General diagnosis - RR exam Flashcards
Acute Bronchitis
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
Aneurysm of the arch of the aorta
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
Asthma
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%
Bronchiectasis
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
Chronic bronchitis
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
Dissecting throacic aorta
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
Emphysmea
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
Fallot’s tetralogy
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
liver failure
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
Lung abscess
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
Pericarditis
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
Lung cancer
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
Plural effusion
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
Pneumonia
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)
Pneumothorax
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
Psoriasis
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
Pulmonary embolism
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
Raynaud’s phenomenon
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
Rickets
pediatrician referral
- lethargy, mm weakness, frontal bossing, bow legs and kyphoscoliosis
- metabolic disorder d/t vitamin D deficiency
Sarcoidosis
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
Tension pneumothrorax
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
Tietze syndrome
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
Tuberculosis
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
Absent breath sounds
pleural effusion, pneumothroax
Absence of nail bed angle or Schamroth space
Clubbing
Biot’s respiration (irregularly irregular rhythem)
damage to the meulla- CVA, truama or tumor
Bronchophony (loud breath sounds)
pneumonia, compression atelectasis
cheyne-stroke breathing (regularly irregular)
CHF or raised intracranial pressure
clubbing of fingers
TB, lung abscess, bronchiectasis, lung cancer
crackles
pneumonia, CHF and bronchietasis
cyanosis-central (blue lips, fingers and toes)
sever respiratory distress, Fallot’s tetralogy
cyanosis-pheriphral (blue fingers and toes)
cold temp, rayaoud’s phenomenon
decreased tactile fremitus
COPD, pleural effusion, asthma
egophony (E sounds like A)
pneumonia, compression atelecasis
flared nasal alae
respiratory distress
gibbus (localized angular kyphosis)
pott’s disease of the spine- tuberculosis
halitosis
bronchiectasis, lung disease
horizontal sloping ribs
emphysema
hyper-resonant percussion
pneumothorax, emphysema, asthma
increased tactile fremitus
pneumonia, TB
intercostal space bulging
pleural effusion and empyema
intercostal space retraction
sever asthma, upper airway obstruction
kussmaul’s breathing (deep rapid breathing)
diabetic ketoacidosis
local lag
obesity, pleural effuion
musty (ammonia), breath (fetor hepaticus)
liver failure
pectus carinatum (pidgin sternum)
rickets or congenital abnormality
pectus excavatum (funnel chest)
rickets or congenital abnormality
pitted nails
psoriasis
pleuritic friction rub
pleurisy
precodial friction rub
pericarditis
pursed-lip breathing
emphysema
rechitic rosary (swollen costochndral joints)
rickets
red currant jelly sputum
Klebsilla (Friedlander’s) pneumonia
rust-color sputum
pneumococcal pneumonia
stony dull percussion note
pleural effusion
sweating with chest pain
MI, PE or dissecting thracic aorta
tender swollen costochondral joint
Tietze syndrome
Tracheal shift
pleural effusion, tension pneumothroax, TB
tracheal tug (downward pull on trachea)
aneurysm of the arch of the aorta
wheeze
asthma, bronchiectasis, COPD
Whispered pectoriloquy (whispered 99 loud)
Pneumonia, compression atelectasis)
