Screening for Pulmonary Disease Flashcards
Pulmonary screening may be performed on pts presenting with ________
neck, shoulder or back pain
what are the most common pulmonary conditions that mimic MSK disoders?
- Pneumonia
- Pleurisy
- Pneumothorax
- Pancoast’s tumor
List major S/S of pulmonary disorders
- Cough
- Dyspnea
- Cyanosis
- Clubbing
- Altered breathing patterns
- May also demonstrate
- chest pain
*
- chest pain
describe cough characteristics that are indicative of pulmonary disorders
- Persistent dry cough
- Productive cough
- purulent sputum → may indicate infection
- non-purulent sputum → airway irritation
- rust colored sputum → may be a sign of pneumonia
- hemoptsis → indicates pathologic condition
what does dyspnea usually indicate?
hypoxia
what is clubbing? how can you clinically test for it?
thickening/widening of terminal phalanges of finger and toes
Schamroth’s Sign
when would clubbing require immediate medical evaluation?
rapid development of digital clubbing over the course of 10 days to 2 weeks
where are the most common referral sites for pulmonary pain?
- Chest
- Ribs
- Upper trap
- Shoulder
- T-Spine
what are pain patterns that indicate pain may be from a pulmonary source?
- pain increases with respiratory movements
- pt notes dyspnea, persistent cough, fever and chills
- palpation and resisted movement will not reproduce
- symptoms may worsen with recumbency
how would you differentiate between a intercostal strain/rib dysfunction and a pulmonary condition?
pulmonary condition pain is typically improved with autosplinting
intercostal strain/rib dysfunction would be worsened with autosplinting
pulmonary pain pattern for pleural pain
- pleural irritation is sharp, localized pain
- autosplinting relieves pain
- present pleurisy, pneumonia, pulmonary infarct, tumor, pneumothorax
describe diaphragmatic pleural pain patterns
- peripheral portions
- sharp pain along costal margins
- can refer to lumbar regions
- central portions
- sharp pain referred to upper trap and shoulder on ipsilateral side of stimulation
what findings would prompt you to perform a Pulmonary review of systems?
- cough, hoarseness
- sputum, hemoptysis
- SOB
- altered breathing
- wheezing
- pursed lip breathing
- night sweats; sweats anytime
- pleural pain
- cyanosis, clubbing
- positive findings on auscultation
- friction rub
- unexpected breath sounds
List pulmonary pathologies
- Pneumonia
- Cancer → Pancoast’s tumor
- Pleurisy
- Pneumothorax
- COPD
- Emphysema
- Asthma
- TB
- Systemic Sclerosis Lung Disease
- Cystic Fibrosis
- PE
- COVID-19
what is pneumonia?
inflammation of the lungs caused by:
- aspiration of foods, fluids, or vomit
- inhalation of toxic or caustic chemicals, smoke, dust or gases
- bacterial, viral or mycoplasmal infections
- may affect one or both lungs
- often follows the flu
List and briefly describe the 3 different types of pneumonia
- Hospital acquired → occurs 0-48 hours post hospitalization
- Ventilatory associated → occurs in individuals who are mechanically ventilated and progress to pneumonia
- Community acquired
List the risk factors for pneumonia
- Very young or old
- smoking
- air pollution
- URI
- altered consciousness
- endotracheal intubation, NG tube
- recent chest surgery
- immunosuppresive therapy
- AIDS
- aspiration of oral/gastric material
Clinical S/S of Pneumonia
- Sudden/sharp pleuritic chest pain
- Shoulder pain
- Hacking, productive cough
- Dyspnea
- Tachypnea
- Cyanosis
- HA
- fever and chills
- generalized aches and myalgia
- may extend to thighs and calves
- knees may be painful/swollen
- fatigue
- confusion in adults/increased confusion in pts with dementia/AD
what is Lung cancer?
malignancy in epithelium of respiratory tract
grouped into small cell and non-small cell lung cancers
T/F: lung cancer is the 5th most commonly diagnosed cancer in men and women
FALSE
it is is the 2nd most common
where does lung cancer typically metastasize to?
