Quiz 6: Pulm_1 Flashcards
If your pt has a cough, what are the different body systems that could be responsible?
Resp, GI (GERD), Renal (CRF), musculoskeletal (herpes zoster), cardiovascular (CHF), CNS (anxiety), endocrine (DM)
If a pt comes to you with respiratory symptoms, what two questions would you be sure to ask in your ROS?
Do you have a cough?
Do you have any difficulty breathing (dyspnea)?
What are other questions you would ask in your ROS of a pt with respiratory symptoms?
- Any concomitant symptoms
- Environmental exposures
- FHx (heredity conditions, shared exposures)
When asking about environmental exposures, what specific types of exposures are you concerned about?
Occupation, household chemicals, recent travel, areas of pollution, smoking, pets, hobbies, sleep environment, type of pillows, bedding, humidifier, heating (electric cleanest)
What are some common causes of coughs?
URI, Lung infx, GERD, 2nd hand smoke, Cystic fibrosis, Anxiety, Asthma, COPD, lung dz, smoking, air pollution, aspiration, CHF, chronic idiopathic cough
What are some questions you would ask in your Hx to investigate a cough?
- Duration
- Sudden or gradual
- What factors affect it
- Sputum (amount, color, quality)
What conditions are sometimes associated with clear sputum?
Allergy, COPD
What conditions are sometimes associated with yellow sputum?
Infection (live neutrophils)
Acute bronchitis, acute pneumonia
What conditions are sometimes associated with green sputum?
Chronic infection (dead neutrophils) Chronic bronchitis, pneumonia, bronchiectasis, CF
What conditions are sometimes associated with brown/black/rust sputum?
“old blood”
Chronic bronchitis, chronic pneumonia, TB, lung CA
What is hemoptysis?
What would you want to clarify regarding hemoptysis?
Expectoration of blood
Source (upper resp, lower resp, GI)
What are some causes of hemoptysis?
Bronchogenic carcinoma (may be frothy), Airway trauma, Lung parenchymal infection (TB {streaks of blood}, pneumonia, abscess), Pulmonary embolism (bright red), Esophageal varices
What is the most common type of dyspnea?
Shortness of breath (SOB) on exertion
What are the six clinical types of dyspnea? Which is most common?
Physiologic, pulmonary, cardiac, chemical, neuromuscular, psychological
Physiologic most common
What are causes of physiologic dyspnea?
Exertion at high altitude
What are the four subtypes of pulmonary dyspnea?
Restrictive, obstructive, infectious, non-infectious
What is the overall problem in restrictive pulmonary dyspnea? What are some causes?
Overall = Low compliance of lungs (worse on exertion) Causes = Pulmonary fibrosis, chest deformities (eg pectus excavatum), scoliosis, broken ribs, obesity
What is the overall problem in obstructive pulmonary dyspnea? What are some causes?
Overall = Increased resistance to airflow, esp. with expiration Causes = Asthma, upper airway edema due to allergies, infection, cystic fibrosis, COPD (emphesema, chronic bronchitis)
What are causes of infectious pulmonary dyspnea?
Pneumonia, severe acute respiratory syndrome (SARS)
What are causes of non-infectious pulmonary dyspnea?
Lung cancer, sarcoidosis, pleural effusion, pneumothorax, pneumoconiosis, atelectasis
What are causes of cardiac pulmonary dyspnea?
CHF, cardiogenic pulmonary edema, cardiomyopathy, pericardial effusion, cardiac asthma (acute resp. insufficiency caused by L ventricular failure with bronchospasm, wheezing and hyperventilation)
What is Cheyne Stokes breathing? What type of pulmonary dyspnea is this a sign of?
Alternating periods of apnea and hyperpnea (gradually increasing depth and frequency of respiration)
Sign of cardiac pulm dysp
What is Orthopnea? What type of pulmonary dyspnea is this a sign of?
Respiratory problems while supine (Left ventricular failure)
Sign of cardiac pulm dysp
What is Paroxysmal Nocturnal Dyspnea (PND)? What type of pulmonary dyspnea is this a sign of?
Pt awakens gasping for breath and must sit or stand up (eg mitral stenosis, aortic insufficiency, HTN)
Sign of cardiac pulm dysp
What type of pulmonary dyspnea is this a sign of?
