Pulmonary differential diagnosis Flashcards
What are PFTs used for?
Evaluating lung volumes, capacities, and flow rates – used to diagnose disease and monitor progression
Restrictive disease: decreased lung volumes
Obstructive disease: increased lung volumes
What are common s/s of pulmonary diseases?
- Altered breath sounds
- cyanosis and/or clubbing
- hypoxemia and/or hypercapnia
- chest pain/tightness
- SOB at rest and with exertion
- cough
- tachypnea
- fatigue
- weakness
- accessory muscle use at rest
What is seen on a CXR in a patient with obstructive disease?
- flattened diaphragm
- hyperlucency
- hyperinflation
diagnosis
Chronic disease that limits expiratory flow due to abnormalities in alveoli and/or airways usually from environmental exposure
Slow progression
COPD
How is COPD diagnosed?
Global Initiative for Obstructive Lung Disease (GOLD) Criteria
combines evaluation of expiratory flow and functional limitation tests (Modified MRC dyspnea scale, COPD assessment test)
diagnosis
chronic inflammation of airways that causes increased mucous production, cough, SOB, and fatigue
chronic bronchitis
When is chronic bronchitis diagnosed?
When chronic coughing is present for >3 months or 2 consecutive years
diagnosis
Progressive alveolar and parenchymal destruction with concomitant enlargement of distal airways usually leading to severe expiratory airflow limitations
emphysema
What is the primary cause of emphysema?
smoking
What are the following diagnoses defined as?
- COPD
- chronic bronchitis
- emphysema
- asthma
- PNA
- bronchiectasis
- cystic fibrosis
- bronchopulmonary dysplasia
- respiratory distress syndrome (RDS)
obstructive disorders
What are the types of COPD?
- emphysema
- chronic bronchitis
diagnosis
Chronic inflamamtory disease caused by increased reactivity of the trachea and bronchi to various stimuli
- variable symptoms and expiratory flow limitations
asthma
(true/false) During remission from asthma, the patient has some degree of airway inflammation
true
What are the types of PNA?
- aspiration
- bacterial
- viral
diagnosis
When aspirated material causes an acute inflammatory reaction within the lungs
aspiration PNA
What populations are normally found to experience aspiration PNA?
- dysphagia
- fixed neck EXT
- intoxication
- impaired consciousness
- NM disease
- recent anesthesia
What is the most common type of PNA? Where is it acquired?
a. bacterial (Type: pneumococcal (streptococcal bacteria))
b. community acquired
What is the most common viral pneumonia in children?
RSV
diagnosis
Chronic congenital or acquired disease characterized by abnormal dilation of the bronchi and excessive sputum production
bronchiectasis
Diagnosis
Genetically inherited disease characterized by thickening of secretions within all exocrine glands that leads to obstruction
CF
(true/false) CF can present as an obstructive, restrictive, or mixed disease
true
What are the clinical signs of CF?
- frequent respiratory infections
- inability to gain weight despite adequate caloric intake
How is CF diagnosed?
- positive postnatal blood test indicating trypsinogen
- positive sweat electrolyte test
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
bronchopulmonary dysplasia
often sequela of premature infants with RDS
diagnosis
alveolar collapse in a premature infants resulting from lung immaturity and inadequate level of pumonary surfactant
respiratory distress syndrome
diagnosis
Chronic, progressive, fibrotic pneumonia that causes irreversible scarring in the lung tissue
idiopathic pulmonary fibrosis
diagnosis
multisystem inflammatory disease consisting of granulomas in multiple organs
sarcoidosis
Where are granulomas from sarcoidosis commonly found?
- lungs
- skin
- lymph nodes
- eyes
- liver
multiple locations
What is the etiology of sarcoidosis? When is the peak onset?
a. unknown
b. middle age (commonly in persons of color)
What can sarcoidosis mimic?
- bronchiectasis
- pulmonary fibrosis
due to scarring from repeated infections
- increased secretions are possible if bronchioles are involved
What medications are used long-term for management of sarcoidosis?
glucocorticoids
Multisystem monitoring is required
What tests are used to monitor progression of sarcoidosis?
6MWT and PFTs
What new symptoms may arise with sarcoidosis?
- skin lesions
- visual changes
- diaphoresis
- palpitations
- joint pain and swelling
- muscle weakness
Diagnosis
Chronic reaction from inhaled causes scarring in lung tissue and interstitial lung disease
occupational exposure diseases
pneumoconiosis, asbestosis, byssinosis, silicosis, etc
What MSK changes are seen with restrictive lung diseases?
- restricted motion of bony thorax
- integumentary changes of chest wall (thoracic burns, scleroderma, etc)
What NM changes are seen with restrictive lung disorders?
decreased strength resulting in the inability of expanding the rib cage
What is a pneumothorax?
Air in the pleural space
caused by laceration in visceral pleura from rib Fx or ruptured bullae
What is a hemothorax?
blood in the pleural space
Caused by laceration in parietal pleura
definition
Blood and edema within the alveoli and interstitial space due to trauma with or without rib Fx
lung contusion
What is pleural effusion? What is the cause?
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 interference of pleral reabsorption from a tumor
What is pulmonary edema?
Excessive seepage of fluid from the pulmonary vascular system into the interstitial space
What can pulmonary edema cause within the lungs?
alveolar edema
What are the types of pulmonary edema?
- cardiogenic
- noncardiogenic
- ARDS
What causes cardiogenic Pulmonary edema?
Increased pressure in pulmonary capillaries associated with one of the following:
- Left ventricular failure
- aortic valve disease
- mitral valve disease
What causes noncardiogenic pulmonary edema?
Increased permeability of the alveolar capillary membranes due to inhalation of toxic fumes, hypervolemia, or narcotic overdose
What is ARDS?
Adult Respiratory Distress Syndrome
acute inflammatory response characterized by pulmonary edema in response to systemic pathology (sepsis, PNA, trauma, substance abuse)
What is a PE?
Thrombus from the peripheral venous circulation becoming embolic and lodging into pulmonary circulation
(true/false) Small emboli can cause infarction
False (not all the time)
What is pulmonary HTN?
increased arterial pressures within the pulmonary vasculature system
What causes pulmonary HTN?
- left heart disease
- chronic lung disease
- hypoxemia
- pulmonary artery obstruction
- multifactorial issues
What is the most common type of bronchogenic carcinoma?
Non-small cell lung cancer
adenocarcinoma > squamous cell carcinoma > larfe cell carcinoma
second most common: small cell lung cancer
What is the largest risk factor for bronchogenic carcinoma?
smoking
others:
- radiation
- environmental exposure
- pulmonary fibrosis
- genetics
- HIV
- alcohol
What is the incubation period of TB?
2-10 weeks
How long does TB last?
10 days - 2 weeks
What is postprimary TB infection?
Reactivation of dormant T that can occur years after initial infection
There is an increased presence of TB in patients with what other diagnosis?
HIV
What symptoms accompany TB?
mild symptoms:
- slight nonproductive cough
- low-grade fever
May go unnoticed
After ___ weeks of receiving antituberculosis drugs renders the host non-infectious
2 weeks
What is Pott’s disease?
Spinal TB (tuberculosis spondylitis)
Where does Pott’s disease (tuberculosis spondylitis) primary affect?
- thoracic vertebrae
- upper lumbar vertebrae
arthritic changes often result in kyphosis
