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Screening for Pulmonary Disease Flashcards

1
Q

what are the overall 2 functions of the pulmonary system

A

provide O2 and carry out CO2
acid-base regulation

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2
Q

norm for O2 sat

A

> /= to 95% on RA

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3
Q

what are activity guidelines for O2 sat

A

O2 sat >/=95 w activity

88-90 - may need supplemental O2, refer to MD if undiagnosed (need titrate order)
- relative indication to stop exercise

</= 87 - needs supplemental O2
- contraindication to initiating activity
- refer to MD if undiagnosed

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4
Q

anemia and O2sat

A

anemia (Hgb <12) - less O2 carrying capacity overall

O2sat is indirect measure of oxygen carrying capacity

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5
Q

why is an O2 order so important

A

hypoxic drive physiology

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6
Q

what are reasons that could contribute to an inaccurate O2 reading (5)

A

PAD
Raynaud’s
cold extremities
AF
dark pigmented skin

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7
Q

what are the 7 most common sx reported to PTs

A
  1. cough (productive, nonproductive)
  2. dyspnea (resting, DOE, orthopenia)
  3. chest pain
  4. altered breathing pattern
    - RR - quantity and quality
  5. abnormal sputum color
    - yellow/green, clear/white
    - rust - streaking in chronic conditions
  6. hemoptysis - blood in lungs
    - tbsps - red flag
  7. cyanosis - nail beds, lips, nose, earlobes
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8
Q

what are the 6 most common acute pulmonary dx

A

pneumonia
PE
pleurisy
PTX
pulmonary arterial HTN
lung CA

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9
Q

3 risk factors to look for in a pulmonary screen

A

> 40 yo
smoking
ms sx that inc w DB and C

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10
Q

what in someone’s PMH are risk factors to screen for

A

breast, prostate, colon, uterine cancer
- metastasize and move to lungs
TB
recent. URI

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11
Q

aging adults w shoulder pain and confusion makes you think of what dx

A

pneumonia

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12
Q

what occupations and events/incidents are risk factors for a pulmonary dz

A

occupational - long term breathing things in on a regular basis
- toxic fumes (firefighters)
- mineral dusts
- silica
- coal dust
- asbestos (construction)

GSW, stabbing, rib fx, crush injury, MVA

scuba diving - recent

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13
Q

what does scuba diving put you at an inc risk for

A

PTX

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14
Q

what is pneumonia

A

inflammation/infection of lungs

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15
Q

what are specific risk factors for pneumonia

A

URI w susceptible pt
- smoking hx
- poor health
- immunosuppression
- rheumotologic/autoimmune dz

kids & aging adults

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16
Q

what is a recommended prophylactic treatment for pneumonia

A

vax - protects against few common strains of pneumonia
- recommended for >55yo

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17
Q

why are kids/peds at inc risk for pneumonia and even RF

A

little trachea
- all the surface area of lungs trying to get thru little trachea

first few years of life, kids chest walls don’t have mechanical advantage

kids exposed to pool of pathogens at schools and daycare

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18
Q

what are sx of pneumonia (5)

A

fever
chills
cough - productive or non
shoulder, LB, or thoracic pain
aging adult - add confusion

