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NPTE > Pulmonary differential diagnosis > Flashcards

Pulmonary differential diagnosis Flashcards

1
Q

What are PFTs used for?

A

Evaluating lung volumes, capacities, and flow rates – used to diagnose disease and monitor progression

Restrictive disease: decreased lung volumes
Obstructive disease: increased lung volumes

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2
Q

What are common s/s of pulmonary diseases?

A
  1. Altered breath sounds
  2. cyanosis and/or clubbing
  3. hypoxemia and/or hypercapnia
  4. chest pain/tightness
  5. SOB at rest and with exertion
  6. cough
  7. tachypnea
  8. fatigue
  9. weakness
  10. accessory muscle use at rest
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3
Q

What is seen on a CXR in a patient with obstructive disease?

A
  • flattened diaphragm
  • hyperlucency
  • hyperinflation
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4
Q

diagnosis

Chronic disease that limits expiratory flow due to abnormalities in alveoli and/or airways usually from environmental exposure

Slow progression

A

COPD

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5
Q

How is COPD diagnosed?

A

Global Initiative for Obstructive Lung Disease (GOLD) Criteria

combines evaluation of expiratory flow and functional limitation tests (Modified MRC dyspnea scale, COPD assessment test)

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6
Q

diagnosis

chronic inflammation of airways that causes increased mucous production, cough, SOB, and fatigue

A

chronic bronchitis

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7
Q

When is chronic bronchitis diagnosed?

A

When chronic coughing is present for >3 months or 2 consecutive years

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8
Q

diagnosis

Progressive alveolar and parenchymal destruction with concomitant enlargement of distal airways usually leading to severe expiratory airflow limitations

A

emphysema

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9
Q

What is the primary cause of emphysema?

A

smoking

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10
Q

What are the following diagnoses defined as?

  • COPD
  • chronic bronchitis
  • emphysema
  • asthma
  • PNA
  • bronchiectasis
  • cystic fibrosis
  • bronchopulmonary dysplasia
  • respiratory distress syndrome (RDS)
A

obstructive disorders

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11
Q

What are the types of COPD?

A
  1. emphysema
  2. chronic bronchitis
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12
Q

diagnosis

Chronic inflamamtory disease caused by increased reactivity of the trachea and bronchi to various stimuli

  • variable symptoms and expiratory flow limitations
A

asthma

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13
Q

(true/false) During remission from asthma, the patient has some degree of airway inflammation

A

true

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14
Q

What are the types of PNA?

A
  1. aspiration
  2. bacterial
  3. viral
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15
Q

diagnosis

When aspirated material causes an acute inflammatory reaction within the lungs

A

aspiration PNA

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16
Q

What populations are normally found to experience aspiration PNA?

A
  1. dysphagia
  2. fixed neck EXT
  3. intoxication
  4. impaired consciousness
  5. NM disease
  6. recent anesthesia
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17
Q

What is the most common type of PNA? Where is it acquired?

A

a. bacterial (Type: pneumococcal (streptococcal bacteria))

b. community acquired

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18
Q

What is the most common viral pneumonia in children?

A

RSV

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19
Q

diagnosis

Chronic congenital or acquired disease characterized by abnormal dilatation of the bronchi and excessive sputum production

A

bronchiectasis

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20
Q

Diagnosis

Genetically inherited disease characterized by thickening of secretions within all exocrine glands that leads to obstruction

A

CF

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21
Q

(true/false) CF can present as an obstructive, restrictive, or mixed disease

A

true

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22
Q

What are the clinical signs of CF?

A
  • frequent respiratory infections
  • inability to gain weight despite adequate caloric intake
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23
Q

How is CF diagnosed?

A
  • positive postnatal blood test indicating trypsinogen
  • positive sweat electrolyte test
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24
Q

Diagnosis

Diagnosis that results from high pressures of mechanical ventilation, high fractions of inspired oxygen, and/or infection – lungs show areas of pulmonary immaturity and dysfunction due to hyperinflation

A

bronchopulmonary dysplasia

often sequela of premature infants with RDS

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25
Q

diagnosis

alveolar collapse in a premature infants resulting from lung immaturity and inadequate level of pumonary surfactant

A

respiratory distress syndrome

26
Q

diagnosis

Chronic, progressive, fibrotic pneumonia that causes irreversible scarring in the lung tissue

A

idiopathic pulmonary fibrosis

27
Q

diagnosis

multisystem inflammatory disease consisting of granulomas in multiple organs

A

sarcoidosis

28
Q

Where are granulomas from sarcoidosis commonly found?

