SYMPTOMS AND SIGNS OF PULMONARY DISEASE

Question 1

Dyspnea and its origins

Answer 1

dyspnea: sensation of breathlessness that is excessive for any given level of physical activity.
Origins:
- pulmonary (disorders of airways, lung parenchyma edema..)
- extra pulmonary ( heart disease, shock, anemia..)
- paroxysmal nocturnal and orthopnea (dyspnea on recumbency, usually are caused by LV dysfunction)

Question 2

persistent cough: causes

Answer 2

• chronic, persistent cough often caused by cygarette, asthma, bronchiectasis, copd
• sometimes caused by drugs (ACE inhibitors), cardiac disease and psychogenic factors
• upper respiratory tract infection

Question 3

stridor: definition and types

Answer 3

-> criowing sound during breathing caused by turbulent airflow through a narrowed upper airway
Types: - inspiratory stridor = suggest extra thoracic airway obstruction
- expiratory stridor = suggest intrathoracic airway obstruction
- inspiratory and expiratory stridor occurring together = suggest fixed obstruction anywhere in the upper airway

Question 4

wheezes:

Answer 4

-> continuous musical or whistling noises caused by turbulent airflow through narrowed intrathoracic airways. mostly due to asthma

Question 5

Hemoptysis

Answer 5

• expectation of blood or blood tinged sputum
• often first indication of bronchopulmonay disease -> bright red, frothy blood
• causes: bronchitis, bronchiectasis, carcinoma must awlays be excluded
• massive = coughing more than 200-600 ml of blood in 24h (caused by tbc or other supportive parenchymal dis)

Question 6

signs: tachypnea

Answer 6

rapid, shallow of breathing, defined as a respiratory rate > 18/min

Question 7

signs: hyperpnea

Answer 7

rapid, deep breaths

Question 8

signs: hyperventilation:

Answer 8

increase of amount of air entering the alveoli, causing hypocapnia (defined as arterial pco2< 40 mmhg

Question 9

signs: thoracic asymmetry at rest

Answer 9

observed in scoliosis, chest wall deformity, severe fibrothorax

Question 10

signs: symmetrically reduced chest expansion

Answer 10

during deep respiration - neuromuscular disease

Question 11

sign: asymmetric chest expansion

Answer 11

during inspiration - unilateral airway obstruction

Question 12

sign: paradoxic pulse

Answer 12

a fall in systolic arterial BP of 10 mmhg or more in inspiration (the arterial BP normally falls about 5 mmhg in inspiration)
it occurs in severe asthma or emphysema, upper airway obstruction, pulmonary embolism, constrictive pericarditis or tamponade, restrictive cardiomyopathy

Question 13

sign: cyanosis

Answer 13

blich coloration of the skin or mucous membranes caused by increased amount (>5g/dl) of unsaturated Hb in the blood

Question 14

sign: types of cyanosis

Answer 14

• central cyanosis: usually caused by hypoxemia from respiratory failure or right to left she-unting, is apparent on inspection of the mucous membranes
• peripheral cyanosis: more likely due to non respiratory causes (reduced cardiac output and vasoconstriction)

Question 15

sign: digital clubbing

Answer 15

the anteroposterior thickness of the index finger at the base of the fingernails exceeds the thickness of the distal interphalangeal joint

Question 16

sign: symmetric clubbing occurs in?

Answer 16

lung cancer, bronchiectasis, lung abscess, pulmonary fibrosis and cystic fibrosis, rarely seen in chronic obstructive pulmonary disease and chronic asthma.
Nonpulmonary causes include carditis, cirrhosis and inflammatory bowel disease
Clubbing may be congenital

Question 17

sign: hyper resonance to percussion occurs in?

