Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2. HDS Pulmonary > Pulmonary Signs and Symptoms > Flashcards

Pulmonary Signs and Symptoms Flashcards

1
Q

Dyspnea

Definition

A

A subjective sensation of breathlessness, air hunger, or shortness of breath.

Not a physical exam finding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dyspnea

Associated Findings

A
  • Tachypnea
  • Labored breathing
  • High minute ventilation
  • No physical signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dyspnea

Physiological Causes

A
  • ↑ Ventilatory requirement
    • Exercise, hypoxia, metabolic acidosis
  • ↑ Airway resistance
    • COPD, asthma, upper airway obstruction
  • ↓ Lung compliance
    • Interstitial lung disease, pulmonary fibrosis
  • ↓ Chest wall compliance
    • Kyphoscoliosis
  • Psychogenic dyspnea
    • “Hyperventilation syndrome”
      • Low CO2 causes sensation that you need to breathe faster
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dyspnea

History

A
  • Duration of sx
    • Chronic vs acute
  • Rate of onset
    • Acute (mins-hrs), subacute (days-weeks), chronic (months-yrs)
  • Exposures
    • Smoking, occupational, environmental
      • Organic dust ⇒ allergic alveolitis
      • Inorganic dust ⇒ pulmonary fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute Dyspnea

Causes

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Subacute Dyspnea

Causes

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chronic Dyspnea

Causes

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Exertional Dyspnea

Causes

A
  • Obstructive lung disease
    • Exertion → ↑ RR → ↓ expiratory time
    • Obstruction → ↓ expiratory flow
    • Trapped air exerts pressure on lungs
  • Interstitial lung disease
    • Exertion → ↑ HR
    • ↓ Time for O2 to diffuse across diseased alveolar-capillary membrane
  • Exercise-induced asthma
  • CHF
  • Peripheral vascular disease
    • Anaerobic threshold sooner → ↑ CO2 → dyspnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Exertional Dyspnea

History

A
  • Quantify amount of exertion → distance
  • Rate of decline
  • Severity
  • Timing/duration of sx
    • During or after exercise
  • Associated symptoms
    • CP, cough, edema
  • Effect of position change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Orthopnea

Definition

A

Dyspnea in a recumbent position which is relieved by sitting up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Orthopnea

Causes

A
  • CHF
    • More fluid into the lungs
  • COPD
    • Diaphragm works better when sitting up
  • Diaphragm weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Paroxysmal Nocturnal Dyspnea

Definition

A

Episodic dyspnea that awakens patient from sleep.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PND

Causes

A
  • CHF
    • Shift of fluid from BLE ⇒ ↑ venous return to the heart ⇒ ↑ fluid in lungs
  • COPD
    • Diaphragm works better upright
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Platypnea

Definition

A

Dyspnea in the upright position which is relieved in a recumbent position.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Orthodeoxyplatypnea

A

Platypnea associated with positional hypoxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Platypnea

Causes

A
  • Right-to-left shunt
    • Usually at the lung base
    • Sitting up pulls more blood into the lower lung
  • Liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Trepopnea

Definition

A

Dyspnea in one lateral position but not the other.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Trepopnea

Causes

A

Seen in unilateral lung disease.

Ex. PNA

Good lung down ⇒ gravity improves ventilation and perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cough

Definition

A

Reflex initiated by stimulation of irritant airway receptors to expel secretions and irritants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cough

Mechanism

A
  1. Initial inspiration
  2. Occlude glottis with vocal cord closure
  3. Contraction of expiratory muscles against a closed glottis
  4. Rapid opening of glottis with release of air under pressure
21
Q

Cough

History

A
  • Smoking hx
  • Duration/onset of cough
    • Acute ⇒ < 3 weeks
    • Subacute ⇒ 3-8 weeks
    • Chronic ⇒ > 8 weeks
  • Position/time of day
    • Recumbent cough ⇒ post-nasal drip, CHF, GERD
  • Presence/quality of sputum
22
Q

Sputum

Qualifications

A
  • Dry cough
    • Viral URI, asthma, GERD, post-nasal drip
  • Clear frothy sputum ⇒ normal saliva
  • Pink frothy sputum ⇒ pulmonary edema
  • Mucoid sputum
    • Lower airway secretions, chronic bronchitis, asthma
  • Purulent sputum
    • Infection ⇒ PNA, bronchitis, bronchiectasis
23
Q

Acute Cough

Causes

A
24
Q

Subacute Cough

Causes

A
25
Q

Chronic Cough

Causes

A
26
Q

Chronic Cough

Management

A

CXR ⇒ r/o serious pathology

History and physical may guide approach:

  • Smoker
    • CXR, PFT, smoking cessation
  • Post-nasal drip
    • Trial antihistamine/decongestant, allergy testing, sinus CT
  • Reflux or cough worse with meals/recumbency
    • Trial H2 blocker or PPI, 24 hour pH probe
  • Wheezy dry cough precipitated by asthma triggers
    • PFT, bronchodilator trial, methacholine challenge
  • Prolonged cough following URI
    • Trial bronchodilator ± inhaled steroid
  • History of ACEi or β-blocker
    • Trial of drug cessation
27
Q

Hemoptysis

Definition

A

Expectoration of blood.

