Pulmonary H&P Flashcards
dyspnea -definition:
- difficult, labored, uncomfortable breathing
- subjective based on what patient is doing
dyspnea - etiology:
- high level of ventilation perceived centrally
- length-tension dissociation of respiratory muscles
- modified by attention, experience, emotional state, and personality traits
dyspnea - history- what to ask:
- type of onset: rapid or gradual
- activity level that causes dyspnea: exertion, walking, bathing, changing clothes, talking, rest, position change
- what else aggravates the symptoms or alleviates:exposures, weather change, medications, posture
- are symptoms progressing or improving? determine severity even though its subjective!
Dyspnea - rapid onset associations:
- asthma -exacerbation
- left ventricular failure -pulmonary edema
- pulmonary embolism
- pneumothorax
- foregin body aspiration
- hyperventilation
- pneumonia-hours to days
Onset over 1-2 hours with wheeze=
- asthma
- left ventricular failure (MI, Vasc disease)
OVer hours/days with fever +/- sputum=
- pneumonia
- acute bronchitis
dyspnea with hyperventilation=
- acidosis
- poisoning
- hyperventilation syndrome
immediate +/- pain=
- pnuemothorax
- pulmonary embolismm
- foreign body aspiration
dyspnea- gradual onset associations:
- COPD
- interstitial lung disease
- pneumoconiosis
- chronic or recurrent pulmonary embolism
- deconditioning
- neuromuscular disease
- Chronic CHF
wheezing definition:
- high pitched sounds, inspiratory or expiratory
- airflow obstruction due to either airway narrowing or secretions
- site of obstruction determines if worse during inspiration or exhalation
- inspiratory wheezes + STRIDOR usually mean= upper airway site
- expiratory wheezes=intrathoracic
Pulmonary chest pain:
- pleuritic-sharp, stabbing pain
- aggravated by deep breath or cough
- severe, usually short duration (hours to 2 days)
- inflammation or irritation of parietal pleura
- mediastinal pain-pressure or heaviness due to acte pulmonary HTN or stretching of mediastinal structures
- patients with pleuritic chest pain like to lie on the SIDE THAT HURTS
persistent cough more common in which gender?
-females
cough physiology:
- rapidly adapting irritant receptors most numerous on posterior tracheal wall, carina, and branches of large airways
- other sites that elicit cough=tympanic membrane, auditory canals, paranasal sinuses, diaphragm, pleura, pharynx, pericardium, and stomach
What to ask about a cough:
- onset: acute or chronic?
- sputum production
- duration
- associated symptoms
- aggravating factors: acitvity, posture, food, exposures
- factors that help cough
classification of cough:
1) acute-less than 3 weeks
2) subacute-3-8weeks
3) chronic->8 weeks
Acute cough common etiologies:
- viral and bacterial infections (esp viral URI=common cold, sinusitis)
- acute aspiration
- pulmonary embolism
- congestive heart failure
chronic productive cough can be:
- chornic bronchitis
- bronchiectasis
- CF
chronic non-productive cough due to:
- upper airway cough syndrome (PNDS) - post nasal drip
- asthma
- GERD
- exclude ACEI induced cough
other causes f chronic cough:
- eosinophilic bronchitis
- postviral cough
- chronic bronchitis -productive
- bronchiectasis-producitve
upper airway cough syndrome causes:
- allergic rhinitis
- perennial non allergic rhinitis
- vasomotor rhinitis
- sinusitis
MOST COMMON of the less common causes of chronic cough
occupational asthma
occult aspiration of object in kids
upper airway cough tx?
steroid