Answer 17

disease accompanied by hyperinflation (asthma, emphysema) and in pneumothorax

Question 18

sign: dullness to percussion

Answer 18

in thickening of the chest wall or pleura, pleural effusion, atelectasis, parenchymal infiltration or consolidation, elevation of the diaphragm or displacement of the abdominal contents into the thorax

Question 19

sign: vesicular breathe sounds

Answer 19

are normal soft, low-pitched sound heard at periphery of the lung

Question 20

sign: Harsh bronchial (tracheal) breath sounds

Answer 20

in areas where vesicular sounds are normally heard implies consolidation, compression, or infiltration of the lung

Question 21

sign: diminished breath sounds

Answer 21

implies inspiratory obstruction to airflow in lagre airway, pleural disease, pneumothorax, marked obesity

Question 22

sign: adventitious sounds

Answer 22

anormal sounds on auscultation may be classified as

• continuous (wheezes, rhonchi)
• discontinuous (crackles, crepitations or rales). they may be generated by the snapping open of small airways during inspiration

Question 23

pulmonary function test: what for?

Answer 23

measuring the ability of the respiratory system to perform gas exchange by assessing its ventilation, diffusion and mechanical properties.

Question 24

what does spirometry and lung volume allow ?

Answer 24

it allows the determination of the presence and severity of obstructive and restrictive pulmonary dysfunction

Question 25

obstructive pulmonary dysfunction:

Answer 25

• reduction of airflow rates (asthma, chronic bronchitis, emphysema, upper airway obstruction)

Question 26

restrictive pulmonary dysfunction

Answer 26

characterize by reduction in lung volumes (pulmonary infiltrates, lung resection, pleural diseases, chest wall disorders)

Question 27

tests: forced vital capacity (FVC)

Answer 27

volume of gas that can be forcefully expelled from the lungs after maximal inspiration

Question 28

Forced expiratory flow from 25 to 75% of the vital capacity (FEV 25 - 75)

Answer 28

maximal midexpiratory airflow rate

Question 29

forced expiratory volume in 1 sec FEV1

Answer 29

volume of gas that can be expelled in the first second of the FVC maneuver

Question 30

peak expiratory flow rate ( PEFR)

Answer 30

maximal airflow rate achieved in the FVC maneuver

Question 31

Maximal voluntary ventilation (MVV)

Answer 31

the maximum volume of gas that can be breathed in 1 min (usually measured for 15 sec and multiplied by 4)

Question 32

lung volumes: slow vital capacity

Answer 32

volume of gas that can be exhaled after a maximal inspiration

Question 33

lung volumes: total lung capacity (TLC)

Answer 33

volume of gas in the lungs after a maximal inspiration

Question 34

lung volumes: functional residual capacity (FRC)

Answer 34

the volume of gas in the lungs at the end of a normal tidal expiration

Question 35

lung volumes: Residual volume (RV):

Answer 35

volume of gas remaining in the lungs after a maximal expiration

Question 36

lung volumes: Expiratory volume (ERV):

Answer 36

volume of gas representing the difference between functional residual capacity and residual volume

Question 37

obstructive dysfunction

Answer 37

graded according to the reduction in the ratio of forced expiratory volume in 1 sec (FEV1) to forced vital capacity (FVC)

Question 38

restrictive dysfunction

Answer 38

graded by reduction to the FVC or total lung capacity, comparing observed values with predicted values. predicted values are derived from studies of normals and in general vary with gender, age and height

Question 39

spirometry

Answer 39

provides a spirogram that displays time versus expired volume and an expiratory flow-volume curve that plots expiratory volume versus expiratory airflow rate
If airway obstruction is evident, spirometry is repeated 10-20 MIN AFTER AN INHALED bronchodilator is administered.

Question 40

Aterial blood gas analysis

Answer 40

indicated whenever a clinically important acid-base disturbance, hypoxemia or hypercapnia is suspected

Question 41

oximetry

Answer 41

provides a mean of monitoring of oxyhemoglobin saturation with oxygen

Question 42

bronchoscopy

Answer 42

uses a fiberoptic bronchoscope used for : evaluation of airways

• diagnosis and staging of bronchogenic carcinoma
• evaluation of hemoptysis
• biopsy of lung infiltrates
• diagnosis of pulmonary infections
• removal of retained secretions and foreign bodies of the airways