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Differential Dx > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

persistent dry cough
be on the look for

A

tumor
congestion
hypersensitive airways

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2
Q

productive cough with purulent sputum
be on the look for

A

infection

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3
Q

productive cough with non-purulent sputum
be on the look for

A

nonspecific, indicates airway irritation

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4
Q

rust colored sputum
be on the look for

A

pneumonia

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5
Q

hemoptysis
be on the look for

A

A pathologic condition—infection, inflammation, abscess, tumor, or infarction

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6
Q

dyspnea

A

Usually indicates hypoxemia
Orthopnea: dyspnea when the patient is lying down

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7
Q

cyanosis

A

Bluish color of the skin & mucous membranes (more evident in lips, tongue, gums)
Depends on the O2 saturation of arterial blood & circulating hemoglobin

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8
Q

clubbing

A

Thickening & widening of the terminal phalanges
Typically result of pulmonary disease & resultant hypoxia

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9
Q

altered breathing patterns

A

Changes in the rate, depth, regularity, and effort of breathing
Observe for accessory muscles (SCM, scalenes, etc.)

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10
Q

most common pulmonary pain patterns
increases with ___

A

anterior chest, ribs, upper trap, shoulder, thoracic spine
Also refers to neck, medial arm from shoulder

Usually increases with inspiratory movements

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11
Q

Tracheobronchial Pain
referred to

A

Referred to neck & anterior chest at the same levels as the points of irritation in air passages
Trachea & large bronchi innervated by vagus trunks
Finer bronchi & lung parenchyma have no pain innervation

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12
Q

tracheobronchial pain
caused by

A

inflammatory lesions, irritating foreign materials, tumors

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13
Q

pleural pain

A

Occurs when disease extends to parietal pleura
Sharp, localized pain
Present with pleurisy, pneumonia, pulmonary infarct, tumor, & pneumothorax

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14
Q

Diaphragmatic pleural pain

A

Pain innervation from phrenic nerve & intercostal nerves- ipsilateral pain pattern
Phrenic nerve damage causes ipsilateral diaphragm paresis
Peripheral area irritation referred to costal margins
Central area irritation refers to shoulder & upper trap
common innervation of C5-6

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15
Q

respiratory acidosis can results from

A

Damage to the medulla
Obstruction of airways
Loss of lung surface ventilation
Weakness of respiratory muscles
Overdose of respiratory depressant drugs

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16
Q

s/sx of respiratory acidosis

A

Decreased ventilation
Confusion
Sleepiness and unconsciousness
Diaphoresis
Shallow, rapid breathing
Restlessness
Cyanosis: observable in mucous membranes, fingertips, lips

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17
Q

respiratory alkalosis

A

Results from increased respiratory rate & depth that decreases the amount of available CO2 and hydrogen
Usually caused by hyperventilation
If more severe, can observe muscular tetany and convulsions

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18
Q

s/sx of respiratory alkalosis

A

Hyperventilation
Light-headedness
Dizziness
Numbness & tingling of the face, fingers, & toes
Syncope

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19
Q

COPD

A

Several disorders that have abnormal airway structures (narrowing airways) resulting in obstruction of air exiting & entering the lungs
A leading cause of morbidity & mortality for smokers
Symptom severity depends on how much lung parenchyma has been damaged or destroyed

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20
Q

predisposing factors of COPD

A

Smoking
Air pollution
Occupational exposure (e.g., aerosol pesticides, art materials)
Genetics
Infection
Allergies
Aging
Potentially harmful drugs and chemicals

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21
Q

acute bronchitis s/sx

A

Mild fever from 1-3 days
Malaise
Back and muscle pain
Sore throat
Cough with sputum production, f/b wheezing
Possible progression to laryngitis

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22
Q

acute bronchitis

A

An inflammation of the trachea and bronchi
Short duration
May result from chemical irritation or with viral infections (measles, whooping cough, influenza)

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23
Q

chronic bronchitis

A

“a person with chronic bronchitis is anyone who coughs for at least 3 months/year for 2 consecutive years without having had a precipitating disease”

Prolonged exposure to nonspecific bronchial irritants
Mucous hypersecretion & structural changes in bronchi

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24
Q

s/sx of chronic bronchitis

A

Persistent cough with production of sputum (worse in the morning & evening)
Reduced chest expansion
Wheezing
Fever
Dyspnea/SOB
Cyanosis
Decreased exercise tolerance

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25
Q

s/sx of bronchiectasis

A

Chronic “wet” cough & abundant foul-smelling secretions
Hemoptysis (spitting blood)
Occasional wheezing sounds
Dyspnea
Sinusitis– inflammation of paranasal cavities
Weight loss
Anemia
Malaise
Recurrent fever and chills
Fatigue

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26
Q

bronchiectasis

A

Chronic, progressive type of bronchitis
Occurs after infections such as childhood pneumonia
Permanent dilation of bronchi and destruction of bronchial walls

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27
Q

emphysema

A

Permanent overdistention of air space and loss of normal elastic tension in the lung tissue
Results in air passage obstruction & difficult expiration