- long bones
- vertebral column
- liver
- adrenal glands
- brain → up to 50% of cases
list primary cancers that metastasize to the lungs
- kidney
- breast
- pancreas
- colon
- uterine
PMH of lung cancer + _________ warrants further investigation
new onset of back pain
List risk factors for lung cancer
- greater than 50 years old
- tobacco use
- previous tobacco-related cancer
- second-hand smoke
- low consumption of fruits and veggies
- genetic predisposition
- exposure to air pollution, toxic, chemicals, fumes, radon gas
- previous lung disease
Clinical S/S of Lung Cancer
- Sharp chest, upper back, shoulder, scapular, rib or arm pain aggravated by inspiration
- chest, shoulder or arm pain; bone aching/joint pain
- atrophy and weakness of arm and hand muscles
- change in respiratory patterns
- recurrent pneumonia or bronchitis
- hemoptysis
- persistent cough
- change in cough in chronic smoker
- hoarseness or dysphagia
- dyspnea
- wheezing
- sudden, unexplained weight loss; anorexia; fatigue
- fecal breath odor
what is a Pancoast’s Tumor?
tumor at the lung apex
aka Apical tumor
how does a Pancoast’s Tumor present?
- Frequently invovlees C8 and T1 nerve
- Presents in distribution of C8-T2 dermatomes
- Loss of hand function
- Horner’s syndrome
- sharp (posterior) shoulder pain most common initial symptom
- can mimic TOS
what is Pleurisy?
Inflammation of pleura
- caused by infection, injury or tumor
- may occur as a result of:
- pneumonia
- TB
- lung abscess
- influenza
- SLE
- RA
- pulmonary infarction
Clinical S/S of Pleurisy
- Chest pain
- Cough
- Dyspnea
- Fever, chills
- Tachypnea
- can refer to shoulder, upper trap, neck, lower chest wall, or abdomen
what is a pneumothorax?
free air in pleural cavity between visceral and parietal pleurae
what is a spontaneous pneumothorax?
air escapes into pleural space from puncture or tear in an internal respiratory structure
when is the peak onset for pneumothorax?
20-40 years old
what is the relationship between scuba diving and pneumothorax?
it can be a risk factor
individuals with asthma, HTN, CHF, DM or a hx of pneumothorax should not scuba dive
Clinical S/S of pneumothorax
- Dyspnea
- Change in respiratory movements
- Sudden, sharp chest pain
- Increased neck vein distension
- Weak and rapid pulse
- Fall in BP
- Dry, hacking cough
- Shoulder pain
- Sitting upright is most comfortable position
what is COPD?
refers to a number of disorders that result in a narrowing of the airways obstructing airflow to and from lungs
a few include obstructive bronchitis, emphysema and asthma
what are predisposing factors for COPD?
- cigarette smoking
- air pollution
- occupational exposure to aerosol pesticides
- irritating dusts or gases or art materials
- hereditary factors
- infection
- allergies
- aging
- potentially harmful drugs/chemicals
what is emphysema?
may develop after long hx of chronic bronchitis
alveolar walls are destroyed causing permanent overdistension of air spaces and loss of normal tension in lung tissue
also causes destruction of pulmonary capillaries
Clinical S/S of Emphysema
- SOB
- dyspnea on exertion
- orthopnea
- chronic cough
- barrel chest
- weight loss
- malaise
- use of accessory muscle of respiration
- prolonged expiratory period w/grunting
- wheezing
- pursed-lip breathing
- increased RR
- peripheral cyanosis
what is Asthma?
reversible obstructive lung disease
increased reaction of the airways to various stimuli
what are the 3 categories of asthma?
- conventional
- occupational
- exercise-induced
T/F: asthma can be life-threatening?
TRUE
if not managed
Clinical S/S that you should listen for in asthma?
- wheezing
- irregular breathing w/prolonged expiration
- nosiy, difficult breathing
- episodes of dyspnea
- clearing the throat
- cough with or w/o sputum
Clinical S/S that you should look for in asthma
- skin retraction (between ribs)
- hunched-over body position
- pursed-lip breathing
- nostrils flaring
- unusual pallor or unexplained sweating
list several factors that may trigger an asthmatic attack
- respiratory infections, colds
- cigarette smoke
- allergic reactions to pollen, mold, animal dander, feather, dust, food, insects
- indoor and outdoor air pollutants, including ozone
- physical exertion or vigorous exercise
- exposure to cold air or sudden temp changes
- excitment or strong emotion, psychologic or emotional stress
what is Tuberculosis?
a bacterial infectious disease
usually spread by airborne droplets from an actively infected person
most commonly spread via repeated close contact w/infected person
T/F: TB only impacts the lungs
FALSE
most often it impacts the lungs but it can also affect the kidneys, bone growth plates, lymph nodes, and meninges
what is Pott’s disease?
a rare form of TB that may affect hip joints and vertebrae
list risk factors for TB
- health care workers
- older adults
- overcrowded housing
- alcohol or chemical dependency
- infants and children <5
- reduced immunity/malnutrition
- RA, DM, end stage renal disease, GI disease
Clinical S/S of TB
- night sweats
- fatigue
- malaise
- anorexia
- weight loss
- low-grade fever
- frequent productive cough
- dull chest pain/tightness
- dyspnea
what is systemic sclerosis lung disease?
