Pulmonary History Lecture Flashcards
4 cardinal symptoms of pulmonary disease
Chest pain
Dyspnea
Cough
Audible respiratory sounds
Levine sign
Closed fist over chest
Indicates cardiac problem
If a patient points at their chest pain with one finger what does this indicate?
Musculoskeletal problem
If a patient points at their chest pain with open hand moving from chest to epigastrum what does this indicate?
GI problem
What is lung pain?
- Either irritation of pleura
- Muscle pain from coughing
- Lungs have no pain fibers!
How is cardiac pain described?
Crushing, squeezing, pressure
Cardiac chest pain is a/w:
SOB
Diaphoresis
Radiation to left arm, neck, jaw
6 dermatome pain
- Cardiac pain radiated to the left arm
- Can be a/w NV, syncope, palpitations, hypotension
Coronary insufficiency
Myocardial ischemia
Chest pain of coronary insufficiency
- Often triggered by exertion/stress
- Can occur following large meal
- Myocardial demand increases, coronaries can’t meet demand –> chest pain
Pericardial chest pain
- Steady substernal pain worsened by breathing, swallowing, hiccuping, lying recumbent
- Has elements of cardiac & pleuritic pain
- Pain is improved by sitting or leaning forward
Pleuritic chest pain
- Sharp
- Inspiration
- Shallow breathing bc of pain
- May be d/t pleurisy (inflammation vs. infection)
- A/w sudden coughing
Sudden onset of sharp chest pain esp w/hx of trauma:
- Rib fracture
- PTX
- No trauma (costochondritis, herpes zoster)
Esophageal or GI related chest pain
- Burning
- A/w meals
- Relieved by antacids or H2 antagonists
- Ulcers, gastritis, GERD
Dyspnea
- “Air hunger”
- Need circumstances: at rest? with exertion and how much exertion?
Associated symptoms of dyspnea
Swelling of ankles Cough Wt loss Wheezing Cyanosis
Paroxysmal nocturnal dyspnea (PND)
Air hunger that awakens pt from sleep
“Run to the window for air”
Cardiac PND
Dry non-productive cough
Pulmonary PND
Productive cough w/improvement on expectoration
Sudden onset of dyspnea could indicate:
PE or PTX
Seasonal or situational dyspnea could indicate:
Allergy/asthma
Occupational exposure to irritants
MC causes of coughing
URI
Smoking
Causes of chronic cough:
Tobacco related chronic bronchitis
Post nasal drip
Occult asthma
GERD
How to calculate pack years
of packs per day multiplied by # of years
What drugs can cause chronic dry cough?
ACE Inhibitors
Beta blockers
Types of sputum
Clear/mucoid
Purulent
Putrid
Rusty/blood stained
Clear and mucoid sputum indicates:
Inhaled irritant (not infected)
Purulent sputum indicates:
Infection like PNA, bacterial bronchitis
Putrid sputum indicates
Anaerobic process - lung abscess, bronchiectasis
If hemoptysis is present, rule out:
- Aspirated blood from epistaxis, UGI bleed
- Overlooked oral or gingival lesion
What is the MC cause of hemoptysis in the US?
Acute bronchitis
Non pulmonary sources of cough:
Heart disease
GERD
ENT disorders
Neurologic disease
Stridor is usually the hallmark of:
Large airway (trachea, bronchus) obstruction
