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Boards 2 chiroessentials (1) > General diagnosis - RR exam > Flashcards

General diagnosis - RR exam Flashcards

1
Q

Acute Bronchitis

A

PCP referral it pts develops fever, sputum becomes productive or vitamin C/A supplements and hydration do not help

  • productive cough, greenish sputum, may have low grade fever
  • acute inflammation of the bronchi, viral origin or irritants
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2
Q

Aneurysm of the arch of the aorta

A

vascular surgeon referral

  • cough, hoarseness, tracheal shift to the right and tug
  • chest xray: widening of the S. mediastinum with deviated trachea to the right
  • Dilation of the arch of the aorta
  • MC cause is atherosclerosis
  • uncommon tertiary syphilis
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3
Q

Asthma

A

urgent referral RR >28 BPM or pts cyanosed

  • paroxysms (sudden attacks), dyspnea and wheezing
  • chronic or episodic reversible airway disease
  • mostly allergic; bronchospasm, inflammation of bronchial mucosa
  • Sputum contains: Charcot leyden crystals and Curschmann’s spirals. FEV1 is decreased <80%
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4
Q

Bronchiectasis

A

pulmonologist referral

  • chronic cough, shortness of breath and excessive production of mucopurulent sputum (am), halitosis and clubbing of the fingers
  • chronic dilation fo bronchi caused by a lon standing lung infecton
  • brochchogram: shows saccular dilations of the bronchi
  • Kartagener’s syndrome: bronchiectasis, sinusitis and situs inversus
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5
Q

Chronic bronchitis

A

Co-manage with pulmonologist (cessation of smoking)

  • dyspnea, cough, cyanosis and BL ankle swelling (blue bloater)
  • irreversible airway disease with chronic cough (>3m for at least 2y)
  • chronic inflammation of the bronchi d/t smoking or irritants
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6
Q

Dissecting throacic aorta

A

911
severe tearing chest pain with diminished upper limb pulses and hypoension
- tunica intima tear (marfan’s, HTN, or severe chest trauma)
- chest xray: widening of S. mediastinum

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7
Q

Emphysmea

A

Co-manage with pulmonolgist (STOP smoking)

  • dyspnea, barrel-shaped chest with horizontal sloping ribs and pursed-lip breathing
  • irreversible airway disease d/t smoking, industrial pollutants leading to destruction of the walls of the alveoli causing overinflation of the lungs (pink puffer)
  • chest xray: overinfalted lungs, flattened diaphragm, large retrosternal/retrocardiac windows
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8
Q

Fallot’s tetralogy

A

pediatric cardiologist referral
cyanosis at birth, clubbing of the fingers, easily fatigued and left parastenal heave
- MC cyanotic congenital heart disease: pulmonary stenosis, right ventricular hypertrophy, overriding aorta and ventricular septal defect
- chest xray: boot-shaped heart with upwardly displaced apex d/t sever right ventricular hypertrophy

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9
Q

liver failure

A

hospital referral

  • jaundice, fetor hepacticus (musty ammonia brasth d/t excertion of unprocessed mercaptans via lungs), ascites (d/t low proteins) and gynecomatia (d/t accumulation of excess estrogens)
  • failure of the liver to detoxify, process bilirubin and manufacture important substances
  • Liver Function Tests: elevated bilirubin, AST, ALT and alkaline phosphatase
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10
Q

Lung abscess

A

hospital referral

  • chills, fever, halitosis and foul-smelling sputum
  • pus-filled cavity in the chest (staphylococcus aureus infection)
  • chest xray: single cavity with air-fluid level
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11
Q

Pericarditis

A

hospital referral

  • sticking retrosternal chest pain (relieved by sitting up and leaning forward
  • inflammation of the pericardial sac (viral, bacterial, chemical)
  • EKG may show ST elevation but NO pathological Q waves
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12
Q

Lung cancer

A

throacic surgeon referral

  • weight loss, chronic cough, hemoptysis and clubbing of the fingers
  • common malignant lung tumor (smoking, M >f)
  • chest xray: solitary mass with irregular boarders
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13
Q

Plural effusion

A

hospital referral (determine cause and treatment)

  • dyspnea, decreased tactile fremitus, stony dull percussion, ABSENT breath sounds, local lag may be present
  • excess fluid in lungs
  • related to: CHF, pneumonia, TB, pleural metastases
  • chest xray: obliteration of a costophrenic angle and meniscus sign
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14
Q

Pneumonia

A

hospital referral: use CURB 65 criteria (Confusion, Urea elevated, RR >30, BP <90/60 or 65yo)

  • chills, fever, dyspnea, pleuritic chest pain, productive cough, increased tactile fremitus, dull percussion and crackles
  • rust colored sputum = streptococcus pneumonia,
  • red currant jelly sputum = Klebsiella pneumonia
  • scanty sputum = pneumocystis jiroveci or mycoplasma pneumonia
  • inflammation of the lung parenchyma d/t viaral, bacterial, fungal infection or chemicals.
  • chest xray: local patchy consolidation of a lobe (lobar pneumonia) or both lungs (bronchopheumonia)
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15
Q

Pneumothorax

A

hospital referral

  • chest pain, sudden onset dyspnea, hyper-resonant percussion, ABSENT breath sounds
  • air in pleural cavity (spontaneous or traumatic)
  • chest xray: collapsed lung with absent lung markings on affected side
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16
Q

