Pulmonary Diseases Flashcards
What is bacterial pneumonia?
An intra-alveolar bacterial infection
List 9 pertinent physical findings associated with bacterial pneumonia.
- Shaking chills
- Fever
- Chest pain if pleuritic involvement
- Cough becoming of purulent, blood streaked or rusty sputum
- Decreased or bronchial breath sounds, and or crackles
- Tachypnea
- Increased WBC count
- Hypoxemia, hypocapnia initially, hypercapnia with increasing severity
- CXR confirmation of infiltrate
What is viral pneumonia?
Interstitial or intra-alveolar inflammatory process caused by viral agents (influenza, measles, herpes etc.)
List 9 pertinent physical findings associated with viral pneumonia.
- Recent history of upper respiratory infection
- Fever
- Chills
- Dry cough
- Headaches
- Decreased breath sounds/crackles
- Hypoexmia and hypercapnia
- Normal WBC count
- CXR confirmation of interstitial infiltrate
What is aspiration pneumonia?
Aspirated material causes an acute inflammatory reaction within the lungs.
List 12 pertinent physical findings associated with aspiration pneumonia.
- Sxs begin shorty after aspiration event
- Cough may be dry at onset, progresses to produce putrid secretions
- Dyspnea
- Tachypnea
- Cyanosis
- Tachycardia
- Wheeze and crackles with decreased breath sounds
- Hypoxemia, hypercapnia in severe cases
- Chest pain over the involved area
- Fever
- WBC count shows varying degrees of leukocytosis
- CXR initially shows pneumonitis
What is tuberculosis? What is incubation period? How long does the primary disease last?
Mycobacterium tuberculosis infection spread by aerosolized droplets from an untreated infected host.
Incubation period: 2-10 weeks
Primary disease lasts 10 days to 2 weeks
_____ on appropriate antituberculin drugs renders the host noninfectious.
2 weeks
Describe the precautions associated with tuberculosis during the infectious stage.
- Patient must be isolated from others in a negative pressure room
- Anyone entering the room must wear a protective TB mask and follow universal precautions
- If patient leaves negative air pressure room, they must wear a specialized mask to keep from infecting others
List 9 pertinent physical findings associated with post primary tuberculosis.
- Fever
- Weight loss
- Cough
- Hilar adenopathy: enlargement of the lymph nodes surrounding the hilum
- Night sweats
- Crackles
- Hemoptysis: blood streaked sputum
- WBC shows increased lymphocytes
- CXR shoes upper lobe involvement and parenchymal fibrosis
What is Pott’s disease?
Tuberculous spondylitis
A form of spinal TB that primarily affects the thoracic and upper lumbar vertebrate (can result in increased kyphosis)
What is pneumocystis pneumonia (PCP)? In what patient populations is this typically found? (3)
Pulmonary infection caused by a fungus (pneumocystis carinii) in immunocompromised hosts.
- Patients s/p transplantation
- Neonates
- Patient infected with HIV
List 7 physical findings associated with pneumocystis pneumonia (PCP).
- Insidious progressive SOB
- Nonproductive cough
- Crackles
- Weakness
- Fever
- Chest x-ray shows interstitial infiltrates
- Complete blood count shows no evidence of infection
What is sarcoidosis?
Multisystem inflammatory disease consisting of granulomas in multiple organs, most often the lungs, skin, lymph nodes, eyes and liver
What is required to confirm a diagnosis of sarcoidosis? (3)
- Radiographic findings
- Histology with granulomas
- Exclusion of all other diagnoses
List 5 physical findings associated with sarcoidosis.
- Fever
- Cough
- SOB
- Chest pain
- Fatigue
What is chronic obstructive pulmonary disease (COPD)?
A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs.
List 6 physical findings associated with COPD.
- Increased resistance to airflow
- Often history of smoking
- Abnormal breath sounds
- Use of accessory breathing muscles
- Increased chest size
- Dry or productive cough
What is asthma?
Increased reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold)
Manifests by widespread narrowing of the airways due to inflammation, smooth muscles constriction, and increased secretions.
List 8 physical findings associated with asthma.