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28
Q

s/sx of emphysema

A

SOB
Dyspnea on exertion
Orthopnea immediately after assuming the supine position
Chronic cough
Barrel chest
Weight loss
Malaise
Use of accessory muscles of respiration (pec minor, SCM, scalenes)
Prolonged expiratory period (with grunting)
Wheezing
Pursed-lip breathing
Increased respiratory rate
Peripheral cyanosis

29
Q

asthma

A

Reversible obstructive lung disease caused by an increased reaction of the airways to various stimuli
Chronic inflammatory condition with acute exacerbations
Inflammation obstructs airways

30
Q

asthma triggers

A

Respiratory infections, colds
Cigarette smoke
Allergic reactions to pollen, mold, animal dander, feather, dust, food, insects
Indoor & outdoor air pollutants
Physical exertion or vigorous exercise
Exposure to cold air or sudden temperature change
Excitement, strong emotion, psychologic or emotional stress

31
Q

pneumonia
what is it and what is it caused by

A

Inflammation of the lungs
Caused by:
Aspiration of food, fluids, or vomitus
Inhalation of toxic or caustic chemicals, smoke, dust, or gases
A bacterial, viral, or mycoplasmal infection

32
Q

pneumonia risk factors (some)

A

Age (very young, very old)
No prior pneumococcal vaccination
Smoking
Air pollution
Upper respiratory infection (URI)
Altered consciousness: alcoholism, head injury, seizure disorder, drug overdose, general anesthesia
Endotracheal intubation, nasogastric tube
Recent chest surgery
Prolonged immobility
Immunosuppressive therapy: corticosteroids, cancer chemotherapy
Nonfunctional immune system

33
Q

pneumonia s/sx

A

Sudden/sharp pleuritic chest pain aggravated by chest movement
Shoulder pain (referral area)
Hacking, productive cough (rust-colored or green, purulent sputum)
Dyspnea
Tachypnea with decreased chest excursion (affected side)
Cyanosis
Headache
Fever and chills
Generalized aches & myalgia
Painful & swollen knees possibly
Fatigue
Confusion in older adult

34
Q

tuberculosis

A

Bacterial infectious disease transmitted by gram-positive, acid-fast bacillus Mycobacterium tuberculosis
Most commonly spread with repeated close contact with an infected person
Full course of treatment lasts 6-9 months

35
Q

TB risk factors

A

Health care workers, especially those working in older hospitals (centralized ventilation), homeless shelters, or extended care facilities
Older adults
Overcrowded housing & homeless
Incarceration
US-born non-Hispanic African Americans
Immigrants from Southeast & Central Asia, Ethiopia, Mexico, Latin America, Eastern Europe
Alcohol or other chemical dependency with resultant malnutrition, debilitation, poor health
Infants/ children < 5 years age
Reduced immunity or malnutrition & HIV-positive lung cancer or head and neck cancer
RA
DM and/or end-stage renal disease
Hx of GI disease

36
Q

s/sx of TB

A

Fatigue
Malaise
Anorexia
Weight loss
Low-grade fever
Night sweats
Frequent productive cough
Dull chest pain, tightness, or discomfort
Dyspnea

37
Q

scleroderma

A

Restrictive lung disease of unknown etiologic origin
Inflammation and fibrosis of many organs
Affects skin and the visceral organs

38
Q

s/sx of scleroderma

A

Dyspnea on exertion
Nonproductive cough
Peripheral edema (secondary to cor pulmonale)
Orthopnea
Paroxysmal nocturnal dyspnea
Hemoptysis

39
Q

s/sx of lung cancer

A

Any change in respiratory patterns
Recurrent pneumonia or bronchitis
Hemoptysis– REFER
Persistent cough
Change in cough or development of hemoptysis (for a chronic smoker)
Hoarseness or dysphagia
Dyspnea
Wheezing
Sharp chest, upper back, shoulder, scapular, rib, or arm pain aggravated by inspiration or accompanied by respiratory SxS
Sudden, unexplained weight loss; anorexia; fatigue
Chest, shoulder, or arm pain; bone aching, joint pain
Atrophy and weakness of the arm and hand muscles
Fecal breath odor

40
Q

s/sx of early stage CF

A

Persistent coughing and wheezing
Recurrent pneumonia
Excessive appetite, but poor weight gain
Salty skin/sweat
Bulky, foul-smelling stools

41
Q

s/sx of CF in older children and young adults

A

Infertility
Nasal polyps
Periostitis
Glucose intolerance

42
Q

possible complications due to CF

A

Pneumothorax
Hemoptysis
Right-sided heart failure secondary to pulmonary hypertension

43
Q

pulmonary embolism

A

Pulmonary vascular obstruction from:
Displaced thrombus (DVT most common cause)
Air bubble
Fat globule
Clump of bacteria
Amniotic fluid
Vegetations on heart valves that develop with endocarditis
Other particulate matter

44
Q

PE rule out criteria

A

Age < 50 years
Heart rate < 100 bpm
Oxyhemoglobin saturation >/= 95%
No hemoptysis
No estrogen use
No prior DVT or PE
No unilateral leg swelling
No surgery or trauma requiring hospitalization within the past 4 weeks