28
Q

Hemoptysis

Look Alikes

A
  • Epistaxis ⇒ blood in nares and/or nasopharynx
    • Blood may be inhaled then expectorated
  • Hematemesis ⇒ vomiting blood
    • Acidic pH
    • Food particles
    • Dark blood
    • Epigastric complaints
29
Q

Hemoptysis

History

A
  • Bright red and frothy sputum
  • Associated cough
  • Alkaline pH
  • Contains alveolar macrophages
  • Pt can often ID source and location
30
Q

Hemoptysis

Causes

A
  • Common
    • Infectious
      • TB, PNA, bronchitis, abscess
    • Bronchogenic cancer
    • PE with infarction
    • Bronchiectasis
  • Unusual
    • Occupational exposures
      • Trimellite anhydride ⇒ heated metal surfaces sprayed with epoxy paints
      • Isocyanates
    • Catamenial hemoptysis ⇒ pulmonary endometriosis
      • Pieces of endometrium ends up in the lungs
      • Undergoes cyclical bleeding similar to uterus
    • Free base cocaine
    • Vasculitis
    • Trauma
31
Q

Bronchiectasis

Definition

A

Abnormal dilation of bronchi with destruction of elastic/muscular components of the bronchial wall.

32
Q

Hemoptysis

Management

A
  • Quantify hemoptysis
    • Massive hemoptysis: > 600 ml/24 hrs
      • Position bleeding side down
        • May worsen bleeding but protects good lung
  • CBC, platelets, PT/PTT
  • Urinalysis ⇒ check for RBC/casts
  • Start codeine 15-30 mg q4h ⇒ suppress cough
  • CXR
  • Sputum culture and sensitivity
    • AFB (Acid fast bacillus) ⇒ check for TB
      • Isolation if suspected
  • Start broad spectrum abx
  • Avoid chest percussion
33
Q

Hemoptysis

Evaluation

A
  • Acute management
  • Bronchoscopy ⇒ localize bleeding
  • Vasculitis work-up if suspected
    • Collagen vascular panel
    • ANCA (Anti-neutrophil cytoplasmic autoantibody)
34
Q

Pleuritic Chest Pain

Definition

A

Sharp knife-like chest pain associated with coughing or breathing.

35
Q

Pleuritic CP

Mechanism

A
  • Stimulation of pain fibers in parietal pleura
    • Visceral pleura and lungs have no pain fibers
  • Caused by inflammation or trauma involving any thoracic structure affected by respiratory movement
    • Ribs, cartilage, muscles, nerves, pleura, pericardium
36
Q

Pleuritic CP

History

A
  • Duration and onset
  • Severity
  • Location
  • Associated sx
    • Fever, SOB, hemoptysis
  • Smoking hx
37
Q

Pleuritic CP

Causes

A
  • Infection
    • Associated w/ fever, cough, purulent sputum
  • Pulmonary infarction
    • Acute-onset, dyspnea, hemoptysis
  • Pleurisy ⇒ viral infection of the pleura
    • Acute-onset, often with other viral sx
  • Malignancy
    • Usually subacute or chronic
  • Pleuritis ⇒ associated with collagen vascular disease
  • Pneumothorax ⇒ collapse of lung d/t air in the pleural space
    • Acute-onset, dyspnea, ↓ breath sounds with hyperinflation of affected side
  • MSK pain
    • Mostly acute-onset
    • Rib fx, costochondritis, myositis, nerve pain
38
Q

Pleuritic CP

Evaluation

A
  • CXR / rib films
  • Cultures and viral serologic studies
  • Collagen vascular disease work-up
  • Possible work-up for PE
39
Q

Wheezing

Definition

A

Continuous adventitous breath sounds.

  • Vibration of air through narrowed airways
  • Most prominent during expiration
40
Q

Wheezing

Characteristics

A
  • Pitch
    • High pitch ⇒ stiff, narrow obstruction
    • Low pitch ⇒ large, floppy airways
  • Complexity ⇒ monophonic vs polyphonic
  • Duration ⇒ short vs long
  • Timing ⇒ inspiratory vs expiratory
41
Q

Wheezing

History

A
  • Smoking hx
  • Duration and onset
  • Triggers / exposures
  • Severity
  • Location
    • Focal or diffuse
    • Upper airway
42
Q

Wheezing

Causes

A
  • Asthma
  • COPD
  • Fixed airway obstruction
    • FB aspiration
    • Upper airway obstruction or tumor
  • CHF
    • “Cardiac asthma” ⇒ caused by edema of the airways
  • Acute inhalation of irritant gas
  • “Laryngeal asthma” ⇒ paradoxical motion of the vocal cords
43
Q

Wheezing

Evaluation

A
  • Complete hx
  • CXR
  • PFTs
  • Evaluation for CHF
44
Q

Stridor

Definition

A

Loud continuous inspiratory breath sounds.

  • Often heard without a stethoscope
  • Usually loudest in the neck
45
Q

Stridor

Causes

A

Usually a sign of an extra-thoracic upper airway obstruction:

  • Goiter
  • Vocal cord polyp
  • Upper airway tumor
  • Croup
46
Q

Clubbing

Definition

A

Painless bulbous enlargement of the distal fingers ± toes, with softening of the nail bed.

47
Q

Clubbing

Diagnosis

A
  • Check nail bed for sponginess
    • Occurs before loss of angle
  • Evaluate angle between nail and adjacent dorsal surface of the distal phalynx
    • Normal angle ⇒ diamond space between thumbs
48
Q

Clubbing

Pulmonary Etiologies

A
  • Lung cancer
  • Chronic infection
    • TB, bronchiectasis, lung abscess
  • Idiopathic pulmonary fibrosis
  • Cystic fibrosis
  • Alveolar proteinosis

***COPD does not cause clubbing, must look for other causes in a smoker.

2. HDS Pulmonary (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions