intro to pulm Flashcards
What areas of care do pulmonologists oversee?
ICU respiratory care unit pulm function lab resp. care dept pulm rehab sleep lab (often run by pulmonary but may be split with neurology)
How common is pulmonary dysfunction as the cause of death in the US?
- 4 of top 10 causes of death in US
- cancer (lung cancer leading cause of cancer deaths)
- COPD
- pneumonia
- sepsis
How are lung diseases classified on the basis of anatomic areas?
- interstitial lung disease (between air sacs)
- pleural disease (in pleural space)
- airway disease
How are lung diseases classified by physiologic alterations in respiratory function?
- denoted by PFTs:
obstructive lung disease (can’t get air out)
restrictive lung disease
(hard to get air into lungs)
Examples of obstructive lung disease?
- asthma (reversible)
- COPD
- cystic fibrosis
Examples of restricted lung disease?
- sarcoidosis
- asbestosis
- drug induced fibrosis
- idiopathic pulmonary fibrosis
Examples of increased vascular resistance?
- pulmonary HTN, thromboembolic disease
What are non-modifiable RFs for pulmonary disease?
- Genetics: alpha-1 antitrypsin deficiency Wegeners Asthma - socioeconomic status - enviro: home situation or occupation
What are modifiable RFs for pulm. disease?
- immunizations (pneumonia vaccine)
- smoking cessation
- reduction of exposure to second hand smoke
- protection from environmental toxins
What are some common sxs of pulmonary disease?
- dyspnea
- chest tighness
- exercise intolerance
- chest pain
- cough
- hemoptysis
- sputum production
- stridor
What common sxs of pulmonary disease overlap with common cardiac complaints?
- dyspnea
- chest tightness
- exercise intolerance
- chest pain
What are impt ?s to ask while taking a pulmonary hx?
- 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
What are some inhalation hx factors?
- 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
What should you ask about dyspnea?
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 ….)
What is chronic dyspnea of unclear etiology likely to be?
- asthma
- COPD
- interstitial lung disease
- myocardial dysfunction
- obesity/deconditioning
What is orthopnea and why is it an impt sx?
- dyspnea when laying flat
- impt because most likely indicates CHF or asthma
What are the DDx of wheezing?
- 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
Different categories of cough?
- acute: less than 3 weeks
- subacute: 3-8 weeks
- chronic: longer than 8 weeks
Cough mechanism of TB or other chronic infections?
mechanism- like pneumonia
- characteristic features: chronic, usually productive cough, hemoptysis
Cough mechanism of lung abscess?
mechanism: like pneumonia
characteristic features: sudden onset or increase in amount of purulent, often foul smelling discharge
cough mechanism of chronic infiltrative or fibrosing lung disease?
mechanism: irritation of peripheral receptors, distortion of airways
- characteristic features: chronic dry cough, progressive dyspnea
Cough mechanism of left sided heart failure?
mechanism: pulmonary edema
chracteristic features: pulmonary edema, nocturnal cough
Range of hemoptysis?
- blood streaking of sputum
- pink frothy sputum
- or presence of gross blood in absence of any accompanying sputum
(think cancer or PE)
When does chest pain not generally originate in the heart?
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
What is the source of chest pain that worsens with inspiration?
- pleuritic pain that is likely from a pulmonary source
taking a deep breath in and its a stabbing pain, shallow breathing to prevent pain
What are some causes of pleuritic chest pain?
- viral pleurisy
- pneumonia
- **acute PE
- pneumothorax
- pericarditis
- collagen vasculat disease: SLE, RA
- drug induced lupus
- IBD
- familial mediterranean fever
- radiation pneumonitis
- pulm. histoplasmosis
What makes up the eval of a pulm. pt
- inspect
- palpate
- percuss
- auscultation
Where do you listen to middle and lower lobes on a pt?
- middle (R: try axilla, hard to hear)
- lower: back
What should you inspect on a pulmonary patient?
- 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
What would be noted on palpation?
- tracheal deviation
- chest expansion
- vocal fremitus
- lymphadenopathy
- subcutaneous emphysema (bubble wrap)
What should be noted on percussion?
- normal
- dull
- hyperresonant
What should you listen to upon ausculation of a pulmonary patient?
- 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
What should the chest wall look like upon normal inspection?
- sternum moves out with lung expansion
- abdomen moves out with descent of diaphragm
What does abnormal respiration look like?
- 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
What does respiratory distress look like?
- flaring nostrils
- notch retraction and intercostal retraction
- strap muscles of neck
- cephalad sternal vector
- abdominal paradox
What are the major and some of the minor accessorry muscles used in respiratory distress?
- major: SCM, scalene (anterior, middle, and posterior), and serratus anterior
- minor: pec major and minor, upper trap, latissimus dorsi
What does ROWL stand for?
- RR
- O2 sat
- words/ sentence (pause)
- labor
What are the diagnostic tests used in pulm?
- O2 sat
- CXR
- bronchoscopy
- CT scan
- PFTs
- peak flow meter
- EKG?
- stress test?
- sleep study
Relationship b/t pulmonary and cardiac etiology?
- 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
