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Block 5 - Pulm and Skeletal > Pulmonary H&P > Flashcards

Pulmonary H&P Flashcards

0
Q

What are the different kinds of productive cough and what does each indicate?

A

Green does not mean bacterial
Productive can be infectious or inflammatory
Dry tends to indicate something other than inf
Large amounts tend to indicate inflammatory or inf

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1
Q

What are the three most common pulmonary symptoms?

A

Cough
Hemoptysis
Shortness of breath (SOB)

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2
Q

What can a nighttime cough be indicative of?

A

Reactive airway disease
Allergies
GERD

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3
Q

What is the ddx of a cough with an abnormal CXR?

A 
Tb
Pneumonia
Lung cancer
Foreign bodies
Bronchiectasis 
Interstitial lung disease
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4
Q

What is the Ddx of a cough with a normal CXR?

A 
Upper respiratory inf - bronchitis
Allergic rhinitis (postnatal drip)
GERD
Atypical pneumonia
Bronchial asthma 
Vocal cord polyps 
Drugs (ACEIs)
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5
Q

What is the difference between hemoptysis and hematemesis?

A

Hemoptysis - blood is from respiratory tract - bright red frothy sputum, hemosiderin laden macrophages, alkaline ph
Hematemesis - blood is from GI tract - associated with nausea, abdominal pain, vomiting, dark red blood, acid ph

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6
Q

What is massive hemoptysis?

A

100-600 ml of blood over 24 hrs
Can cause aspiration and asphyxiation
Usually indicates arterial source

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7
Q

What is the Ddx of hemoptysis?

A 
Bronchitis
Lung abscess
Bronchiectasis 
Pneumonia
Tb
Lung carcinoma 
Pulm infarct
Cf
CHF
Fungal disease
Vasculitis
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8
Q

What is the most specific pulmonary symptom for CHF?

A

PND

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9
Q

What is the Ddx of SOB?

A 
Asthma
COPD
Interstitial lung disease
Pneumonia
Tb
Pulmonary embolism
Pneumothorax 
Mitral or aortic stenosis
Hyperthyroidism 
MI
CHF
Anemia
Anxiety
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10
Q

What accessory muscles are used in certain respiratory abnormalities?

A

First scalenes but can’t see them
SCM - indicates FEV1 has decreased to ~30% normal
Intercostal muscles and spaces
Abdominal wall muscles

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11
Q

What abnormalities are seen when the intercostal muscles kick in during respiration?

A

Decreased inward retraction indicates increased expansion of lungs - consolidation, tension pneumothorax, pleural effusion
Exaggerated outward bulging - increased intrapleural pressure or lungs unable to empty - emphysema, acute asthma exacerbation, tension pneumothorax, flail chest
Constant bulging of spaces - massive pleural effusion

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12
Q

What is the respiratory paradox?

A

Diaphragm is weak or overloaded
Moves up during inspiration and abdominal wall moves in
Sign of respiratory failure and usually indicates patient needs mechanical ventilation

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13
Q

What is the significance of tracheal deviation?

A

Toward hemithorax with lower pressure - atelectasis, consolidation with closed bronchus
Away from hemithorax with higher pressure - pleural effusion, pneumothorax

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14
Q

What is the significance of splinting?

A

Asymmetric expansion of chest

Causes include unilateral diaphragmatic paralysis, pneumothorax, bronchial obstruction, massive pleural effusion

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15
Q

What is the significance of clubbing?

A

Rounding of distal phalanx of each finger
Seen in chronic hypoxia, congenital heart disease, endocarditis, chronic renal insufficiency, or congenital
Shunts allow megakaryocytes fragments to bypass lungs and deposit in capillaries

16
Q

What are causes of generalized cyanosis? Peripheral?

A

Methemoglobinemia
Sulfhemoglobinema
Deoxyhemoglobinemia - only if patients hemoglobin >5
Peripheral from tissue hypoperfusion - hemoglobin normal

17
Q

How is the I/E ratio used in the pulm exam?

A

Normal is 1:2

Increased (1:3 or higher) means patient trying to get air out - asthma or COPD

18
Q

When is decreased fremitus seen?

A 
Atelectasis
Consolidation with closed bronchus
Pneumothorax 
Diaphragmatic paralysis
Pleural effusion
19
Q

When is increased fremitus seen?

A

Fluid in alveoli -
Consolidation with open bronchus
Pneumonia
Heart failure

20
Q

When is dullness to percussion seen?

A

Consolidation of lung - open or closed bronchus

Pleural effusion

21
Q

When is hyper resonance to percussion seen?

A

Pneumothorax - unilateral

COPD or asthma - bilateral

22
Q

What is diaphragmatic excursion?

A

Elevation of left hemidiaphragm always abnormal

Could be due to diaphragmatic paralysis, LUQ mass, pleural effusion, occasionally left lower lobe lesion

23
Q

What does it mean if breath sounds are decreased in one area of the chest (focal)?

A

Disease either in the bronchi or alveoli of that region

24
Q

What does generalized decrease in breath sounds indicate?

A

Restrictive lung disease
Expanded lungs with obstruction (COPD)
Obstructive lung disease

25
Q

What is bronchophony?

A

Tracheal breath sounds in lung from consolidation with open bronchus

26
Q

What are the different normal breath sounds?

A

Vesicular - normal or alveolar, present longer during inspiration that expiration
Bronchial - louder and higher frequency, heard best at manubrium, hard to hear normally, longer in expiration that inspiration
Tracheal - equal in inspiration and expiration, louder

27
Q

What are the possible adventitious breath sounds?

A 
Stridor
Rhonchi
Wheezes
Crackles (rales)
Pleural rub
28
Q

What is stridor?

A

Hissing noise in inspiration that indicates upper airway obstruction
Inspiratory = hot potato voice - obstruction near trachea, larynx, of epiglottis, emergency
Expiratory - obstruction in lower airways

29
Q

What are rhonchi?

A

Continuous sound produced in larger airways caused by fluid rupture or airway wall vibrations
Low pitched snoring sounds
Indicate secretions in large airways or collapsible large airways

30
Q

What are wheezes?

A

Continuous sounds indicating airway obstruction
Air in trachea trachea through narrowed bronchi or bronchioles to point of closure
Musical high frequency noise

31
Q

What are crackles (rales)?

A 
Discontinuous sounds caused by explosive opening of small airways and alveoli creating a crackle noise
Wet rales (course crackles) heard in mid-late inspiration - heard in bronchiectasis, pneumonia, CHF - sound like hair
Fine (dry crackles) - late inspiration - interstitial lung disease, sound like Velcro
32
Q

What is the Ddx of FINE crackles?

A 
S arcoid
H eart failure, hemorrhage
I nfection, idiopathic pulm fibrosis, inhalation
T rauma, toxins
F ungal, familial 
A spiration, allergic, alveolar proteinosis
C ancer, collagen vascular disease
E osinophilic syndromes
D rugs, dusts
33
Q

How can a pleural rub be differentiated form rhonchi?

A

Rhonchi heard with same intensity in inspiration and expiration and can change with deep breathing
Rubs are localized and louder during inspiration

34
Q

What are sound changes seen in consolidation?

A

Egophony - e to a change
Bronchophony - can understand 99 when patient says it
Pectoriloquy - you can actually hear 66 with the stethoscope when the patient whispers it

Block 5 - Pulm and Skeletal (19 decks)

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