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pulmonology > intro to pulm > Flashcards

intro to pulm Flashcards

1
Q

What areas of care do pulmonologists oversee?

A 
ICU
respiratory care unit
pulm function lab
resp. care dept
pulm rehab
sleep lab (often run by pulmonary but may be split with neurology)
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2
Q

How common is pulmonary dysfunction as the cause of death in the US?

A
  • 4 of top 10 causes of death in US
  • cancer (lung cancer leading cause of cancer deaths)
  • COPD
  • pneumonia
  • sepsis
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3
Q

How are lung diseases classified on the basis of anatomic areas?

A
  • interstitial lung disease (between air sacs)
  • pleural disease (in pleural space)
  • airway disease
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4
Q

How are lung diseases classified by physiologic alterations in respiratory function?

A
  • denoted by PFTs:
    obstructive lung disease (can’t get air out)
    restrictive lung disease
    (hard to get air into lungs)
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5
Q

Examples of obstructive lung disease?

A
  • asthma (reversible)
  • COPD
  • cystic fibrosis
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6
Q

Examples of restricted lung disease?

A
  • sarcoidosis
  • asbestosis
  • drug induced fibrosis
  • idiopathic pulmonary fibrosis
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7
Q

Examples of increased vascular resistance?

A
  • pulmonary HTN, thromboembolic disease
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8
Q

What are non-modifiable RFs for pulmonary disease?

A 
- Genetics: 
alpha-1 antitrypsin deficiency
Wegeners
Asthma 
- socioeconomic status
- enviro: home situation or occupation
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9
Q

What are modifiable RFs for pulm. disease?

A
  • immunizations (pneumonia vaccine)
  • smoking cessation
  • reduction of exposure to second hand smoke
  • protection from environmental toxins
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10
Q

What are some common sxs of pulmonary disease?

A
  • dyspnea
  • chest tighness
  • exercise intolerance
  • chest pain
  • cough
  • hemoptysis
  • sputum production
  • stridor
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11
Q

What common sxs of pulmonary disease overlap with common cardiac complaints?

A
  • dyspnea
  • chest tightness
  • exercise intolerance
  • chest pain
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12
Q

What are impt ?s to ask while taking a pulmonary hx?

A
  • inhalation history: occupation, hobbies (weld), social hx
  • SOB: with exertion, at rest, orthopnea, PND, trepopnea (dyspnea that is relieved by laying down)
  • wheezing
  • cough: productive or not, sputum characteristics
  • hemoptysis
  • smoking hx or exposure to 2nd hand smoke
  • calculate pack years and denote how long ago they quit smoking
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13
Q

What are some inhalation hx factors?

A
  • work enviro: list all jobs and duties, ID of materials exposed to and duration, use of respirator, co-workers conditions
  • home enviro: pets, birds, dust, remodeling, cleaning agents, roaches, overcrowding
  • individual factors: family hx of lung disease, atopy, exposure to meds with pulm toxicity, travel hx
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14
Q

What should you ask about dyspnea?

A

always try to determine:

  • onset
  • provoking and alleviating factors
  • severity
  • associated sxs
  • duration of sx
  • chronicity of sxs (every day vs every time I do ….)
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15
Q

What is chronic dyspnea of unclear etiology likely to be?

A
  • asthma
  • COPD
  • interstitial lung disease
  • myocardial dysfunction
  • obesity/deconditioning
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16
Q

What is orthopnea and why is it an impt sx?

A
  • dyspnea when laying flat

- impt because most likely indicates CHF or asthma

17
Q

What are the DDx of wheezing?

A
  • asthma
  • acute and chronic bronchitis
  • emphysema
  • cardiac asthma (pulm edema)
  • aspiration
  • sarcoidosis
  • hypersensitivity pneumonitis
  • **acute PE
  • carcinoid
  • systemic mastocytosis
  • central airway obstruction (tumor, FB, stricture, laryngeal spasm)
  • bronchiolitis
  • cystic fibrosis
18
Q

Different categories of cough?

A
  • acute: less than 3 weeks
  • subacute: 3-8 weeks
  • chronic: longer than 8 weeks
19
Q

Cough mechanism of TB or other chronic infections?

A

mechanism- like pneumonia

- characteristic features: chronic, usually productive cough, hemoptysis

20
Q

Cough mechanism of lung abscess?

