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CPD I > Pulmonary I > Flashcards

Pulmonary I Flashcards

1
Q

What are the five common presenting symptoms of pulmonary issues?

A
  1. Cough
  2. Sputum
  3. Hemoptysis
  4. Dyspnea
  5. Chest pain
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2
Q

What are four important questions to ask in the hx?

A
  1. Which “system” is source of sxs?
    (Respiratory, Cardiovascular, GI, Renal, MS, CNS, Endocrine)
  2. What are the concomitant sxs?
  3. What are the environmental exposures? (occupation, house, travel, bedroom)
  4. Family hx of dz? (e.g. atopic triad)
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3
Q

What are important questions to ask about a cough?

A
  1. Duration (acute 8 weeks)
  2. What factors affect it? (cold air, eating, exercise, etc.)
  3. Sputum production (amount, quality, color)
  4. Concomitant sxs
  5. Patterns (posture change, happens when eating, AM/PM)
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4
Q

What are the typical colors of sputum and what do they infer?

A
  1. Clear - allergy, COPD
  2. Yellow - infection (acute bronchitis or pneumonia)
  3. Green - chronic infection
  4. Brown/black/rust - “old blood” (chronic dz, TB, lung cancer)
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5
Q

Besides sputum color, what other two characteristics should one ask about?

A

Quantity - scant or profuse

Quality - thin, stringy, thick

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6
Q

What is the first thing to do when presented with hemoptysis?

A

Determine source: upper or lower respiratory, upper GI

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7
Q

What are the 6 types of dyspnea?

A

Physiologic, pulmonary, cardiac, chemical, neuromuscular, and psychological conditions

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8
Q

In pulmonary dyspnea, what are the 4 categories?

A
  1. Restrictive - low compliance of the lungs
  2. Obstructive - increased resistance to airflow
  3. Infectious
  4. Non-infectious
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9
Q

What are three signs that dyspnea has a cardiac origin?

A
  1. Cheyne-Stokes respiration - alternating periods of apnea and hyperpnea
  2. Orthopnea - respiratory problems while supine (left ventricular heart failure)
  3. Paroxysmal nocturnal dyspnea (PND) - pt awakes gasping for breath and must sit or stand up
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10
Q

What are the 5 types of chest pain?

A

Cardiac, pulmonary, GI, MS/skin, CNS

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11
Q

What are the characteristics of cardiac chest pain?

A

Crushing, pressing or squeezing, generally aggravated by exertion, cold weather, stress, and after meals. May radiate to neck, jaw or arm. Nausea and diaphoresis are common classic concomitants to MI

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12
Q

What are the characteristics of pulmonary chest pain?

A

localized, sharp and knifelike; worse breathing or coughing

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13
Q

What are the characteristics of GI chest pain?

A

May be sharp, burning, squeezing, or heavy; affected by swallowing large meals, certain foods, body position, GERD

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14
Q

What are the characteristics of MS/skin chest pain?

A

Pain will be elicited or noticed by PE

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15
Q

What are the 4 steps for a PE of the pulmonary system?

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
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16
Q

During the PE, what are important landmarks?

A

Ventral - 6th rib
Dorsal - 10th (expiration level) and 12th rib (inspiration level)
Oblique - 8th rib

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17
Q

What do you assess during the inspection stage of a PE?

A 
Effort of breathing (tripod position)
RR
Asymmetry of chest
Splinting
Trachea midline?
Skin color
Nails/toes for presence of clubbing
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18
Q

During palpation of the PE, what are you assessing?

A

If pt complains of chest pain, palpate location
Chest expansion posteriorly and anteriorly
Tactile fremitus posteriorly and anteriorly

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19
Q

When you are percussing the lungs, what are you listening for?

A
  1. Resonance - normal
  2. Flat - soft, short duration, like over thigh
  3. Dull - like over liver, thickening
  4. Hyperresonant - like over cheek, suggests trapped air
  5. Tympanic - like over stomach
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20
Q

When auscultating the lungs, what are the two types of sounds you listen for?

A
  1. Bronchiovesicular - near main bronchi

2. Vesicular - rest of the lungs

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21
Q

What are some changes in breath sounds that one might find during auscultation?

A

Absent breath sounds
Decreased lung sounds
Bronchial breathing

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22
Q

What are the adventitious lung sounds?

A

Crackles - popping sounds during inspiration, do not clear during cough
Ronchi - “snoring” or “gurgling” quality caused by secretions that are obstructing large bronchi
Wheezes - high pitched, whistling sounds caused by a narrowing or obstruction of small bronchi.
Pleural sounds - friction rub on the pleura. Sounds like sitting on a leather couch.

23
Q

What are the three voice transmission tests?

A
  1. Bronchophony - “99”
  2. Whispered Pectoriloquy - pt whispers “1, 2, 3”
  3. Egophony - “ee to ay”
24
Q

Pulmonary function tests (PFT) tell you what?

