Exam 2 - respiratory Flashcards
Which individuals should be prioritized for the influenza vaccine?
Adults with chronic pulmonary and cardiovascular conditions and renal, hepatic, neurologic, hematologic, or metabolic disorders Immunocompromised, morbidly obese, adults >50 years of age Pregnant women and women up to 2 weeks postpartum Residents in nursing homes and longterm care facilities, healthcare personnel Household contacts and caregivers of children <5 years and adults >50 years with clinical conditions placing them at higher risk
Which individuals should be prioritized for the pneumococcal vaccine?
Adults >65 years Children and adults 2-64 years with chronic illnesses associated with increased risk (sickle cell, cardiovascular and pulmonary disease, DM, alcoholism, cirrhosis, cochlear implants, leaks of CSF) Adults 19-64 who are smokers or have asthma Adults and children >2 years who are immunocompromised Residents of nursing homes or longterm care facilities
What are the various lung cancer screening recommendations?
Annual low-dose computed tomography (LDCT) for current smokers (or those who have quit within the last 15 years) aged 55-79 years American Cancer Society - annual screening until 74 years old
Causes of chest pain: angina pectoris - process
Temporary myocardial ischemia (secondary to coronary atherosclerosis)
Causes of chest pain: angina pectoris - symptoms
Dyspnea, nausea, sweating
Causes of chest pain: angina pectoris - quality
Pressing, squeezing, tight, heavy, occasionally burning Often described as discomfort rather than pain
Causes of chest pain: MI - process
Prolonged myocardial ischemia, resulting in irreversible muscle necrosis
Causes of chest pain: MI - symptoms
Dyspnea, N/V, sweating, weakness
Causes of chest pain: MI - quality
Pressing, squeezing, tight, heavy, occasionally burning
Causes of chest pain: pericarditis - process
Irritation of parietal pleura adjacent to pericardium
Causes of chest pain: pericarditis - symptoms
Seen in autoimmune disorders, post myocardial infarction, viral infection, chest irradiation
Causes of chest pain: pericarditis - quality
Sharp, knife-like
Causes of chest pain: aortic dissection - process
Splitting within layers of aortic wall, allowing passage of blood to dissect a channel
Causes of chest pain: aortic dissection - symptoms
Hoarseness, dysphagia, syncope, hemiplegia, paraplegia
Causes of chest pain: aortic dissection - quality
Ripping, tearing
Causes of chest pain: pleuritic pain - process
Inflammation of parietal pleura (e.g. pleurisy, PNA, pulmonary infarction)
Causes of chest pain: pleuritic pain - symptoms
Of underlying illness
Causes of chest pain: pleuritic pain - quality
Sharp, knife-like
Causes of chest pain: GERD - process
Irritation or inflammation of esophageal mucosa
Causes of chest pain: GERD - symptoms
Regurgitation, dysphagia, cough, laryngitis, asthma
Causes of chest pain: GERD - quality
Burning, squeezing
Causes of chest pain: diffuse esophageal spasm - process
Motor dysfunction of esophageal muscle
Causes of chest pain: diffuse esophageal spasm - symptoms
Dysphagia
Causes of chest pain: diffuse esophageal spasm - quality
Squeezing
Causes of chest pain: chest wall pain, costochondritis - process
Trauma, inflammation of costal cartilage
Causes of chest pain: chest wall pain, costochondritis - symptoms
Local tenderness
Causes of chest pain: chest wall pain, costochondritis - quality
Stabbing, sticking, or dull, aching
Causes of chest pain: anxiety, panic disorder - symptoms
Breathlessness, palpitations, weakness, anxiety
Causes of chest pain: anxiety, panic disorder - quality
Stabbing, sticking, or dull, aching
Causes of dyspnea: left sided HF - process
Elevated pressure in pulmonary capillary bed with fluid into interstitial spaces and alveoli, decreased compliance, increased work of breathing
Causes of dyspnea: left sided HF - timing
Dyspnea may progress slowly or suddenly like in acute pulmonary edema
Causes of dyspnea: left sided HF - symptoms
Cough, orthopnea, paroxysmal nocturnal dyspnea, sometimes wheezing
Causes of dyspnea: chronic bronchitis - process
Excessive mucus production in bronchi followed by chronic obstruction of airways
Causes of dyspnea: chronic bronchitis - timing
Chronic productive cough followed by slowly progressive dyspnea
Causes of dyspnea: chronic bronchitis - symptoms
Chronic productive cough, recurrent respiratory infections, wheezing
Causes of dyspnea: COPD - process
Over distention of air spaces distal to terminal bronchioles, with destruction of alveolar septa, alveolar enlargement, limitations of expiratory air flow
Causes of dyspnea: COPD - timing
Slowly progressive dyspnea, mild cough later
Causes of dyspnea: COPD - symptoms
Cough, scant mucoid sputum
Causes of dyspnea: asthma - process
Reversible bronchial hyper responsiveness, increased airway secretions, bronchoconstriction
Causes of dyspnea: asthma - timing
Acute episodes, separated by symptom-free periods (nocturnal periods common)
Causes of dyspnea: asthma - symptoms
Wheezing, cough, tightness in chest
Causes of dyspnea: diffuse interstitial lung diseases - process
Abnormal and widespread infiltration of cells, fluid, collagen into interstitial space between alveoli
Causes of dyspnea: diffuse interstitial lung diseases - timing
Progressive dyspnea
Causes of dyspnea: diffuse interstitial lung diseases - symptoms
Weakness, fatigue, cough less common
Causes of dyspnea: PNA - process
Infection of lung parenchyma from the respiratory bronchioles of the alveoli
Causes of dyspnea: PNA - timing
Acute illness; timing varies with causative agent
Causes of dyspnea: PNA - symptoms
Pleuritic pain, cough, sputum, fever
Causes of dyspnea: spontaneous pneumothorax - process
Leakage of air into pleural space through blebs on visceral pleura –> partial or complete collapse of the lung
Causes of dyspnea: spontaneous pneumothorax - timing
Sudden onset dyspnea
Causes of dyspnea: spontaneous pneumothorax - symptoms
Pleuritic pain, cough
Causes of dyspnea: acute pulmonary embolism - process
Sudden occlusion of part pulmonary arterial tree by blood clot that usually originates in deep veins of legs or pelvis
Causes of dyspnea: acute pulmonary embolism - timing
Sudden onset dyspnea, tachypnea
Causes of dyspnea: acute pulmonary embolism - symptoms
Retrosternal oppressive pain if massive occlusion, pleuritic pain, cough, syncope, hemoptysis, unilateral leg swelling and pain from instigating DVT
Causes of dyspnea: anxiety with hyperventilation - process
Overbreathing, with resultant respiratory alkalosis and fall in arterial partial pressure of CO2
Causes of dyspnea: anxiety with hyperventilation - timing
Episodic, often recurrent
Causes of dyspnea: anxiety with hyperventilation - symptoms
Sighing, lightheadedness, numbness or tingling of hands and feet, palpitations, chest pain
Causes of cough and hemoptysis: laryngitis - symptoms
Acute fairly minor illness with hoarseness Often associated with viral rhino sinusitis
Causes of cough and hemoptysis: acute bronchitis - symptoms
Acute, often viral, illness general w/o fever or dyspnea At times with burning retrosternal discomfort
Causes of cough and hemoptysis: mycoplasma and viral PNA - symptoms
Acute febrile illness, often with malaise, HA, possible dyspnea
Causes of cough and hemoptysis: bacterial PNA - symptoms
Acute illness with chills, high fever, dyspnea, chest pain
Causes of cough and hemoptysis: postnasal drip - symptoms
Seen in posterior pharynx Associated with allergic rhinitis, with or without sinusitis
Causes of cough and hemoptysis: chronic bronchitis - symptoms
Recurrent wheezing and dyspnea
Causes of cough and hemoptysis: bronchiectasis - symptoms
Recurrent bronchopulmonary infections, sinusitis may co-exist
Causes of cough and hemoptysis: pulmonary TB - symptoms
Early, no symptoms Later, anorexia, weight less, fatigue, fever, night sweats
Causes of cough and hemoptysis: lung abscess - symptoms
Usually from aspiration PNA with fever and infection Often with dysphagia or episodes of impaired consciousness
Causes of cough and hemoptysis: asthma - symptoms
Episodic wheezing and dyspnea, cough may occur alone History of allergies
Causes of cough and hemoptysis: GERD - symptoms
Wheezing (at night, often mistaken for asthma), early morning hoarseness, repeated attempts to clear throat Heartburn and regurgitation
Causes of cough and hemoptysis: lung cancer - symptoms
Dyspnea, weight loss
Causes of cough and hemoptysis: left ventricular failure or mitral stenosis - symptoms
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Causes of cough and hemoptysis: pulmonary embolism - symptoms
Tachypnea, chest or pleuritic pain, dyspnea, fever, syncope, anxiety
Causes of cough and hemoptysis: irritating particles, chemicals, gases
Exposure to irritants; eyes, nose, throat
What exam findings would the FNP expect in the patient with: pneumonia?
Percussion: dull Trachea: midline Breath sounds: bronchial over involved area Adventitious sounds: late inspiratory crackles Tactile fremitus: increased (w/ egophony, bronchophony)
What exam findings would the FNP expect in the patient with: COPD?
Percussion: hyperresonant Trachea: midline Breath sounds: decreased to absent, with delayed expiration Adventitious sounds: none Tactile fremitus: decreased
What exam findings would the FNP expect in the patient with: atelectasis?
Percussion: dull Trachea: shifted toward involved side Breath sounds: usually absent when bronchial plugs persist Adventitious sounds: none Tactile fremitus: usually absent when bronchial plugs persist
What exam findings would the FNP expect in the patient with: pleural effusion?
Percussion: dull Trachea: shifted toward unaffected side in large effusions Breath sounds: decreased to absent Adventitious sounds: none except a possible pleural rub Tactile fremitus: decreased to absent, but may be increased toward top of large effusion
What exam findings would the FNP expect in the patient with: pneumothorax?
Percussion: hyper resonant Trachea: shifted toward unaffected side if tension Breath sounds: decreased to absent Adventitious sounds: none, except possible pleural rub Tactile fremitus: decreased to absent
What exam findings would the FNP expect in the patient with: asthma?
Percussion: resonant to diffusely hyperresonant Trachea: midline Breath sounds: often obscured by wheezes Adventitious sounds: wheezes, possibly crackles Tactile fremitus: decreased
What exam findings would the FNP expect in the patient with: rib fracture?
Tenderness, bruising, bony “step offs”, increase in local pain
What exam techniques would the FNP use to assess for a rib fracture?
AP compression of chest will elicit local pain and tenderness One hand on sternum, and other side of thoracic spine, squeeze chest
What are the various locations in which retractions can occur?
What is different about the pediatric thorax and lung exam as compared to the adult?
Infant breath sounds louder and harsher than those adults because stethoscope closer to origin of sounds
Periodic breathing (5-10 seconds)
Check for retractions, nasal flaring, grunting, wheezing
What are the pediatric cutoffs for bradypnea? Tachypnea?
Tachypnea >60/min from birth to 2 months and >50/min from 2-12 months
What exam findings would the FNP expect in the patient with: PNA in peds?
Best physical finding to r/o PNA is absence of tachypnea
Rapid respirations (up to 80-90/min) and increased work of breathing (grunting, nasal flaring, use of acessory muscles)
What exam findings would the FNP expect in the patient with: croup?
Stridor, hoarse voice plus cough, prolonged inspiration
