Clinical Presentation Of Respiratory Diseases

Question 1

Three major categories of respiratory diseases

Answer 1

Obstructive

Restrictive

Vasculature abnormalities

Question 2

Common concerning symptoms

Answer 2

Chest pain

Dyspnea

Wheezing

Cough

Hemoptysis

Daytime sleepiness and/or disordered sleep

Question 3

Top 3 causes for chronic coughing

Answer 3

Asthma
- usually associated with wheezing

GERD
- symptoms worse at night

Allergies
- shows allergy symptoms in conjunction

• note chronic coughing is almost always non-infectious

Question 4

3 types of restrictive pulmonary diseases and examples

Answer 4

Parenchyma disease

• idiopathic pulmonary fibrosis
• asbestosis
• sarcoidosis

Neuromuscular weakness

• ALS
• guillian-Barre syndrome
• myasthenia gravid

Pleural diseases

• scoliosis
• ankylosis spondylitis
• pleural effusions

Question 5

4 main types of chests

Answer 5

1) normal
- ratio of AP diameter to lateral is 0.7-0.9
- increases with aging
- normal shaped

2) pectus excavatum (funnel chest)
- sternum is posteriorly displaced dramatically
- can appear with murmurs

3) barrel chest
- AP diameter is increased
- accompanies with obstructive disorders

4) pectus carinatum
- sternum is anteriorly displaced dramatically

Question 6

Flail chest

Answer 6

Multiple rib fractures in multiple places

• produces an inward movement of ribs when inhaling and moves outward with expiration
• moves separately from the rest

Question 7

Special landmarks for respiratory

Answer 7

2nd intercostal space near sternum
- area for needle insertion for tension pneumothorax

4th intercoastal space mid way better run sternum and anterior axillary line
- area for chest tube insertion

T7-8 intercostal space posteriorly
- area for thoracentesis just superior to the 8th rib

Question 8

Normal respiratory rates in children and adults

Answer 8

Adults= 14-20

Children = 14-44

Question 9

Bradypnea

Answer 9

Slow breathing with or without increased tidal volume to maintain alveolar ventilation

Without increased tidal volume = uremia, respiratory depression, increased intracranial pressures

Question 10

Sighing respiration

Answer 10

Breathing rates that are normal except for frequent punctuated sighs
- suggests hyperventilation syndrome and is a common cause of dyspnea/dizziness

can be normal to prevent atelectasis as long as it is not frequent (<1 min)

Question 11

Tachypnea

Answer 11

Rapid shallow breathing

Numerous causes but is commonly seen in restrictive lung diseases or fractured ribs/sternum

Question 12

Cheye-stokes breathing

Answer 12

Periods of deep breathing alternating w/ periods of apnea (no breathing)

Normal in children and older adults

Not normal in young adults
- signals brain injury, heart failure, uremia and/or respiratory depression

Question 13

Obstructive breathing

Answer 13

Always found in obstructive lung diseases
- asthma and COPD are most common

Inspiration is normal, but expiration is prolonged since the narrowed airways increase resistance to air flow

Question 14

Hyperpnea

Answer 14

Rapid deep breathing that occurs in a metabolic demand increased
- examples are: sepsis, high altitude, anemia

Is often seen in diabetic ketoacidosis

Question 15

Ataxic breathing

Answer 15

“Blot breathing”

Breathing is irregular w/ periods of apnea alternating w/ regular deep breaths

Causes include

• meningitis
• respiratory depression
• brain injury

Question 16

Types of breathing sounds

Answer 16

Tracheal
- loud harsh sounds heard over the trachea in the neck

Bronchial

• loud harsh and high pitchers sounds in the lungs
• produce short silence between inspiration and expiration as well

Bronchovesicular
- sounds in inspiration and expiration are equal in length but sometimes present w/ silent intervals

Vesicular

• soft/low pitched breathing
• heard well in inspiration, but fade away in the middle of expiration

Question 17

Key things to do with auscultation

Answer 17

Ask patient to cough once or twice to clear mild non-pathological sounds

Always place the stethoscope directly on skin and not clothing

Question 18

Stridor

Answer 18

Musical high-pitched sound heard best over trachea or upper airways

Almost always indicates upper-airway obstruction W/ lesions
- needs ER to treat.

Question 19

Rhonchus

Answer 19

Musical low-pitched sounds similar to snoring
- lower pitched than wheezing and can be heard on either inspiration ro expiration

Associated with rupture of fluid films, abnormal airway collapsibility
- bronchospasms, edema

Question 20

Pleural friction rubs

Answer 20

Non musical explosive biphasic sounds usually heard in basal regions of lungs
- often indicates pleural effusions

Question 21

What is the sound characterizes for abnormal percussion

Answer 21

1) Dullness sounds
- Usually indicates any of the following
- pneumonia
- pleural effusions of any kind
- fibrous tissue/tumors

2) generalized hyper resonance
- indicates COPD/asthma due to increased air present in lungs

3) unilateral hyper resonance
- indicates large pneumothorax
- 100% pneumothorax if tracheal shift is present on imaging

Question 22

Abnormalities in palpation

Answer 22

1) unilateral decreases of delays in chest expansion
- chronic fibrosis
- pneumoniae
- pleural effusions
- diaphragm paralysis

2) frenitus (vibratory tremors, ask patient to say 99 or blue balloons)
- COPD
- Pleural effusion
- pneumonothorax

Crepitus (crackling/rales)

• respiratory distress
• emphysema

Question 23

Accessory muscle use

Answer 23

SCM
Scalenes
Intercostals
Abdominal obliques

*monitor all of these muscles and if they are being used, can signify respiratory distress

Question 24

What is the value for total lung capacity that indicates restrictive pulmonary diseases?

Answer 24

<80% (0.8)

Question 25

What is the cardinal value for obstructive lung diseases?

Answer 25

FEV1% = <70% (0.7)