Respiratory 2 Flashcards
What is the MC presenting complaint of emphysema?
Dyspnea (cough rare)
Compare and contrast the physical exam findings of chronic bronchitis and emphysema
Tactile fremitus: normal with chronic bronchitis, descreased with emphysema
Percussion: resonant with CB, hyperresonant with E
Breath sounds: normal with CB (may have prolonged expiration, wheeze, or crackles), decreased/absent with E
Asthma is a key ddx for COPD. How can you tell the difference?
Onset: COPD in mid-life, asthma in early life
Symptom progression: COPD slowly progressive, Asthma varies day-to-day but worse at night/early morning
History: COPD smoker, Asthma allergy/rhinitis/eczema
Airflow limitation: irreversible in COPD, reversible in asthma
Name 9 common asthma triggers
Allergens Viruses Air pollution Foods/additives Drugs Occupational factors Emotional stress Cold air Exercise
True or false: inflammation associated with asthma is episodic
False - asthma attacks are episodic but airway inflammation in chronically present
What are the typical spirometry findings associated with asthma?
FVC is normal but FEV1 is reduced
DDX for URTI
Viral rhinitis
Sinusitis
What 6 viruses are associated with the “common cold”? Which is MC?
MC: Rhinovirus Coronaviruses Influenza C Parainfluenza virus Adenoviruses RSV
How long is the incubation period of the common cold?
2-4days
True or false: fever is a common feature of the common cold
Flase
Which OTC supplement has been shown to reduce the duration of subjective symptoms of the common cold?
Zinc lozenges
2 MC causative organisms of sinusitis
H. Influenzae
Strep pneumoniae
What are the 3 types of sinusitis?
Maxillary
Frontal
Ethmoid
What are 2 key history features of sinusitis
Yellow-green purulent discharge
Bending over makes symptoms worse
How can you check for sinusitis in the physical exam?
Transillumination
For how long is an individual contageous with influenza?
24 hours before to 7 days after symptoms began
S&S of influenza
High Fever (up to 104F)/chills 2-5d Marked fatigue Muscle aching - Malaise especially in back and legs Headache Dry cough Sore throat Headaches Children may have vomiting or diarrhea
What is a possible complication of influenza which is suspected if fever, cough, and respiratory symptoms last for >5d?
Bacterial infection
4 at-risk populations for severe disease
- Chronic pulmonary diseases
- Heart disease
- Prenant women in 3rd trimester
- Elderly/young/bed-ridden
What 2 medications can help shorted the duration of influenza and may be prescribed in at-risk popualtions?
Zanamivir
Tamiflu
True or false: headache is a common feature of the common cold but uncommon with the flu
False - other way around
S&S of pneumonia
fever/chills, green mucous, shortness of breath, (sharp/plueritic) chest pain, headache, crackling, dullness to percussion, enhanced voice sounds on ausculation, egophony, whispered pectroiloquy
MC causative organism of bacterial pneumonia
S. Pneumonia
MC causative organism of bacterial pneumonia in children
H. influenza
Which causative organism tends to cause a more aggressive form of bacterial pneumonia and is associated with destructive changes in the lungs and rapid onset
Klebsiella pneumonia
K = Kill - higher mortality especially in <1yr and >60yo
What is a key clinical feature of K. pneumoniae-associated pneumoniae?
Thick blood-tinged sputum sometimes called currant jelly sputum
S&S of atypical pneumoniae
Constitutional symptoms (not respiratory)
Fever, malaise, HA
Non-productive cough
No findings of consolidation
MC causative organism of atypical pneumonia
Mycoplasma pneumonia
What is a key clinical feature of atypical pneumonia?
Maculopapular rash (may be diagnostic)
What is the CURB-65? What are the 6 criteria?
Prognositc tool to assess whether or no to hospitalize patients with CAP. 1. Confusion 2. BUN >19mg/dL 3. RR >30bpm 4. SBP <90mmHg 5. DBP <60mmHg Age >65yo
What CRB-65 score would indicate an individual should be hospitalized?
