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ICM Block 2 > Respiratory (common diseases) > Flashcards

Respiratory (common diseases) Flashcards

1
Q

what are the symptoms of pneumonia?

A
  • Fever with sweating and chills
  • Cough with or without sputum production
  • Dyspnea
  • Chest discomfort and pleurisy
  • Hemoptysis ±
  • Fatigue, myalgias, anorexia, headache
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2
Q

What are the signs of pneumonia?

A
  • Tachypnea, tachycardia
  • Increased Tactile Vocal Fremitus
  • Dullness to percussion if pleural effusion
  • Bronchovesicular / Bronchial breath sounds
  • crackles
  • Vocal Resonance: bronchophony, egophony & whispered pectoroliquy
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3
Q

what symptoms are not found in atypical pneumonia?

A

no: sputum, chest pain, cyanosis, consolidation

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4
Q

how do you confirm a diagnosis of pneumonia?

A

chest radiography

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5
Q

what do you look for in a chest radiography if you suspect pneumonia?

A

hilar lymph nodes

patchy airspace infiltration to lobar consolidation

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6
Q

what is this?

A

pneumonia (cavitation)

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7
Q

what is this?

A

pneumonia- lobar consolidation

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8
Q

what is this?

A

right middle pneumonia

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9
Q

what is this?

A

right middle pneumonia

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10
Q

what is this?

A

right middle pneumonia

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11
Q

what organisms may cause pneumonia?

A
  1. Pseudomonas
  2. Mycoplasma pneumoniae
  3. Legionella pneumophilia
  4. Klebsiella
  5. Chlamydia pneumoniae
  6. Chlamydia psittaci
  7. Viral pneumonia
  8. Pneumocystis pneumonia
  9. Avian influenza
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12
Q

what is Pleural effusion?

how do we classify it?

A

collection of fluid in the pleural space

  1. empyematous,
  2. hemorrhagic,
  3. chylous,
  4. exudative, or transudative
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13
Q

what are the main two types of effusion?

what is the difference?

A
  • Transudates: increase hydrostatic or lower oncotic pressures without altering the pleural permeability
  • Exudates: production of pleural fluid by increasing the permeability of the pleura;
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14
Q

what causes trasudate effusion?

A
  1. CHF
  2. Liver cirrhosis
  3. Nephrotic syndrome
  4. SVC obstruction
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15
Q

transudate effusion is always bilateral or unilateral?

A

bilateral

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16
Q

what causes exudate effusion?

A
  1. Trauma
  2. Cancer
  3. Infection (pneumonia & TB)
  4. Inflammation (rheumatoid arthritis, SLE)
  5. Esophageal rupture
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17
Q

what symptoms do you see with pleural effusion?

A
  • Symptoms: Pleuritic chest pain, Dyspnea
  • Mediastinal Displacement: to opposite side
  • Chest Wall Movement: Reduced over affected area
  • Vocal Fremitus: Absent or markedly decreased
  • Percussion Note: Dull to flat
  • Breath Sounds: Absent over fluid; bronchial at upper border
  • Added Sounds: Absent; pleural rub may be found above effusion
  • Voice Sounds: Absent over effusion; increased with egophony at upper border
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18
Q

what is this?

A

compression atelectasis - pleural effusion

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19
Q

what is this?

A

mainly due to mediastinal tumor

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20
Q

what can you see here?

A

Blunting of the costophrenic angle (key word) in pleural effusion

white part in right lung is fluid

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21
Q

what can you see here?

A

Blurring of the posterior diaphragm in the lateral view - pleural effusion

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22
Q

what is a thoracocentesis?

at what level do you insert the needle?

A

remove fluid from the pleural cavity of your patient

look at the costophrenic angle, tell him to exhale, and insert between seven and 8

23
Q

in a radiograph, how do you know which lung is which?

A

look at the lungs and a shadow close to it, which ever is higher, the shadow or the bright lungs is the right

24
Q

pseudomonas cause which type of pneumonia?

how does Mycoplasma pneumonia cause pneumonia?

how does Legionella pneumophilia cause pneumonia?

how does klebsiella cause pneumonia?

A

hospital acquired pneumonia

occurs in epidemics (every 4 yrs)

infects older smokers if near contaminated water sources

alcoholics

25
Q

when does Chlamydia pneumoniae cause pneumonia?

How do you acquire Chlamydia psittaci to cause pneumonia?

A

first look for pharyngitis, hoarseness, otitis before the pneumonia

Acquired from infected birds

26
Q

what is a key word for pneumonia?