45
Q

s/sx of PE

A

Dyspnea
Pleuritic (sharp, localized) chest pain
Diffuse chest discomfort
Persistent cough
Hemoptysis– REFER
Apprehension, anxiety, restlessness
Tachypnea– increases RR
Tachycardia
Fever

46
Q

s/sx of cor pulmonale

A

Peripheral edema (bilateral LEs)
Chronic cough
Central chest pain
Exertional dyspnea or dyspnea at rest
Distention of neck veins
Fatigue
Wheezing
Weakness

47
Q

cor pulmonale

A

Emergency cardiac condition from sudden dilation of the right ventricle due to PE

48
Q

pulmonary arterial hypertension

A

Vasoconstriction of pulmonary arterial vascular bed
Can lead to eventual right-sided heart failure

49
Q

risk factors of pleurisy

A

Pneumonia
TB
Lung abscess
Influenza
Systemic lupus erythematosus
RA
Pulmonary infarction

50
Q

types of pleurisy

A

Dry: fluid between pleural layers not changed
Wet: abnormal increase of fluid between pleural layers
Purulent pleurisy: if fluid becomes infected & pus forms

51
Q

s/sx of pleurisy

A

Pain distributions
Ipsilateral shoulder, upper trap, neck, lower chest wall, abdomen
Cough
Dyspnea
Fever, chills
Tachypnea

52
Q

causes of pneumothorax

A

Pulmonary disease
Trauma (with perforation of chest wall; ex: stab wound)
Scuba diving (arterial gas embolism)
Overexertion
Sx/ medical procedures involving chest wall or thorax

53
Q

s/sx of pneumothorax

A

Dyspnea
Change in respiratory movements (affected side)
Sudden, sharp chest pain (upper & lateral thoracic wall with referral to ipsilateral shoulder, across chest, abdomen)
Increased neck vein distention
Weak and rapid pulse (>100 bpm)
Fall in blood pressure
Dry, hacking cough
Shoulder pain
Sitting upright is most comfortable

54
Q

cardiac valvular disease s/sx

A

Easy fatigue
Dyspnea
Palpitation
Chest pain
Pitting edema
Orthopnea or paroxysmal dyspnea
Dizziness and syncope

**all increase with workload

55
Q

rheumatic fever
what is it and what are common symptoms

A

Infection caused by streptococcal bacteria
Rheumatic heart disease: chronic condition due to scarring & deformity of heart valves
Most common symptoms: fever & joint pain

56
Q

endocarditis
caused by what

A

Heart infection
Causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valve
Caused by bacteria entering bloodstream remotely (e.g. skin infection, oral infection)

57
Q

endocarditis risk factors

A

High risk:
Previous valvular damage
Injection drug users
Postcardiac surgical presentations

Congenital & degenerative heart disease

Invasive diagnostic procedures

58
Q

s/sx with endocarditis

A

Arthralgia
Arthritis
MSK symptoms
Low back/sacroiliac pain
Myalgia
Petechiae/splinter hemorrhage
Constitutional symptoms
Dyspnea, chest pain
Cold and pain in the extremities

59
Q

s/sx of fibrillation (damage to heart muscle cells)

A

Subjective report of palpitations
Sensations of fluttering, skipping, irregular beating or pounding, heaving action
Dyspnea
Chest pain
Anxiety
Pallor, fatigue
Dizziness, light-headedness, fainting
Nervousness
Cyanosis

60
Q

sinus tachycardia

A

Abnormally rapid heart rate (>100 bpm)
Physiologic response to stressors (e.g., hypotension)

61
Q

s/sx of sinus tachycardia

A

Palpitation
Restlessness
Chest discomfort or pain
Agitation
Anxiety and apprehension

62
Q

sinus bradycardia

A

Sinus node discharges at a rate < 60 bpm
May be normal in athletes or young adults

63
Q

s/sx sinus bradycardia

A

Sudden onset of weakness, sweating, nausea, pallor, vomiting, and distortion or dimming of vision
Reduced pulse rate
Syncope

64
Q

raynaud’s phenomenon
what is it and what are triggers

A

Intermittent episodes during which small arteries or arterioles in extremities constrict, causing temporary pallor and cyanosis of the digits and change in skin temperature

Triggers:
Cold temperature
Strong emotion

65
Q

s/sx of raynauds phenomenon

A

Pallor in the digits
Cyanotic, blue digits
Cold, numbness, pain of digits
Intense redness of digits

66
Q

s/sx of superficial venous thrombosis

A

Subcutaneous venous distention
Palpable cord
Warmth, redness
Indurated (hard)

67
Q

s/sx deep venous thrombosis
what do you use to dx this

A

Unilateral tenderness or leg pain
Unilateral swelling (>3 cm difference in leg circumference)
Warmth
Discoloration

wells criteria

68
Q

chronic venous disorders are identified by

A

Chronic swollen limbs
Thick, coarse, brownish skin around the ankles
Venous stasis ulceration

69
Q
A

Differential Dx (3 decks)

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