea that occurs several hours after lying down

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12
Q

Paroxysmal nocturnal dyspnea is often associated with _______ & is due to ______.

(TQ!!)

A
  • CHF
  • ⇡ venous return to heart → interstitial edema

(assoc. w/asthma also)

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13
Q

Most common cause of wheezing

A

asthma

(though not the only cause)

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14
Q

Causes of wheezing, other than asthma (4)

A
  1. CHF
  2. COPD
  3. bronchial obstruction (tumor, FB)
  4. acute bronchitis (asthmatic bronchitis)

(asthmatic bronchitis = bronchitis with wheezing)

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15
Q

Cough may be dry or productive (mucous) and commonly accompanies _____.

A

bronchitis

(may be severe enough to induce emesis or syncope)

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16
Q

Common cause of cough (3)

A
  1. Mild infection (i.e. bronchitis, common cold)
  2. croup
  3. pneumonia

(whooping cough/bordetella pertussis on the rise)

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17
Q

________ may cause a dry cough months after initiation.

A

ACE inhibitors

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18
Q

Define cough variant asthma

A

Cough is the only symptom of asthma

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19
Q

What are the most common causes of chronic cough (4)?

A
  1. Post nasal drip
  2. Asthma
  3. GERD
  4. Smoking
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20
Q

Define chronic bronchitis

A

persistent productive cough for 3 months out of the year, over 2 years

(can be due to asthma)

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21
Q

How do you clinically characterize sputum (4)?

A
  1. quantity?
  2. color?
  3. blood?
  4. timing/frequency?
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22
Q

colored sputum usually indicates _____; clear frothy sputum usually indicates _______.

A
  • bacterial infection
  • CHF
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23
Q

Clear sputum usually indicates _____ (2); clear and frothy usually indicates _______.

A
  1. allergic condition
  2. viral illness
  • CHF
24
Q

Hemoptysis is usually due to _____.

A

persistent or forceful cough (bronchitis) → irritation of bronchial lining.

(most common = infection; less common = pneumonia)

25
Q

What is an important question to ask a patient who has hemoptysis?

A

How much blood are you producing?

(large amounts (500cc in 24 hours) could be cancer or TB)

26
Q

MC causes of massive hemoptysis (4)

A
  1. lung CA
  2. pulmonary hemorrhage
  3. AV malformations
  4. bronchiectasis
27
Q

Define Pleurisy

A

pleuritic chest pain during deep inspiration “sharp or stabbing pain”

(due to inflammation of pleura, lung does NOT have pain receptors)

28
Q

Chest pain due to pulmonary emboli, infection and pneumothorax are usually ______ (type of pain)

A

pleuritic

(Pulmonary HTN usually dull & unrelated to respiration)

29
Q

How can you distinguish benign chest pain?

A

benign is usually reproducible w/movement or palpation

(must r/o other serious causes including compression fx)

30
Q

Define atelactasis

A

lungs not expanding fully leading to a space under lung

(one of the MC respiratory complications following surgery)

31
Q

Risk of lung disease from smoking is directly related to which 2 risk factors?

A
  1. genetics
  2. pack/years of exposure
32
Q

Histoplasmosis is endemic to ______ (2).

A
  1. Ohio
  2. Mississippi River valleys

(ask about travel hx)

33
Q

Tuberculosis is endemic to _______.

A

developing countries

(ask about travel hx)

34
Q

deviation of trachea may suggest _____ (2).

A
  1. lung collapse
  2. mass
35
Q

Define fremitus

A

faint vibration felt when patient says “99”

36
Q

Tactile fremitus is increased in areas with _______ and decreased in areas with _______ (3).

A
  • lung consolidation (pneumonia)
  • obstruction, pneumothorax, emphysema

(fluid = increase; air = decrease)

37
Q

Hyperresonance on percussion of the chest usually indicates ________ (2).

A

pneumothorax or hyperinflation

(air increases resonance & decreases fremitus)

38
Q

Which 2 breath sounds are described as loud & high pitched? Describe a tracheal breath sounds

A
  1. tracheal
  2. bronchial

(wheezing is also high pitched, but with a hissing)

39
Q

Describe vesicular breath sounds (2).

A
  1. major normal breath sound
  2. soft & low pitch

(heard over most of lungs)

40
Q

3 common auscultation errors to avoid

A
  1. listening over clothes
  2. misinterpreting hair or tubing that rubs against clothes or rails as adventitious
  3. patient breathing w/mouth closed
41
Q

Describe crackles aka rales (on auscultation)

A
  • velcro-like

(coarse or fine)

42
Q

Crackles aka rales produce sounds due to _______.

A

mucous in the airways or openings

(coarse in medium or large airways, fine in alveoli)

43
Q

Crackles aka rales are commonly heard in _______ (2 conditions).

A
  1. edema
  2. pneumonia
44
Q

Describe wheezing sounds on lung auscultation (2).

A
  1. high pitched
  2. hissing
45
Q

Wheezing is commonly heard in _____ (4).

A
  1. anaphylaxis
  2. Obstruction (COPD, tumor, FB)
  3. CHF
  4. PE
46
Q

Describe rub sounds on lung auscultation.

A

pieces of leather rubbing against each other

(heard in pneumonia, PE or pleurisy)

47
Q

When is a “crunching sound” heard? Dx?

(“Hamman’s Crunch)

A
  1. timed with the cardiac cycle and not with the respirations
  2. pneumomediastinum
48
Q

4 Causes of absent breath sounds

A
  1. pneumothorax
  2. hydrothorax
  3. hemothorax
  4. obstruction (main stem)
49
Q

Chest x-rays provide information about _______ (5).

A
  1. thoracic bones
  2. pleura
  3. lung parenchyma
  4. mediastinum
  5. cardiac silhouette
50
Q

Arterial blood gas gives direct measurements of _______ (3).

A
  1. arterial oxygen
  2. CO2
  3. pH
51
Q

_______ is essential for the assessment of interstitial lung diseases & masses.

A

CT

(with contrast is excellent for pulmonary vasculature)

52
Q

Bronchoscopy allows for ______ (2)

A
  1. direct visualization of airways
  2. biopsy
53
Q

For respiratory c/c, ask about which conditions that run in the family (5)?

A
  1. Cystic fibrosis
  2. alpha 1-antitrypsin deficiency
  3. asthma
  4. emphysema
  5. lung CA
54
Q

On physical exam, check the skin for which 2 conditions?

A
  1. cyanosis
  2. fingernail clubbing
55
Q

what do blood chemistries tell you about respiratory disease?

A
  1. hb
  2. electrolytes
56
Q

When do you send them to the ICU?

A

they have a condition that may deteriorate rapidly leading to death

Pulmonology - OMS 2 (28 decks)

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