A

mechanism: like pneumonia

characteristic features: sudden onset or increase in amount of purulent, often foul smelling discharge

21
Q

cough mechanism of chronic infiltrative or fibrosing lung disease?

A

mechanism: irritation of peripheral receptors, distortion of airways
- characteristic features: chronic dry cough, progressive dyspnea

22
Q

Cough mechanism of left sided heart failure?

A

mechanism: pulmonary edema

chracteristic features: pulmonary edema, nocturnal cough

23
Q

Range of hemoptysis?

A
  • blood streaking of sputum
  • pink frothy sputum
  • or presence of gross blood in absence of any accompanying sputum
    (think cancer or PE)
24
Q

When does chest pain not generally originate in the heart?

A

when:

  • there is a constant achiness that lasts all day
  • stays in 1 position (pt can point ot it)
  • made worse by pressing on precordium
  • it is a fleeting, needle like jab that lasts only a second or 2
25
Q

What is the source of chest pain that worsens with inspiration?

A
  • pleuritic pain that is likely from a pulmonary source

taking a deep breath in and its a stabbing pain, shallow breathing to prevent pain

26
Q

What are some causes of pleuritic chest pain?

A
  • viral pleurisy
  • pneumonia
  • **acute PE
  • pneumothorax
  • pericarditis
  • collagen vasculat disease: SLE, RA
  • drug induced lupus
  • IBD
  • familial mediterranean fever
  • radiation pneumonitis
  • pulm. histoplasmosis
27
Q

What makes up the eval of a pulm. pt

A
  • inspect
  • palpate
  • percuss
  • auscultation
28
Q

Where do you listen to middle and lower lobes on a pt?

A
  • middle (R: try axilla, hard to hear)

- lower: back

29
Q

What should you inspect on a pulmonary patient?

A
  • observation for anxiety, distress, malnutrition, somnolence
  • chest wall shape, deformity
  • RR, depth, pattern
  • paradoxic respiratory motion of chest or abdomen
  • retractions
  • use of accessory muscles
  • pursed lip breathing (self PEEP - seen in obstructive disease)
  • cyanosis
30
Q

What would be noted on palpation?

A
  • tracheal deviation
  • chest expansion
  • vocal fremitus
  • lymphadenopathy
  • subcutaneous emphysema (bubble wrap)
31
Q

What should be noted on percussion?

A
  • normal
  • dull
  • hyperresonant
32
Q

What should you listen to upon ausculation of a pulmonary patient?

A
  • normal breath sounds: vesicular over periphery and bronchial centrally
  • adventitious (abnormal):
  • pleural rub,
  • stridor: high pitch that is entirely or predominately inspiratory
  • crackles: fine or coarse
  • wheezes: musical sounds when air flows rapidly through bronchi that are narrowed to nearly pt of closure
33
Q

What should the chest wall look like upon normal inspection?

A
  • sternum moves out with lung expansion

- abdomen moves out with descent of diaphragm

34
Q

What does abnormal respiration look like?

A
  • sternum moves up with diaphragmatic dysfunction, work done by straps
  • end inspiratory retraction at lower ribs (hoovers sign)
  • abdominal paradox: abdomen passively drawn in by negative pleural pressure across fatigued or paralyzed diaphragm
35
Q

What does respiratory distress look like?

A
  • flaring nostrils
  • notch retraction and intercostal retraction
  • strap muscles of neck
  • cephalad sternal vector
  • abdominal paradox
36
Q

What are the major and some of the minor accessorry muscles used in respiratory distress?

A
  • major: SCM, scalene (anterior, middle, and posterior), and serratus anterior
  • minor: pec major and minor, upper trap, latissimus dorsi
37
Q

What does ROWL stand for?

A
  • RR
  • O2 sat
  • words/ sentence (pause)
  • labor
38
Q

What are the diagnostic tests used in pulm?

A
  • O2 sat
  • CXR
  • bronchoscopy
  • CT scan
  • PFTs
  • peak flow meter
  • EKG?
  • stress test?
  • sleep study
39
Q

Relationship b/t pulmonary and cardiac etiology?

A
  • useful to help distinguish b/t a plum or cardiac etiology
  • overlap of sxs b/t 2 systems
  • many pts have disorders of both systems so let pt hx and presentation guide your eval

pulmonology (20 decks)

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