Pulmonary History and Exam

Question 1

What is Dyspnia?

Answer 1

Uncomfotably labored breathing.

Provokes fear.

Question 2

What causes Dyspnia?

Answer 2

High level of ventilation percieved centrally

Length tension dissociation of resp muscles

Modified by attention, experience, emotional state, and personality

Question 3

How do you ask about SOB in History?

Answer 3

What is the activity level that causes SOB?
Exertion and activities
Position
Rest
Onset Rapid vs Gradual?
Aggrivates or alleviates?
Exposure, meds, weather
Symptoms progressing or improving?

Question 4

What are some causes of acute onset SOB?

Answer 4

Asthma
LV Failure-Pulm Edema
Pul Embolism
Pneumothorax
Foreign Body
Hyperventilation
Pneumonia(hrs to days)

Question 5

What is the definition of Hyperventilation?

Answer 5

Decreased pCO2 on ABG

not the same as tachypnia

Question 6

What are causes of Gradual onset Dyspnia?

Answer 6

COPD
Interstitial lung disease (many causes)
Pneumoconoisis
Chronic or recurrent pulm. embolism
Deconditioning
Neuromuscular disease
Chronic CHF

Question 7

What is Wheezing?

Answer 7

High Pitched sounds, insp or exp
Airflow obstruction due to airway narrowing or secretions
Volume not indicative of severity
Persistant Localized wheezing needs to be explored

Question 8

What is pleuritic chest pin?

Answer 8

Sharp stabbing pain(localized)

• aggrivated by deep breath
• doesn’t cross midline

Question 9

How is cough classified?

Answer 9

Acute 8 weeks

Question 10

What needs to be ruled out in chronic cough?

Answer 10

ACEI Induced Cough (RULE OUT FIRST)
Upper airway cough syndrome
Asthma
GERD

Question 11

What are the steps of the Physical exam of the Pulmonary System?

Answer 11

Initial Observation
inspection
palpation
percussion
auscultation of lungs and heart

exam of extra-thoracic sites including neck, upper ext, lower ext, abdomen