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19
Q

flag for pneumonia

A

refer to PCP

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20
Q

why has there been an inc in TB cases

A

more drug resistant strains
meds for 6-9months
- incomplete treatment

people start to feel better and stop taking meds, creating resistance

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21
Q

what is the medical test for TB

A

Mantoux test
- bubble test
- right below skin and see if blood reacts

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22
Q

what are the risk factors for TB

A

travel and child adoptions
- former soviet union
- central Asia

mostly seen in immigrant population

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23
Q

sx of TB

A

not seen until later stages of infection
same sx as pneumonia

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24
Q

what is a PE

A

blood clot traveling to lungs from DVT

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25
flag for a PE
emergent referral duh.
26
what are 2 risk factors for a PE
birth control trauma/injury
27
pathophys for a PE
as clot travels prox, vessels get bigger and bigger - once you get past right ventricle, vessels get smaller and smaller again
28
what is a saddle PE
embolism that sits in the bifurcation of R and L main stem pulmonary arteries - these are deadly higher up in pulmonary vascular tree that it lodges, the deadlier that it is
29
sx of a PE (8)
dyspnea (sudden onset) sharp chest pain (localized, sudden onset) persistent cough hemoptysis apprehension, anxiety - fear of impending death tachycardia (usually) tachypnea (if big enough) fever
30
what are the Wells criteria to predict a PE (6)
DVT sx - leg swelling, pain HR >100 immobilize 3+ days or surgery past month previous DVT hemoptysis malignancy
31
how to interpret wells criteria for PE screening
PE likely >2 - medical consult for further screening PE not likely <2
32
what is pleurisy
inflammation of pleura
33
what PMH inc risk of pleurisy (3)
SLE RA recent infection (ie pneumonia)
34
sx of pleurisy (5)
chest pain cough dyspnea fever/chills tachypnea
35
how can sx of chest pain cause the other sx seen in pleurisy
chest pain causes inc in sympathetic nervous system - causing other sx seen
36
what is a PTX
collapsed lung air b/w parietal and visceral pleura
37
what are sx of PTX (8)
dyspnea (sudden onset) unilateral resp wall mvt changes - diminished breath sounds sudden/sharp chest pain neck vein distention tachycardia BP drop dry cough sitting upright dec sx - depending on where it is
38
where are PTXs usually located
apices
39
if from trauma or surgery where are PTXs usually located
lateral lower lobes
40
what about the location of PTXs should be considered
is it dependent area or not - that area will be perfused more than it is ventilated >> this makes it hard to breathe
41
risk factors for PTX (6)
trauma - GSW/stabbing, fx rib, MVA scuba diving overexertion - to an extent surgery / procedures chronic pulmonary dz - CF, bronchiectasis taller pts - something to do w length of lungs
42
what is pulmonary arterial hypertension
vasoconstriction of pulmonary arterial vascular bed
43
primary vs secondary PAH
primary - idiopathic secondary - more common - anything that causes hypoxia
44
what are things that PAH can be secondary to (6)
anything that causes hypoxia - PE - sickle cell dz - Graves - polycythemia - portal HTN - sleep apnea
45
what can PAH cause
R HF - cor pulmonale - looks like R CHF
46
what are sx of PAH (4)
seen in late stages of cor pulmonale - progressive dyspnea (dec O2 w activity, fine at rest) - neck v distention - peripheral edema (B legs) - cough, chest pain
47
how common is lung cancer
2nd most diagnosed cancer in men and women
48
risk factors of lung cancer (4)
>50yo smoking (pack yr >25yo, 4x lung CA risk) air exposure to toxins - asbestos, radon, fumes previous lung dz (COPD, TB)
49
what are common metastatic sites of lung cancer
long BONES spine LIVER brain
50
what is a pancoast tumor
apical lung tumor - C8-T2 sx - looks like TOS or brachial plexus injury
51
sx of lung cancer
general pulmonary sx - dyspnea - coughing new ones: - hoarseness (dysphagia) - wt loss >10% in 1 mo
52
what is dysphagia a pretty big sign of
esophageal cancer
53
what are the big main red flags for cancer
night sweats and pain
54
how to dx lung cancer
CXR
55
what is respiratory acidosis caused by
CO2 retention - COPD - pneumonia
56
sx of respiratory acidosis (7)
confusion sleepiness HA diaphoretic shallow, rapid breathing - similar to diabetic ketoacidosis restlessness cyanosis
57
what flag is respiratory acidosis
emergent referral
58
what does an acute flare of asthma present as
hear stridor and/or wheezing
59
PT education for asthma
ask pt to bring inhaler to all PT sessions develop habit of having it on them
60
what are your emergent red flag medical referrals (4)
dyspnea - sudden onset - with tachycardia and weak pulse - BP drop chest pain, shoulder pain following scuba respiratory acidosis lung cancer w change of status
61
what are your soon referrals (yellow flag ?)
shoulder sx that change w valsalva shoulder pain inc supine, dec sitting inc asthma sx w exercise
62
what are 5 important screening questions to ask if hx of
SOB productive coughing difficulty sleeping lying flat lung problems asthma

Med Screening (17 decks)

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