Sign of cardiac pulm dysp
What type of pulmonary dyspnea is this a sign of?
Sign of cardiac pulm dysp
What is chemical dyspnea? What are some causes?
Acidosis may result in slow, very deep gasping respirations ie “Kussmaul breathing” (trying to blow off CO2 to compensate for acidosis).
Diabetes (DKA), chronic anemia, pregnancy, renal failure
What are causes of neuromuscular dyspnea?
MS, ALS, myasthenia gravis, Guillain Barré Syndrome
Name two psychological conditions that can produce dyspnea.
Anxiety, panic attacks
What types of symptoms are experienced with cardiac chest pain (angina, MI)?
Usually 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.
What symptoms are experienced with pulmonary chest pain? What are some conditions that produce this?
Localized, sharp and knifelike; worse breathing or coughing (pleural pain)
Pleurisy, pneumonia, TB, cancer, atelectasis, thromboembolism, pleural effusion, histoplasmosis, pneumothorax
What symptoms are experienced with chest pain that originate in the GI system? What are some triggers?
May be sharp, burning, squeezing, or heavy; affected by swallowing (spasm), large meals, certain foods, body position, GERD
What symptoms are experienced with chest pain that is musculoskeletal/cutaneous in nature?
Costochrondritis, fractured rib (history of fall)–(pain will be elicited by palpation exam), herpes zoster (prodromal sx, then vesicles erupt along dermatome)
How do symptoms in the CNS relate to chest pain?
Anxiety/panic attack may create pain simulating MI or reflux.
What are the required parts of the physical exam?
Inspection
Palpation
Percussion
Auscultation
What are the neccessary parts of the physical exam INSPECTION?
RR, Sn of resp. distress, chest configuration, coloration, etc
What are the neccessary parts of the physical exam PALPATION?
Assess area of pain, chest expansion, tactile fremitis
What are the necessary parts of the physical exam PERCUSSION?
Listen and feel for intensity, pitch and duration of note produced (Resonant, flat, dull, hyperresonant, tympanic)
Assess Diaphragmatic Excursion
What is assessed during the AUSCULATION part of the physical exam?
Change in breath sounds (absent, decreased, bronchial breathing)
Adventitious (superimposed) lung sounds (crackles, rhonchi)
Pleural sounds (loud creak or grating sound like leather chair, friction rub, pleural fluid decreased or absent; usually due to inflammation of pleura; On both I and E.
What are the normal sounds heard during auscultation?
Vesicular - soft, low pitch, normal w most lung fields; inspiration longer than expiration I>E
Bronchial – loud, moderately high pitched. Heard over central bronchus. I=E
Bronchovesicular - medium intensity and pitch, normal over main-stem bronchi
Tracheal - loud, high in pitch, normally heard over trachea, E>I (not performed)
What are the three voice transmission tests? Why are they done?
Bronchophony (vocal fremitus) “99” (louder, clear if abnorm)
Whispered Pectoriloquy “1,2,3” (clearly heard is abnorm)
Egophony “ee” (E to A if abnormal)
All these tests become abnormal with lung consolidation
What lab tests might you order?
CBC – for infection, allergies etc.
CMP – electrolytes, glucose, lipids; liver enzymes
Sputum cultures
Arterial Blood Gases (pH, PaO2, PaCO2, HCO 3-)
TB testing—Quantiferon, Mantoux (older)
How would you use a peak flow meter? What does this value roughly correlate with?
- Ask the patient to take a deep breath.
- Then ask them to pinch nose and blow as hard as they can thru the peak flow meter.
- Repeat the measurement 3 times and report the highest reading
Roughly correlates with the FEV1.
What is pulse oximetry? What is the normal range for this test?
Non-invasive test of oxygen saturation in arterial blood. Portable, fingertip sensor uses photodiode. Normal saturation range is 95-99%
Why would you order pulmonary function tests (spirometry)?
Order to determine the presence of obstructive and restrictive diseases (also done routinely pre-surgical/pre-anesthesia in elderly, smokers, etc)
What do pulmonary function tests assess?
- How much air volume is moved
- How fast the air in the lungs can be moved
- Lung and chest wall compliance
- How the lungs respond to chest physical therapy procedures or bronchodilator tx