Psoriasis

A

Co-manage with dermatologist

  • silvery scaly plaques on the extenor aspects of the neck, elbow, sacrum and knees, pitting of the nails and joint pain
  • chronic skin condition d/t rapid turn over of skin cells
  • positive HLA B27
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17
Q

Pulmonary embolism

A

911
classic triad: sudden onset of dyspnea, pleuritic chest pain, hemoptysis
- breakaway clot fro DVT causing obstruction to pulmonary artery or a branch
- +d-dimer (sensitive)
- diagnostic: Lung perfusion scan or spiral CT of the chest

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18
Q

Raynaud’s phenomenon

A

Co-manage with internist or rheumatologist

  • intermittent vasospasm (white), cyanosis and red (reactive hyperemia) in response to cold and stress
  • vasospastic distorder of small aa. associated with connective tissue disorders like SLE and Sleroderma
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19
Q

Rickets

A

pediatrician referral

  • lethargy, mm weakness, frontal bossing, bow legs and kyphoscoliosis
  • metabolic disorder d/t vitamin D deficiency
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20
Q

Sarcoidosis

A

Co-manage with pulmonologist

  • fatigue, dyspnea, erythema nodosum
  • chronic multi system disease (idiopathic), characterized by non-caseous granulomas
  • hypercalcemia, leucopenia may be present
  • chest xray: BL hilar lymphadenopathy or diffuse pulmonary fibrosis
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21
Q

Tension pneumothrorax

A

911
sudden onset: shortness of breath following chest injury, increasing cyanosis with tracheal deviation to the opposite side
- air in the pleural cavity caused by trauma to the chest

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22
Q

Tietze syndrome

A

rheumatologist referral if chiro care unsuccessful

  • localized chest pain with swollen tender costochondral joint (of joint is tender w/o swelling - Dx: costochondritis)
  • inflammation of the 2nd - 5th costochondral joints
  • commonly with repetitive microtruama
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23
Q

Tuberculosis

A

Infection disease specialist referral for Dx and treatment

  • cough, night sweats, fever, hemoptysis and weight loss
  • Sputum with Aiehl Neelsen staining bacilli grow best in Lowenstein Jensen medium
  • Chronic infection caused by Mycobacterium TB
  • Characterized by Ghon focus and complex with caseous necrosis and granulomas
  • Chest xray: apical consolidation and cavitation
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24
Q

Absent breath sounds

A

pleural effusion, pneumothroax

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25
Q

Absence of nail bed angle or Schamroth space

A

Clubbing

26
Q

Biot’s respiration (irregularly irregular rhythem)

A

damage to the meulla- CVA, truama or tumor

27
Q

Bronchophony (loud breath sounds)

A

pneumonia, compression atelectasis

28
Q

cheyne-stroke breathing (regularly irregular)

A

CHF or raised intracranial pressure

29
Q

clubbing of fingers

A

TB, lung abscess, bronchiectasis, lung cancer

30
Q

crackles

A

pneumonia, CHF and bronchietasis

31
Q

cyanosis-central (blue lips, fingers and toes)

A

sever respiratory distress, Fallot’s tetralogy

32
Q

cyanosis-pheriphral (blue fingers and toes)

A

cold temp, rayaoud’s phenomenon

33
Q

decreased tactile fremitus

A

COPD, pleural effusion, asthma

34
Q

egophony (E sounds like A)

A

pneumonia, compression atelecasis

35
Q

flared nasal alae

A

respiratory distress

36
Q

gibbus (localized angular kyphosis)

A

pott’s disease of the spine- tuberculosis

37
Q

halitosis

A

bronchiectasis, lung disease

38
Q

horizontal sloping ribs

A

emphysema

39
Q

hyper-resonant percussion

A

pneumothorax, emphysema, asthma

40
Q

increased tactile fremitus

A

pneumonia, TB

41
Q

intercostal space bulging

A

pleural effusion and empyema

42
Q

intercostal space retraction

A

sever asthma, upper airway obstruction

43
Q

kussmaul’s breathing (deep rapid breathing)

A

diabetic ketoacidosis

44
Q

local lag

A

obesity, pleural effuion

45
Q

musty (ammonia), breath (fetor hepaticus)

A

liver failure

46
Q

pectus carinatum (pidgin sternum)

A

rickets or congenital abnormality

47
Q

pectus excavatum (funnel chest)

A

rickets or congenital abnormality

48
Q

pitted nails

A

psoriasis

49
Q

pleuritic friction rub

A

pleurisy

50
Q

precodial friction rub

A

pericarditis

51
Q

pursed-lip breathing

A

emphysema

52
Q

rechitic rosary (swollen costochndral joints)

A

rickets

53
Q

red currant jelly sputum

A

Klebsilla (Friedlander’s) pneumonia

54
Q

rust-color sputum

A

pneumococcal pneumonia

55
Q

stony dull percussion note

A

pleural effusion

56
Q

sweating with chest pain

A

MI, PE or dissecting thracic aorta

57
Q

tender swollen costochondral joint

A

Tietze syndrome

58
Q

Tracheal shift

A

pleural effusion, tension pneumothroax, TB

59
Q

tracheal tug (downward pull on trachea)

A

aneurysm of the arch of the aorta

60
Q

wheeze

A

asthma, bronchiectasis, COPD

61
Q

Whispered pectoriloquy (whispered 99 loud)

A

Pneumonia, compression atelectasis)

Boards 2 chiroessentials (1) (25 decks)

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