A
  • lungs
  • skin
  • lymph nodes
  • eyes
  • liver

multiple locations

29
Q

What is the etiology of sarcoidosis? When is the peak onset?

A

a. unknown

b. middle age (commonly in persons of color)

30
Q

What can sarcoidosis mimic?

A
  • bronchiectasis
  • pulmonary fibrosis

due to scarring from repeated infections

  • increased secretions are possible if bronchioles are involved
31
Q

What medications are used long-term for management of sarcoidosis?

A

glucocorticoids

Multisystem monitoring is required

32
Q

What tests are used to monitor progression of sarcoidosis?

A

6MWT and PFTs

33
Q

What new symptoms may arise with sarcoidosis?

A
  • skin lesions
  • visual changes
  • diaphoresis
  • palpitations
  • joint pain and swelling
  • muscle weakness
34
Q

Diagnosis

Chronic reaction from inhaled causes scarring in lung tissue and interstitial lung disease

A

occupational exposure diseases

pneumoconiosis, asbestosis, byssinosis, silicosis, etc

35
Q

What MSK changes are seen with restrictive lung diseases?

A
  1. restricted motion of bony thorax
  2. integumentary changes of chest wall (thoracic burns, scleroderma, etc)
36
Q

What NM changes are seen with restrictive lung disorders?

A

decreased strength resulting in the inability of expanding the rib cage

37
Q

What is a pneumothorax?

A

Air in the pleural space

caused by laceration in visceral pleura from rib Fx or ruptured bullae

38
Q

What is a hemothorax?

A

blood in the pleural space

Caused by laceration in parietal pleura

39
Q

definition

Blood and edema within the alveoli and interstitial space due to trauma with or without rib Fx

A

lung contusion

40
Q

What is pleural effusion? What is the cause?

A

a. excessive fluid between the visceral and parietal pleura

b. caused by increased pleural permeability to proteins from inflammatory diseases, neoplastic disease, decrease in osmotic pressure, peritoneal fluid within the pleral space, or interferenceof pleral reabsorption from a tumor

41
Q

What is pulmonary edema?

A

Excessive seepage of fluid from the pulmonary vascular system into the interstitial space

42
Q

What can pulmonary edema cause?

A

alveolar edema

43
Q

What are the types of pulmonary edema?

A
  1. cardiogenic
  2. noncardiogenic
  3. ARDS
44
Q

What causes cardiogenic Pulmonary edema?

A

Increased pressure in pulmonary capillaries associated with one of the following:

  • Left ventricular failure
  • aortic valve disease
  • mitral valve disease
45
Q

What causes noncardiogenic pulmonary edema?

A

Increased permeability of the alveolar capillary membranes due to inhalation of toxic fumes, hypervolemia, or narcotic overdose

46
Q

What is ARDS?

Adult Respiratory Distress Syndrome

A

acute inflammatory response characterized by pulmonary edema in response to systemic pathology (sepsis, PNA, trauma, substance abuse)

47
Q

What is a PE?

A

Thrombus from the peripheral venous circulation becoming embollic and lodging into pulmonary circulation

48
Q

(true/false) Small emboli can cause infarction

A

False (not all the time)

49
Q

What is pulmonary HTN?

A

increased arterial pressures within the pulmonary vasculature system

50
Q

What causes pulmonary HTN?

A
  • left heart disease
  • chronic lung disease
  • hypoxemia
  • pulmonary artery obstruction
  • multifactorial issues
51
Q

What is the most common type of bronchogenic carcinoma?

A

Non-small cell lung cancer

adenocarcinoma > squamous cell carcinoma > larfe cell carcinoma

second most common: small cell lung cancer

52
Q

What is the largest risk factor for bronchogenic carcinoma?

A

smoking

others:
- radiation
- environmental exposure
- pulmonary fibrosis
- genetics
- HIV
- alcohol

53
Q

What is the incubation period of TB?

A

2-10 weeks

54
Q

How long does TB last?

A

10 days - 2 weeks

55
Q

What is postprimary TB infection?

A

Reactivation of dormant T that can occur years after initial infection

56
Q

There is an increased presence of TB in patients with what other diagnosis?

A

HIV

57
Q

What symptoms accompany TB?

A

mild symptoms:
- slight nonproductive cough
- low-grade fever

May go unnoticed

58
Q

After ___ weeks of receiving antituberculosis drugs renders the host non-infectious

A

2 weeks

59
Q

What is Pott’s disease?

A

Spinal TB (tuberculosis spondylitis)

60
Q

Where does Pott’s disease (tuberculosis spondylitis) primary affect?

A
  • thoracic vertebrae
  • upper lumbar vertebrae

arthritic changes often result in kyphosis

NPTE (22 decks)

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