> 1 = should consider hospitalization
3 or 4 = urgent hospitalization
S&S TB
su asymptomatic
- primary symptom: chronic productive cough
- fever w/ night sweats
- anorexia/weight loss
- malaise, fatigue
- cough, hemoptysis
- dyspnea, pleuritic chest pain w/ inspiration
- calcification
- positive sputum culture
What is TB of the spine called?
Potts disease
3 causes of venous thrombi
- Venous stasis (immobilization)
- Endothelial damage to veins (trauma/infection)
- Hypercoagulation (genetic, physiologic, pharmacologic)
3 MC locations of thrombi?
Calf
Thigh
Pelvis
Describe the pathogenesis of pulmonary embolism
- Embolus dislodges from thrombus
- Once in lung, clot releases vasoactive substances producing vasoconstruction & bronchoconstriction
- Decreased surfactant produced –> atelectasis
- Increased pulmonary resistance leads to right-sided heart failure
s/s of pulmonary embolism
chest pain, wheezing, pain/swelling in one or both legs, shortness of breath, cough/anxiety
How are pulmonary embolisms treated?
Manage respiratory distress
Anticoagulative meds (heparin/coumadin)
Thromboysis (streptokinase)
Surgery if large (embolectomy)
5 MC sources of mets in the lung
Kidney Breast Colon Cervix Skin (Melanoma)
S&S lung cancer
- dry hacking cough
- hoarseness/dysphagia
- dyspnea
- hemoptysis/rust colored sputum
- pain in chest area
- diminished breath sounds/wheezing
- constitutional: loss of appetite, tiredness, general discomfort
- weight loss
- pneumonia/fever
DDX clubbing fingers
Cardiovascular dx Lung dx (incl lung cancer)
What stage of tumour is considered not surgically resectable?
T4 - have invaded mediastinum (involve heart great vessels, trachea, or esophagus)
In which type of lung cancer do 95% of cases have mets at the time of dx?
Small cell carcinoma
Where is small cell carcinoma MC located in the lung?
Centrally - extensive mediastinal node involvement
Prognosis for small cell carcinoma
5-10% 5yr survival
Tx for small cell carcinoma
usually just chemo due to early & rapid spread
What are the 3 types of non-small cell lung cancer?
- Squamous cell
- Adenocarcinoma
- Large cell
Which is MC associated with smoking: small cell or non-small cell lung cancer?
Non-small cell - smoking increses risk by 4-120x
7 non-smoking risk factors for developing non-small cell carcinoma
Exposure to: - asbestos - toxic agents (arsenic, nickel, chromium, chloromethyl ether) - uranium, radon History of: - Interstitial lung disease - Lung cancer - COPD - HIV infection
MC non-small cell carcinoma
Adenocarcinoma (50% of all bronchogenic carcinomas)
Also MC cell type seen in women and nonsmokers
What does adenocarcinoma secrete?
Mucin
Compare S&S of small cell vs non small cell carcinoma
SCC: - cough uncommon - sputum, - wheezing - atelectasis, tracheal shift - infection with fever, pain, and weight loss - pleural effusion - SVC syndrome - dyspnea from intrapulmonary spread NSCC: - cough - bloody, purulent sputum - stridor/wheezing/dyspnea - atelectasis, tracheal shift - infection with fever, pain, and weight loss
What is the typical pattern of involvement of NSCC?
Coin lesion (easier to resect)
What is SVC syndrome?
obstruction of blood flow through the SVC Causes the following symptoms: - dyspnea (MC) - trunk/UL extremity swelling - facial swelling - cough - orthopnea - HA - nasal stuffiness - light-headedness/dizziness/stupor - swollen jugular veins/venous system of upper chest/shoulders/neck - visual disturbances
Which type of lung cancer is a pancoast tumour?
Squamous cell
