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