Screening for Pulmonary Disease (Exam 2)

Question 1

List the signs and symptoms of pulmonary disease.

what are the 2 most common?

Answer 1

• *1.Cough (most common)
  2. Dyspnea (most common)**
  3. Cyanosis
  4. Clubbing
  5. Altered Breathing Patterns
  6. May also demonstrate chest pain, abnormal sputum, hemoptysis

Question 2

describe cough

Answer 2

Persistent dry cough or

Productive cough
• Purulent sputum=may indicate infection
• Non-purulent sputum=airway irritation
• Rust colored sputum=may be a sign of pneumonia
• Hemoptysis=indicates pathologic condition

Question 3

describe what dyspnea usually indicates

Answer 3

usual indicates hypoxia (can indicate fear/anxiety as well)

Question 4

describe cyanosis

Answer 4

bluish color of skin and mucous membranes

Question 5

describe clubbing

when would it require a med referral?

Answer 5

Thickening/widening of terminal phalanges of fingers and toes
• Usually results from chronic O2 deprivation in tissue beds
• Often observed in pts with COPD, congenital heart defects and cor pulmonale
• Can occur w/in 10 days in pt with acute systemic condition (ie pulmonary abscess, malignancy or polycythemia)
• Rapid development of digital clubbing over the course of a 10-day to 2-week period requires immediate medical evaluation.
• Schamroth’s window disappears with clubbed fingernails (the window of space visible between two fingers when placed facing each other)

Question 6

what is an altered breathing pattern?

Answer 6

Changes in rate, depth, regularity and effort

Question 7

We should screen individuals presenting with complaints of what body regions for pulmonary disease in the presence of pulmonary signs and symptoms? (5 main sites)

Answer 7

• Most common referral sites are chest, ribs, upper trap, shoulder, and thoracic spine

Question 8

3. What are the most common pulmonary conditions that may mimic a MSK disorder?

Answer 8

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Question 10

Summarize key findings for pulmonary pain patterns

Answer 10

Pulmonary Pain patterns: Pain from pulmonary source

• Increases with inspiratory movements
• Pt notes dyspnea, persistent cough, fever and chills
• Palpation and resisted movements will not reproduce
• Symptoms may worsen with recumbency

How would you differentiate intercostal strain/broken rib from a pulmonary condition?

• Autosplinting will NOT be present.

Pleural Pain: Pleural irritation is sharp, localized pain

• Autosplinting: Pain is relieved by lying ON the affected side.
• Present pleurisy, pneumonia, pulmonary infarct, tumor, pneumothorax

Diaphragmatic Pleural Pain:

• Peripheral portions: Sharp pain along costal margins (can refer to lumbar region)
• Central portions: sharp pain referred to upper trap and shoulder on ipsilateral side of stimulation

Question 11

5. How would you differentiate intercostal strain/broken rib from a pulmonary condition?

Answer 11

Autosplinting for pulmonary NOT intercostal strain/broken rib, not reproducible with palapation etc.

Question 12

What is auto splinting

Answer 12

Pain is relieved by lying ON the affected side.

Question 13

7. What region(s) of the body is referred pain likely to be in a patient with pneumonia?

Answer 13

• Sudden/sharp pleuritic chest pain
• Shoulder pain

Question 14

8. What areas of the body is lung cancer most likely to metastasize to? Which are is most common?

Answer 14

• Metastasizes usually to long bones, vertebral column, liver, adrenal glands and brain
• Brain is most common, with 50% of cases metastasize to the brain

Question 15

9What primary cancers are most likely to metastasize to the lung?

Answer 15

• Kidney
• breast
• pancreas
• colon
• uterus

Question 16

What clinical features would increase concern for a Pancoast’s tumor?

what nerves are most frequently involved?

Where is the pain for most people (most common initial symptom)

Answer 16

Apical (Pancoast’s) Tumor

• Tumor of the lung apex
• Frequently involve 8th cervical and 1st thoracic nerve
• Presents in distribution of C8, T1 and T2 dermatomes

1. Loss of hand function
2. Horner’s syndrome
3. Enophthalmos (sunken in eyes)
4. Ptosis
5. Anhidrosis (inability to sweat)
6. Miosis

• Sharp (posterior) shoulder pain most common initial symptom
• Can mimic thoracic outlet syndrome

Question 17

Note the clinical signs & symptoms that would accompany a spontaneous pneumothorax. (9)

Answer 17

1. Dyspnea
2. Change in respiratory movements
3. Sudden, sharp chest pain
4. Increased neck vein distention
5. Weak and rapid pulse
6. Fall in BP
7. Dry, hacking cough
8. Shoulder pain
9. Sitting upright is most comfortable position

Question 18

What is asthma?

