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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
when does Chlamydia pneumoniae cause pneumonia? How do you acquire Chlamydia psittaci to cause pneumonia?
first look for pharyngitis, hoarseness, otitis before the pneumonia Acquired from infected birds
26
what is a key word for pneumonia?
vocal resonance
27
in pleural effusion, if you
28
how much fluid is needed to be considered pleural effusion
more than 25 is pleural effusion
29
what is pneumothorax?
* When air is leaked into pleural space, lung recoils & blocks transmission of sounds
30
into what do we divide spontaneous pneumothorax? in who do we see each of these divisions?
* primary: tall, thing, young men w/o any disease * secondary: complication of a pre-existing disease
31
what is traumatic or iatrogenic pneumothorax?
usually happnes with stab injury or could happen due to mechanical ventilation causing lung rupture
32
what is a tension pneumothorax?
progressive accumulation of air leading to compression of mediastinal structures & cardiovascular collapse
33
what are the Clinical features of Tension Pneumothorax?
* 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
what is this showing? from what angle is this?, how do you know?
X ray-Chest (Spontaneous Pneumothorax) PA view, because we can see the shadow of the anterior ribs vs clear posterior ribs
35
what is atelectasis?
Lobar obstruction: when mucus , foreign body or tumor blocks a main bronchus leading to collapse of affected lung
36
what are the clinical findings for Atelectasis?
* 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
what is asthma?
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
what are the clinical findings for asthma?
* 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
how do you describe a whieeze?
low pitch sound, around 600 MHz, heard better on expiration
40
asthma patients can suffer from pulsus paradoxicus, what is this? in what other condition can you see it?
on deep inspiration, systolic BP falls by more than 10 mmHg cardiac tamponade
41
identify which is normal, which is restrictive and which is obstructive?
42
what are the symptoms of chronic bronchitis?
cough and sputum dyspnea
43
what is COPD? who usually gets it?
chronic bronchitis with emphysema smokers
44
what are the signs of chronic bronchitis?
* Cyanosis * Peripheral edema * Hyperinflated chest * Reduced expansion on palpation * Hyper-resonance * Decreased breath sounds, wheezes and crackles * Cor pulmonale
45
in chronic bronchitis, do you have hypertrophy or hyperplasia?
tsk tsk, both
46
what do you hear with chronic bronchitis?
ronchi (sounds like someone snoring) test: ask pt to cough, will cause ronchi to disappear
47
what are pts with chronic bronchitis called?
blue bloaters (right HF and cant breathe)
48
what is this? what can we see here?
chronic bronchitis too much white, we see tram track appearance (white lines all over), enlarged heart, flat diaphragm
49
what can cause emphysema?
1. alpha 1 antitrypsin deficiency 2. smoking
50
what are the symptoms of emphysema?
dyspnea scanty sputum production
51
how do patients with emphysema appear? what signs can you find?
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
what is this? what can you see?
emphysema * no vascular marks * narrow heart * decreased markings
53
identify each of the diagnosis?
54

ICM Block 2 (3 decks)

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