Lung Screening

Question 1

Persistent dry cough might be indicative of ____

Answer 1

Tumor, congestion, or hypersensitive
airways

Question 2

Productive cough with purulent
sputum (yellow or green) may indicate____

Answer 2

infection

Question 3

a productive cough with non-
purulent sputum (thus it is clear or white) is best described as __

Answer 3

Nonspecific, indicates airway irritation

Question 4

Rust-colored sputum is characteristic of

Answer 4

pneumonia

Question 5

A pathologic condition—infection,
inflammation, abscess, tumor, or infarction might all present as this red flag (hint: IMMEDIATE REFERRAL)

Answer 5

Hemoptysis

Question 6

___ is a specific type of dyspnea that occurs when a pt is lying down

Answer 6

orthopnea

Question 7

cyanosis is a sign that indicates a problem with ____ can be observed in the skin, nails, and tongue.

Answer 7

Oxygen saturation and circulating Hgb

Question 8

the thickening and widening of the terminal phalanges, also known as clubbing, is commonly caused by ____

Answer 8

Hypoxia

Question 9

T/F: Referral pain is often unchanged with with respiratory movement

Answer 9

False. it increases

Question 10

where does pulmonary pathology often refer?

Answer 10

neck and upper traps
chest, shoulder and medial arm
thoracic spine and ribs

Question 11

T/F: While generally tracheobronchial pain is usually local, when observing finer bronchi and lung parenchyma, there is no pain innervation at all.

Answer 11

true

Question 12

tracheobronchial pain is generally caused by ___

Answer 12

inflammation, foreign materials and tumors.

Question 13

pleural pain is best described as

Answer 13

sharp and localized

Question 14

diaphragmatic pain occurs with phrenic nerve damage and presents with _____ paresis. (contralateral or ipsilateral? )

Answer 14

ipsalateral

Question 15

when considering diaphragmatic pleural pain , peripheral irritation refers to ___ while central irritation refers to ____

Answer 15

peripheral: costal margins
central : shoulder and upper trap

Question 16

Any condition that decreases
pulmonary ventilation
increases retention and
concentration of CO2,
hydrogen, & carbonic acid will put the body in a state of ___

Answer 16

respiratory acidosis

Question 17

respiratory acidosis is often linked with s/s such as

Answer 17

diaphoresis, shallow and rapid breath, cyanosis, restlessness and decreased consciousness/alertness

Question 18

A condition of increased respiratory rate &
depth that decreases the amount of
available CO2 and hydrogen is best described as

Answer 18

respiratory alkalosis

Question 19

T/F : Usually caused by hyperventilation, respiratory acidosis can result in tetany and convulsions if severe enough.

Answer 19

False. It’s respiratory alkalosis

Question 20

respiratory alkalosis is often linked with s/s such as

Answer 20

hyperventilation, lightheadedness, and numbness/tingling of face and digits

Question 21

T/F: Chronic Obstructive Pulmonary Disease, an umbrella term describing abnormal airway structures blocking airflow, is a leading cause of morbidity and mortality for young children.

Answer 21

False-it’s the leading cause for smokers.

Question 22

Predisposing factors of COPD are

Answer 22

smoking, environmental pollution (occupational or air), allergies, infection, aging, potentially harmful drugs and chemicals, genetics

Question 23

Though both chronic and acute bronchitis are characterized by productive coughs f/b wheezing, for chronic bronchitis the episodes are worse ____ (time of day)

Answer 23

in the morning AND evening.

Question 24

Acute bronchitis s/s:

Answer 24

a few days of cold s/s (fever ,sore throat ,malaise) + muscle/back pain, potential laryngitis

Question 25

what visual s/s might we observe in a patient with chronic bronchitis?

Answer 25

CYANOSIS, reduced chest wall expansion , SOB and decreased exercise tolerance, fever

Question 26

what s/s might indicate that chonic bronchitis has evolved into bronchiectasis?

Answer 26

"foul smelling" secretions and hemoptysis, sinusitis, weight loss and anemia, fatigue

Question 27

why are patients with bonchiectasis predisposed to frequent respiratory infections?

Answer 27

permanent bronchi dilation and wall destruction via inflammation

Question 28

____is described as a type of COPD characterized by supersized alveoli lacking normal elastic tension

Answer 28

emphysema

Question 29

describe the breathing patterns characteristic of a patient with emphysema

Answer 29

SOB/dyspnea at rest and w/ exertion, pursed lip breathing, prolonged expiration (+ grunts) , use of accessory muscles, wheezing and increased RR, supine orthopnea

Question 30

What physical attributes might you expect of a pt with emphysema

Answer 30

barrel chest, weight loss, peripheral cyanosis

Question 31

What are the 4 common COPD conditions?

Answer 31

acute and chronic bronchitis, emphysema, bronchiectasis

Question 32

The general triggers for asthma attacks include allergies, physical exertion, temp, excitement/stress and ___ (2)

Answer 32

resp infections/colds and environmental pollutants

Question 32

What are the 5 inflammatory/infectious diseases we've discussed?