Answer 18

Reversible obstructive lung disease

Increased reaction of the airways to various stimuli

Can be life-threatening if not managed

Categorized as conventional asthma, occupational asthma or exercise-induced asthma

Question 19

What clinical signs and symptoms should you listen for in a patient with asthma?

Answer 19

◦ Wheezing
◦ Irregular breathing with prolonged expiration
◦ Noisy, difficult breathing
◦ Episodes of dyspnea
◦ Clearing the throat
◦ Cough with or without sputum

Question 20

What clinical signs and symptoms should you look for in a patient with asthma?

Answer 20

◦ Skin retraction (between the ribs)
◦ Hunched-over body position
◦ Pursed-lip breathing
◦ Nostrils flaring
◦ Unusual pallor or unexplained sweating

Question 21

What are factors that may trigger asthma?

Answer 21

◦ 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 temperature change
◦ Excitement or strong emotion, psychologic or emotional stress

Question 22

Name key characteristics of TB

Answer 22

Bacterial infectious disease
Usually spread by airborne droplets from an actively infected person
Most commonly spread via repeated close contact with an infected person
Most often involves the lungs; however, extrapulmonary TB may affect the kidneys, bone growth plates, lymph nodes and meninges
Rare but TB may affect hip joints and vertebrae (Potts disease) greater risk for spinal fractures

Question 23

What are risk factors for TB? (7)

What 4 conditions put you at a greater risk for TB?

Answer 23

1. Health care workers
2. Older adults
3. Overcrowded housing
4. Alcohol or chemical dependency
5. Infants and children <5
6. Reduced immunity/malnutrition
7. RA, DM, end stage renal disease, GI disease

Question 24

What are clinical signs and symptoms of TB? (9)

Answer 24

1. Night Sweats
2. Fatigue
3. Malaise
4. Anorexia
5. Weight loss
6. Low-grade fever
7. Frequent productive cough
8. Dull chest pain/tightness
9. Dyspnea

Question 25

What is cystic fibrosis?

Answer 25

• Inherited disease of the exocrine glands
• Defective copy of CF transmembrane conductance regulator (CFTR)
• Causes salt to accumulate in cell lining in lungs and digestive tissues
• Making surrounding mucus abnormally thick and sticky
• Usually manifests in early childhood

Question 26

What are clinical signs and symptoms of cystic fibrosis?

Answer 26

• Tachypnea
• Sustained chronic cough with mucus production and vomiting
• Barrel chest
• Use of accessory muscles for respiration
• Cyanosis and digital clubbing
• Exertional dyspnea with decreased exercise tolerance

Further complications

• Pneumothorax
• Hemoptysis
• Right-sided heart failure secondary to pulmonary hypertension

Question 27

What are the 3 most common signs of a PE?

Answer 27

Dyspnea
Tachypnea
Pleuritic Chest Pain

Question 28

How are the Well’s criteria for a PE interpreted?

Answer 28

a. 0-2 points = low risk
b. 3-6 points = moderate risk
c. >6 points = high risk

Question 29

17. What are the current established signs and symptoms of COVID-19? What constitutes a fever? (11)

Answer 29

1. Fever or chills (100.4+)
2. Cough
3. Shortness of breath or difficulty breathing
4. Fatigue
5. Muscle or body aches
6. Headache
7. New loss of taste or smell
8. Sore throat
9. Congestion or runny nose
10. Nausea or vomiting
11. Diarrhea

Question 30

What are the emergency warning signs of Covid-19? What should you do if anyone is showing these signs?

Answer 30

◦ Hypoxemia [may be asymptomatic for hypoxemia]
◦ Trouble breathing
◦ Persistent pain or pressure in the chest
◦ New confusion
◦ Inability to wake or stay awake
◦ Bluish lips or face

seek immediate emergency care if displaying these signs

Question 31

18. List as many clues that would prompt you to screen for a pulmonary condition as you can.

Answer 31

•Hx of smoking for many years
•Hx of breast, prostate, kidney, pancreas, colon or uterine CA
•Recent upper respiratory infection
•MSK pain 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

Question 32

Guidelines for immediate medical attention

Answer 32

1. Abrupt onset of dyspnea with weak and rapid pulse and fall in BP
2. Symptoms of inadequate ventilation

Question 33

Guidelines for MD referral (6)

Answer 33

1. Shoulder pain aggravated by respiratory movements
2. Shoulder pain aggravated by supine positioning (worse when lying down and improves with sitting up/leaning forward)
3. Shoulder/chest pain that subsides with auto-splinting
4. Signs of asthma during exercise
5. Presence of persistent cough, dyspnea or constitutional symptoms
6. Any red flag signs and symptoms in a client with a previous history of CA, especially lung CA