- Wheezing cough
- Increased secretions
- Dyspnea
- Increased accessory muscle use
- Anxiety
- Tachycardia and tachypnea
- Hypoxemia and hypocapnia
- Cyanosis
What is cystic fibrosis?
A genetically inherited disease characterized by thickening of secretions of all exocrine glands, leading to obstruction (i.e. pulmonic, pancreatic, GI)
List 3 clinical signs of cystic fibrosis.
- Menconium ileus
- Frequent respiratory infections
- Inability to gain weight despite adequate caloric intake
What testing is needed to confirm a diagnosis of cystic fibrosis?
Postnatally by a blood test indicated trypsinogen
OR
Positive sweat electrolyte test
List 6 physical findings associated with cystic fibrosis.
- Onset of sxs usually in early childhood
- Frequent respiratory infections
- Inability to gain weight
- Rales, wheezing
- Production of large amounts of mucoid or purulent sputum
- May have hemoptysis
What is bronchiectasis?
A chronic congenital or acquired disease characterized by abnormal dilation of bronchi and excessive sputum production.
What is respiratory distress syndrome?
Respiratory distress due to atelectasis caused by insufficient surfactant in premature lungs
List 7 physical findings associated with respiratory distress syndrome.
- Respiratory distress
- Crackles
- Tachypnea
- Hypoxemia
- Cyanosis
- Accessory muscle use
- Expiratory grunting, flaring nares
What is bronchogenic carcinoma?
Tumor that arises from the bronchial mucosa that can cause obstruction of compression of the airway, blood vessels or nerves.
What are the 2 most frequent causal agents of bronchogenic carcinoma?
Smoking and occupational exposures are the most frequent causal agents
List 8 pertinent physical findings associated with bronchogenic carcinoma.
- Unexplained weight loss
- Hemoptysis
- Dyspnea
- Weakness
- Fatigue
- Wheezing
- Pneumonia with productive cough due to airway compression
- Hoarseness with compression to the laryngeal nerve
What is the difference between a rib fracture and a flail chest?
Fracture of the ribs usually due to blunt trauma
Flail chest is 2 or more fractures in 2 or more adjacent ribs
List 5 pertinent physical findings of a rib fracture/flail chest.
- Shallowing breathing
- Splinting due to pain (especially with deep inspiration or cough)
- Crepitation during ventilation over the flail site
- Paradoxical movement of a flail section during ventilation (inspiration, the flail section is pulled inward; exhalation, the flail moves outward)
- Confirmation by CXR
What is the difference between a pneumothorax and a hemothorax?
Pneumothorax: Air in the pleural space, usually through a lacerated visceral pleura from a rib fracture or ruptured bullae
Hemothorax: Blood in the pleural space usually from a laceration of the parietal pleura
List 8 physical findings associated with a pneumothorax and/or a hemothorax .
- Decreased or absent breath sounds
- Dry cough
- Tracheal and mediastinal shift away from side of injury
- Local or referred pain
- Respiratory distress
- Confirmation by CXR
- Increased tympany with mediate percussion (pneumo)
- Possible signs of blood loss (hemo)
What is a lung contusion?
Blood and edema within the alveoli and interstitial space due to blunt chest trauma with or without rib fractures
What is pulmonary edema?
Excessive seepage of fluid from the pulmonary vascular system into the interstitial space; may eventually cause alveolar edema
List 5 physical findings associated with pulmonary edema.
- Cough with pink, frothy secretions
- Crackles
- Tachypnea
- Dyspnea
- Hypoxemia
What is pleural effusion?
Excessive fluid between the visceral and parietal pleura caused mainly by increased pleural permeability to proteins from inflammatory diseases
List 5 physical findings associated with pleural effusion.
- Decreased breath sounds over effusion
- Mediastinal shift away from large effusion
- Breathlessness with large effusions
- CXR shows fluid in the pleural space in gravity dependent areas of the thorax if > 300 mL
- Pain and fever only if pleural fluid is infected (empyema)
What is atelectasis?
Collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilatory cycle, bronchial obstruction/compression, low tidal volumes, or neurologic insult
List 5 physical findings associate with atelectasis.
- Decreased breath sounds
- Dyspnea
- Tachycardia
- Increased temperature
- CXR with platelike streaks