A

Obstructive or restrictive air flow

25
Q

What is the 3rd leading cause of death in the U.S.?

A

COPD

26
Q

What are risk factors assoc. with the development of COPD?

A

Tobacco smoking, air pollution, second-hand smoke, hx of childhood respiratory infections, occupational exposure, asthma

27
Q

What are the S/Sx of COPD?

A

Dyspnea, chronic productive cough, wheezing, barrel chest, use of accessory muscles, hyperresonance, cyanosis, nail clubbing, peripheral edema

28
Q

What is the diagnostic work-up for COPD?

A

Pulmonary Function Tests
CBC
Pulse oximetry
Forced expiratory time (FET) > 6sec - indicates considerable expiratory flow obstruction

29
Q

What are the two primary forms of COPD?

A

Emphysema and Chronic bronchitis

30
Q

Emphysema can be genetic. What is the missing enzyme?

A

Alpha-1-antitrypsin (AAT). Will see a family hx of the dz.

31
Q

What is the key S/Sx of emphysema?

A

Dyspnea

32
Q

Upon PE of a emphysema pt, what would you see?

A

Barrel chest, cachexia, purse-lipped breathing, hyperresonance on percussion, decreased diaphragmatic excursion, decreased breath sounds, no peripheral edema, PMI deviated towards sternum

33
Q

At what ages do we generally see chronic bronchitis develop?

A

In late 30s and 40s

34
Q

What are the primary S/Sx of chronic bronchitis?

A

Cyanosis, chronic productive cough, cough worse in AM

35
Q

What do you see in the PE of a chronic bronchitis pt that would differentiate them from an emphysema pt?

A

Early crackles upon inspiration, pt is often overweight, right-sided heart problems (JVP)

36
Q

In late-stage COPD, what concomitants do we begin to see?

A

Hypoxemia, pneumonia, pulmonary hypertension, cor pulmonale, respiratory failure

37
Q

What are some DDx for COPD?

A

Central airway stenosis, bronchiectasis, heart failure, cystic fibrosis (in the young), constrictive bronchiolitis

38
Q

What is the key difference between asthma and other COPD dz’s?

A

The narrowing of the airways in asthma is REVERSIBLE

39
Q

What are the three major features of asthma?

A
  1. Airway obstruction that is episodic and reversible.
  2. Inflammation of the bronchial tubes
  3. Airway irritability from triggers
40
Q

What are the S/Sx of asthma?

A

Cough (esp. with exercise), episodic wheezing, SOB, chest tightness

41
Q

During the PE of an asthmatic, what do you see?

A

Signs of respiratory distress, inc. RR and HR, pulsus paradoxus, wheezing with auscultation, possibly visualize polyps in the turbinates of the nose, eczema, allergies

42
Q

What are some ominous clinical signs of an asthma attack?

A

Inability to speak, drink. May be experiencing status asthmaticus if routine bronchodilators are unresponsive.

43
Q

What are some other tests that one would perform for an asthma pt?

A

Allergy skin testing
24-hr gastric pH to monitor for GERD
Pulmonary function testing

44
Q

What are some DDx of asthma?

A

Vocal cord paralysis, angioedema, aspiration, COPD, bronchiectasis

45
Q

In bronchiectasis, what is the epidemiologic spread?

A

Women >50y/o

46
Q

What are some etiologic explanations of bronchiectasis?

A

Congenital bronchial obstruction, immunodeficiency, infections, IBD

47
Q

What are the S/Sx of bronchiectasis?

A

Chronic, daily, productive cough; hemopytsis; dyspnea; rhinosinusitis; chronic fatigue; reduced sense of smell and urinary incontinence

48
Q

Upon PE, what would one note in a bronchiectasis pt?

A

Fever, weight loss, crackles bilaterally, nasal polyps; mostly nonspecific

49
Q

What is the key dx tool for bronchietasis?

A

Chest HRCT

50
Q

What are the S/Sx of cystic fibrosis?

A

Sx at birth often, but can develop later
Persistent, productive cough with sputum, barrel chest, Obstructive findings on PFT, chronic infections. Is a multi-organ dz.

51
Q

What are PE findings one sees in a cystic fibrosis pt?

A

Rhinitis, tachypnea, cyanosis, cough, abdominal distention, hepatosplenomegaly, dry skin, cheilosis, kyphosis

52
Q

How would you dx a pt you suspect has cystic fibrosis?

A

IRT blood test, sweat chloride test, genetic screening, stool analysis for steatorrhea

53
Q

What is the median survival rate of a pt with cystic fibrosis?

A

37.4 years

54
Q

What are the tx goals of cystic fibrosis?

A

Focus on respiratory and digestive components of dz. Drainage of lung secretions
High calorie, high-protein diet, fat soluble vitamin supplementation
Supplement with N-acetylcysteine and pancreatic enzymes

CPD I (7 decks)

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