Pulmonary Podcast

Question 1

Pack years

Answer 1

packs/day times years smoked

Risk factor for emphysema, chronic broncihtis, and lung cancer

Question 2

Occupational exposures

Answer 2

Asbestos - old insulation, ship workers, auto mechanics

Adult onset asthma - Baker’s

Slica and coal dust as well

Question 3

Dyspnea

Answer 3

Disconnect between expect amount of breathing and system output

Hypercarbia

Exertion should worsen…pts will also accomodate to chronic states

Question 4

Resp distress

Answer 4

Sensorium
Diaphoresis
Posture - should be upright if able…don’t place supine until ready to intubate
Acc muscle use
Paradoxial abdominal motion - chest goes out and abdomen in with inspiration…indicates diaphragmatic problem

Question 5

Insp and exp acc muscles

Answer 5

Insp - scalene, SCM, trap, intercostals

Exp - abdominal

Question 6

Hoover’s sign

Answer 6

Inf chest pulled inward with insp…indicates hyperexpansion

Question 7

Tactile fremitus

Answer 7

Inc - pneumonia
Dec- penumothroax

Pleural effusion and atelectasis have reduced fremitus despite dullness

Question 8

Percussion

Answer 8

Dull note - pleural fluid, consolidation,. collapse

Hyperresonant - hyperexp, or pneumothroax

Question 9

Breaht sounds

Answer 9

Wheezes - narrowed small airways
Rhonchi - fluid in large airways

Fine crackles - opening of alveolar structures - interstitial fibrosis

Coarse crackles - fluid in small airways - pneumonia

Question 10

Consolidation findings

Answer 10

Bronchophony
Egophony
Whispered pectoriloquey

Question 11

Dxx of unilateral dullness to percussion

Answer 11

If shift toward the dull side…look for atelectasis or pneumothorax (dull side normal) or pnuemonia

If tracheal shift away from dull side…think atelectasis or pneumothorax

If no tracheal shift - look for consolidation signs or dec breaht sounds

If trachealshift away from dull side - think pleural effusion