Diagnosis of Respiratory diseases Flashcards
Major categories of respiratory system diseases
- Obstructive
- Restrictive
- Abnormalities of vasculature
Obstructive lung diseases
- Asthma
- COPD
- Bronchiectasis
- Bronchiolitis
Cardinal symptoms of respiratory disease
dyspnea and cough
Chronic cough
> 8 weeks
nonrespiratory causes of cough
- Gerd
2. Postnasal dri
kind of cough of Diffuse parenchymal lung disease
persistent and non productive
Wheezing
asthma
T or F, Lung parenchyma is innervated with pain fibers?
False
Diseases associated with smoking
COPD, bronchogenic lung cancer, diffuse parenchymal lung diseases
kyphoscoliosis
restrictive
How to establish diagphragm excursion and lung size
percussion
Role of palpation
subcutaneous air -> barotrauma
Tactile frenitus finding for consolidation
INCREASED
Tactile frenitus finding for pleural effusion
DECREASED
Rhonchi
Obstruction of medium sized air ways, most often with secretions
viral or bacterial bronchitis
Chronic rhonchi
suggests bronchiectasis or COPD
high pitched, focal inspiratory wheeze, usually head over the neck
Stridor , manifestation of upper airway obstruction
Crackles or rales
commonly sign of alveolar disease
Kind of crackles for pneumonia
Focal
pulmonary edema is prominent where?
bases
Kind of crackles for IF
Like velcro being ripped apart
How to Differentiate crackles of IF and alveolar diseases
Egophony - ausculation of “AH” instead of “EEE” when the pt phonates EEE
- pneumonia
Quiet chest with diffusely decreased breath sounds
emphysema
Area of absent breath sound
pneumothorax
Kind of edema that suggests cor pulmonale
symmetric pedal edema
Characteristic of pulse in patients with obstructive lung disease
Pulsus paradoxus
Cyanosis is seen at what level of deoxygenated hemoglobin?
> 5g/dL
Initial pulmonary functional test
SPIROMETRY
FEV1/FVC ratio of obstructive
<70% of expected
What does plateau of inspiratory and expiratory curves suggests?
Large airway obstruction in extrathoracic and intrathoracic locations
Total lung capacity for patients with restrictive lung disease
<80% of the predicted value for a patient’s age, race, sex, and height
Causes of restrictive lung disease
parenchymal, neuromuscular weakness, or chest wall or pleural disease
Normal spirometry, normal lung volumes, and low DLCO
evaluate for pulmonary vascular disease
Increased (A-a) DO2 at rest
V/Q mismatch or shunt physiology
Function of Respiratory system
- oxygenate blood
2. eliminate carbon dioxide
Blood flow through the lung
Unidirectional via continuous vascular path
Alveolar surface area
70 sq.m
Average volume of thoracic cavity
7L
X ray position to detect free flowing fluid
lateral decubitus
X ray position to visualize apices
apical lordotic view
Limitations of poratable x ray
- single AP view
- Variability in over and underexposed film
- shorter focal spot-film distance - lack of edge sharpness and loss of detail
- magnification of cardiac silhouette
Produces images using echoes or reflection of US beam from interfaces between tissues with differing acoustic properties
Ultrasound
Modality used to identify sepatations within loculated collections and can facilitate placement of needle for sampling
Ultrasound
US probe is passed through a broncoscope
Endobronchial US
Modality that is valuable in assessing hilar and mediastinal disease and in identifying and characterizing disease adjacent to the chest wall or spine.
CT scan
Distinguish vascular from non vascular structure (modality)
CT scan
Thickness of cross sectional images in high resolution CT scan
1-2 mm
Thickness of cross sectional images in conventional CT scan
7-10 mm
Standard method for thoracic CT
Helical scanning
Can obtain multiple slices in single rotaion that are thinner and can be acquired in a shorter period of time
multidetector CT scan
commonly used to identify malignant lesions in the lung based on their increased uptake and metabolism of glucose
PET scanning
Radiolabel in PET scan
FDG
Modality useful in demonstrating pulmonary emboli, aortic lesions, or other vascular abnormalities
MRI
sampling of pleural liquid
thoracentesis
direct visualization of the tracheobronchial tree
Bronchoscopy
Specimen of choice for recovery of pneumocystis jiroveci
bronchoalveolar lavage