Answer 32

asthma, pneumonia, tuberculosis (TB) , scleroderma, and lung cancer

Question 32

T/F: Asthma is an irreversible obstructive lung disease caused by inflammatory response of the airways to various stimuli

Answer 32

false. it is reversible

Question 33

What do we typically want to look for in asthma pts? (hint: PUSH'N P)

Answer 33

pushing pumps lol -pursed lip breathing -unusual pallor or sweat -skin retraction (chest region) -hunched posture -nostrils flaring

Question 34

What do we typically want to ask our asthma pts?

Answer 34

sleep restlessness, vomiting, abnormal fatigue

Question 35

what are we supposed to listen for in asthma pts?

Answer 35

wheezing, noisy and irregular breathing w/ prolonged expiration, unproductive cough or throat clearing (esp w/o a cold or post-exercise)

Question 36

what are the 3 causes of pneumonia?

Answer 36

aspiration, inhalation of toxins or irritants, infection

Question 37

In addition to general signs of infection (fever, fatigue malaise,etc) , patients with pneumonia may present with dyspnea, tachypnea, hakcing cough and ___ (think MSK pain)

Answer 37

sudden/sharp chest pain, shoulder pain, general myalgia and potentially swollen knees

Question 38

this infectious disease is transmitted by gram-positive acid fast bacillus and spread by repeated close contact.

Answer 38

tuberculosis (TB)

Question 39

T/F: TB treatment should only take place until symptoms resolve.

Answer 39

false. pts should comply with full course (6-9 months) to avoid passing drug resistant strains.

Question 40

extrapulmonary TB can occur in the kidneys, growth plates, meninges, and ___

Answer 40

spine (Pott's), lymph nodes, and hips

Question 41

In addition to typical s/s of infection, TB pts might experience

Answer 41

DULL chest pain or discomfort, anorexia/weight loss, and frequent productive cough

Question 42

____is a restrictive lung disease with unknown etiology that features inflammation and fibrosis of the skin and viscera

Answer 42

scleroderma

Question 43

these 6 symptoms are characteristic for someone with scleroderma: exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, ___

Answer 43

peripheral edema, nonproductive cough, ad hemoptysis

Question 44

what are the 2 major divisions of lung cancer?

Answer 44

small cell lung cancer non-small cell lung cancer

Question 45

what are the 3 subtypes on non-small cell lung cancer?

Answer 45

squamous cell carcinoma adenocarcinoma large cell carcinoma

Question 46

Along with breathing changes and sharp inspiratory pain in the UE/trunk, what other s/s are specifically related to lung cancer—as opposed to other cancers (5)

Answer 46

recurrent pneumonia or bronchitis, hemoptysis, UE atrophy/weakness, fecal breath odor, hoarseness/dysphagia

Question 47

___ is a genetic disease of the exocrine glands that mainly impacts the GI and respiratory systems

Answer 47

cystic fibrosis

Question 48

T/F: Cystic fibrosis is a recessive trait that typically manifests in early childhood

Answer 48

true

Question 49

In cystic fibrosis, ____ accumulates in tissue lining and creates viscous mucous and duct obstructions.

Answer 49

salt

Question 50

pneumothorax, hemoptysis, and _____ are severe complications of cystic fibrosis.

Answer 50

RHF secondary to pulmonary HTN

Question 51

How might we distinguish early or undiagnosed CF from asthma?

Answer 51

excessive appetite w/ no gains, bulky and foul stools, salty skin/sweat, frequent pneumonia

Question 52

how might CF present in young adults?

Answer 52

nasal polyops, glucose intolerance, periostitis, infertility

Question 53

Along with the "5 No's", what are the PE rule out criteria?

Answer 53

Age <50 y/o, HR<100, O2 sat>/=95%

Question 54

What are the "5 No's" of PE rule out criteria

Answer 54

no hemoptysis, estrogen use, prior DVT/PE, unilateral leg swelling, trauma or hospitalization in the past 4 weeks.

Question 55

what qualifies as pulmonary arterial HTN?

Answer 55

mean PA pressure >/= 25 mmHg and capillary wedge pressure

Question 56

what is the difference between types of pleurisy?

Answer 56

dry or wet based on presence of abnormal increase of fluid between pleural layers. When infected, it's considered purulent

Question 57

what are the typical pain distributions for pleurisy?

Answer 57

ipsilateral shoulder, upper trap, neck, lower chest wall and abs (>> basically . ipsi shoulder + trunk)

Question 58

Pneumothorax can be secondary to _____(3)

Answer 58

puncture, spontaneous or idiopathic spontaneous

Question 59

what is a common sign of spontaneous pneumothorax?

Answer 59

abrupt dyspnea in healthy person common in 20s-40s

Question 60

tight skin around the eyes, lips and joints is characteristic of this inflammatory pleural condition

Answer 60

scleroderma

Question 61

according to the PERC tool for PE, what is the cutoff score that indicates a need for referral?

Answer 61

> /= 2