A

vocal resonance

27
Q

in pleural effusion, if you

A
28
Q

how much fluid is needed to be considered pleural effusion

A

more than 25 is pleural effusion

29
Q

what is pneumothorax?

A
  • When air is leaked into pleural space, lung recoils & blocks transmission of sounds
30
Q

into what do we divide spontaneous pneumothorax?

in who do we see each of these divisions?

A
  • primary: tall, thing, young men w/o any disease
  • secondary: complication of a pre-existing disease
31
Q

what is traumatic or iatrogenic pneumothorax?

A

usually happnes with stab injury or could happen due to mechanical ventilation causing lung rupture

32
Q

what is a tension pneumothorax?

A

progressive accumulation of air leading to compression of mediastinal structures & cardiovascular collapse

33
Q

what are the Clinical features of Tension Pneumothorax?

A
  • Ipsilateral Pleuritic chest pain
  • dyspnea
  • tachycardia
  • Mediastinal-Tracheal Displacement: to opposite side if under tension
  • Chest Wall Movement: Decreased over affected area
  • Vocal Fremitus: Absent
  • Percussion Note: Hyper-resonant when compared to other side
  • Breath Sounds: Absent or decreased
  • Added Sounds: Absent
  • Voice Sounds: Absent
34
Q

what is this showing?

from what angle is this?, how do you know?

A

X ray-Chest (Spontaneous Pneumothorax)

PA view, because we can see the shadow of the anterior ribs vs clear posterior ribs

35
Q

what is atelectasis?

A

Lobar obstruction: when mucus , foreign body or tumor blocks a main bronchus leading to collapse of affected lung

36
Q

what are the clinical findings for Atelectasis?

A
  • Mediastinal Displacement: Ipsilateral shift
  • Chest Wall Movement: Decreased over affected area
  • Vocal Fremitus: Variable
  • Percussion Note: Dull
  • Breath Sounds: Absent or diminished
  • Added Sounds: absent
  • Voice Sounds: Absent
37
Q

what is asthma?

A

Episodic dyspnea and wheezing or Cough with thick mucoid sputum. History of allergy

(person speaks in 1 word) (needs to forcefully breath in as well as breathe out)

38
Q

what are the clinical findings for asthma?

A
  • Use of accessory muscles
  • Mediastinal Displacement: None
  • Chest Wall Movement: Decreased symmetrically
  • Vocal Fremitus: Normal or decreased
  • Percussion Note: resonant
  • Breath Sounds: Prolonged expiratory phase
  • Added Sounds: Wheeze
  • Voice Sounds: Normal or decreased
39
Q

how do you describe a whieeze?

A

low pitch sound, around 600 MHz, heard better on expiration

40
Q

asthma patients can suffer from pulsus paradoxicus, what is this?

in what other condition can you see it?

A

on deep inspiration, systolic BP falls by more than 10 mmHg

cardiac tamponade

41
Q

identify which is normal, which is restrictive and which is obstructive?

A
42
Q

what are the symptoms of chronic bronchitis?

A

cough and sputum

dyspnea

43
Q

what is COPD?

who usually gets it?

A

chronic bronchitis with emphysema

smokers

44
Q

what are the signs of chronic bronchitis?

A
  • Cyanosis
  • Peripheral edema
  • Hyperinflated chest
  • Reduced expansion on palpation
  • Hyper-resonance
  • Decreased breath sounds, wheezes and crackles
  • Cor pulmonale
45
Q

in chronic bronchitis, do you have hypertrophy or hyperplasia?

A

tsk tsk, both

46
Q

what do you hear with chronic bronchitis?

A

ronchi (sounds like someone snoring)

test: ask pt to cough, will cause ronchi to disappear

47
Q

what are pts with chronic bronchitis called?

A

blue bloaters (right HF and cant breathe)

48
Q

what is this?

what can we see here?

A

chronic bronchitis

too much white, we see tram track appearance (white lines all over), enlarged heart, flat diaphragm

49
Q

what can cause emphysema?

A
  1. alpha 1 antitrypsin deficiency
  2. smoking
50
Q

what are the symptoms of emphysema?

A

dyspnea

scanty sputum production

51
Q

how do patients with emphysema appear?

what signs can you find?

A

thin and often elderly with pursed lips (using accessory muscles)

  • chest hyperinflation and reduced chest xpansion
  • hyper resonant with decreased breath sounds
  • cor pulmonary is infrequent
52
Q

what is this?

what can you see?

A

emphysema

  • no vascular marks
  • narrow heart
  • decreased markings
53
Q

identify each of the diagnosis?

A
54
Q
A

ICM Block 2 (3 decks)

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