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Med Screening > Screening for Pulmonary Disease > Flashcards

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
Q

flag for a PE

A

emergent referral
duh.

26
Q

what are 2 risk factors for a PE

A

birth control
trauma/injury

27
Q

pathophys for a PE

A

as clot travels prox, vessels get bigger and bigger
- once you get past right ventricle, vessels get smaller and smaller again

28
Q

what is a saddle PE

A

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
Q

sx of a PE (8)

A

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
Q

what are the Wells criteria to predict a PE (6)

A

DVT sx - leg swelling, pain
HR >100
immobilize 3+ days or surgery past month
previous DVT
hemoptysis
malignancy

31
Q

how to interpret wells criteria for PE screening

A

PE likely >2
- medical consult for further screening

PE not likely <2

32
Q

what is pleurisy

A

inflammation of pleura

33
Q

what PMH inc risk of pleurisy (3)

A

SLE
RA
recent infection (ie pneumonia)

34
Q

sx of pleurisy (5)

A

chest pain
cough
dyspnea
fever/chills
tachypnea

35
Q

how can sx of chest pain cause the other sx seen in pleurisy

A

chest pain causes inc in sympathetic nervous system
- causing other sx seen

36
Q

what is a PTX

A

collapsed lung
air b/w parietal and visceral pleura

37
Q

what are sx of PTX (8)

A

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
Q

where are PTXs usually located

A

apices

39
Q

if from trauma or surgery where are PTXs usually located

A

lateral lower lobes

40
Q

what about the location of PTXs should be considered

A

is it dependent area or not
- that area will be perfused more than it is ventilated&raquo_space; this makes it hard to breathe

41
Q

risk factors for PTX (6)

A

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
Q

what is pulmonary arterial hypertension

A

vasoconstriction of pulmonary arterial vascular bed

43
Q

primary vs secondary PAH

A

primary - idiopathic
secondary - more common
- anything that causes hypoxia

44
Q

what are things that PAH can be secondary to (6)

A

anything that causes hypoxia
- PE
- sickle cell dz
- Graves
- polycythemia
- portal HTN
- sleep apnea

45
Q

what can PAH cause

A

R HF - cor pulmonale
- looks like R CHF

46
Q

what are sx of PAH (4)

A

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
Q

how common is lung cancer

A

2nd most diagnosed cancer in men and women

48
Q

risk factors of lung cancer (4)

A

> 50yo
smoking (pack yr >25yo, 4x lung CA risk)
air exposure to toxins - asbestos, radon, fumes
previous lung dz (COPD, TB)

49
Q

what are common metastatic sites of lung cancer

A

long BONES
spine
LIVER
brain

50
Q

what is a pancoast tumor

A

apical lung tumor
- C8-T2 sx
- looks like TOS or brachial plexus injury

51
Q

sx of lung cancer

A

general pulmonary sx
- dyspnea
- coughing

new ones:
- hoarseness (dysphagia)
- wt loss >10% in 1 mo

52
Q

what is dysphagia a pretty big sign of

A

esophageal cancer

53
Q

what are the big main red flags for cancer

A

night sweats and pain

54
Q

how to dx lung cancer

A

CXR

55
Q

what is respiratory acidosis caused by

A

CO2 retention
- COPD
- pneumonia

56
Q

sx of respiratory acidosis (7)

A

confusion
sleepiness
HA
diaphoretic
shallow, rapid breathing
- similar to diabetic ketoacidosis
restlessness
cyanosis

57
Q

what flag is respiratory acidosis

A

emergent referral

58
Q

what does an acute flare of asthma present as

A

hear stridor and/or wheezing

59
Q

PT education for asthma

A

ask pt to bring inhaler to all PT sessions
develop habit of having it on them

60
Q

what are your emergent red flag medical referrals (4)

A

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
Q

what are your soon referrals (yellow flag ?)

A

shoulder sx that change w valsalva
shoulder pain inc supine, dec sitting
inc asthma sx w exercise

62
Q

what are 5 important screening questions to ask if hx of

A

SOB
productive coughing
difficulty sleeping lying flat
lung problems
asthma

Med Screening (17 decks)

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