Systemic Sclerosis is aka Scleroderma
- characterized by inflammation and fibrosis of many organs
- restrictive lung disease of unknown etiology
- lungs 2nd most common organ targeted
- causes intersitial fibrosis
Clinical S/S of Systemic Sclerosis Lung Disease
- Dyspnea on exertion
- Nonproductive cough
- Peripheral edema
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Hemoptysis
- skin changes typically precede visceral alterations
how may skin changes present in scleroderma?
the abnormal build-up of fibrosus tissue in the skin can cause the skin to tighten so severely that the fingers curl and lose their mobility
what is Cystic Fibrosis?
inherited disease of the exocrine glands
- defective copy of CF transmembrane conductance regulator (CFTR)
- causes salt to accumualte in cell lining in lungs and digestive tissues
- makes surrounding mucus abnormally thick and sticky
- usually manifests in early childhood
Clinical S/S of CF
- Exertional dyspnea w/decreased exercise tolerance
- tachypnea
- sustained chronic cough w/mucus production and vomiting
- barrel chest
- use of accessory muscles
- cyanosis and digital clubbing
list further complications of CF
- pneumothorax
- hemoptysis
- Right sided HF secondary to pulmonary HTN
Pulmonary Embolism mortality
- associated with high morbidity and mortality
- researchers estimate that more than 50% of PE-related deaths are potenitally preventable
- proximal DVT is most common cause
- PE related mortality is 5-20%
Risk Factors for PE
- Previous hx of PE
- Hx of DVT
- Immobility
- Hx of abdominal, pelvic surgery
- Total hip or knee replacement
- late-stage pregnancy
- lower limb frxs
- malignancy of pelvis or abdomen
Clinical manifestations of PE
- dyspnea
- tachypnea
- pleuritic chest pain, intensified w/deep respiration and cough
- persistent cough
- apprehension, anxiety
- tachycardia
- palpitations
describe Covid-19
caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
highly contagious
transferred via respiratory secretions
describe the range of symptom presentations in Covid pts
- 80% are asymptomatic or have mild URI
- 15% are more severe and require O2
- 5% are critical and require ventilation and life support
who are higher risk individuals for Covid?
- Older
- Male
- At least one co-exisiting comorbidity
- higher severity of illness scores
- elevated D-dimer levels
- lymphocytopenia
List symptoms of Covid-19
- Fever (>104) or chills
- cough
- SOB or difficulty breathing
- fatigue
- muscle or body aches
- HA
- new loss of taste or smell
- sore throat
- congestion or runny nose
- N/V/D
what are emergency warning signs for Covid-19?
signs that warrant seeking immidate medical attention:
- hypoxemia
- trouble breathing
- persistent pain or pressure in the chest
- new confusion
- inability to wake or stay awake
- bluish lips or face
List clues for screening for pulmonary involvment
- Hx of smoking for many years
- Hx of breast, prostate, kidney, pancreas or uterine CA
- recent URI
- MSK increased by respiratory movements
- respiratory movements are diminished or absent on one side
- dyspnea
- unable to localize pain with palpation
- pain unchanged by spinal motions
- pain unchanged with alterations of position
- increased symptoms with recumbency
- presence of pulmonary signs/symptoms
- autosplinting decreases pain
- older person with shoulder pain and confusion
guidelines for immediate medical attention
- abrupt onset of dyspnea with weak and rapid pulse and fall in BP
- symptoms of inadequate ventilation
Guidelines for MD referral
- shoulder pain aggravated by respiratory movements
- shoulder pain aggravated by supine positioning
- worse when lying down and improves w/sitting up/leaning forward
- shoulder/chest pain that subsides with auto-splinting
- signs of asthma during exercise
- presence of persistent cough, dyspnea or constitutional symptoms
- any red flag S/S in a client w/previous hx of CA, especially lung CA
