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S7- Differential Diagnosis > Week 6- Screening For Pulmonary Disease > Flashcards

Week 6- Screening For Pulmonary Disease Flashcards

1
Q

PART 1

A

PART 1

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2
Q

Pulmonary screening may need to be performed with patients presenting with referred pain where? (3)

A
  • neck
  • shoulder
  • back
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3
Q

What are the (4) most common pulmonary conditions that can mimic MSK disorders?

A
  • Pneumonia
  • Pleurisy
  • Pneumothorax
  • Pancoast’s Tumor
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4
Q

Previous Hx of _______ is a red flag and risk factor for reoccurrence.

A

cancer (primary lung cancer or cancer that commonly metastasize to the lung)

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5
Q

What are the (5) S//Sx of pulmonary disorder? Which 2 are the most common?

A
  1. ) Cough***
  2. ) Dyspnea***
  3. ) Cyanosis
  4. ) Clubbing
  5. ) Altered Breathing Patterns

-May also demonstrate chest pain, abnormal sputum, hemoptysis.

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6
Q

Cough:

  • Can be ___________ cough or ______ cough.
  • What are the (4) presentations of productive cough and what do they indicate?
A

-persistent dry cough or productive cough

  1. ) purulent (infection)
  2. ) non-purulent (airway irritation)
  3. ) rust-colored (pneumonia)
  4. ) hemoptysis (pathological condition)
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7
Q
  • _______ is a bluish coloration of skin and mucous membranes.
  • ________ usually indicates hypoxia.
  • __________ involve change in rate, depth, regularity, and effort.
  • _________ is a thickening/widening of terminal phalanges of fingers and toes.
A
  • Cyanosis
  • Dyspnea
  • Altered Breathing Patterns
  • Clubbing
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8
Q
  • When does clubbing require immediate medical attention?

- What is a test used to assess for clubbing?

A
  • Rapid development over 10-14 day period.

- Schamroth’s Sign

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9
Q

What are the most common referral sites for pulmonary pain? (5)

A
  1. ) chest
  2. ) ribs
  3. ) upper trap
  4. ) shoulder
  5. ) thoracic spine
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10
Q

Pulmonary Pain Patterns:

  • What are (2) things that indicate pain is coming from a pulmonary source?
  • Will palpation and resisted movements reproduce pain?
  • Symptoms may worsen with what position?
A
  • Increases with inspiratory movements. Pt notes dyspnea, persistent cough, fevers and chills.
  • NO
  • recumbent positioning
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11
Q

Pleural vs Diaphragmatic Pleural Pain:

Pleural

  • Pleural irritation is _____, _______ pain.
  • ___________ (prefer to lie on side involved in order to decrease symptoms)
  • Present pleurisy, pneumonia, pulmonary infarct, tumor, pneumothorax.

Diaphragmatic Pleural Pain

  • Peripheral portions: Sharp pain along ___________ (can refer to _______ region).
  • Central portions: Sharp pain referred to _________/_______ on _________ side of stimulation.
A

Pleural

  • sharp, localized pain
  • Autosplinting

Diaphragmatic Pleural Pain

  • costal margins (can refer to lumbar region)
  • upper trap/shoulder on ipsilateral side
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12
Q

What will be done if a cluster of S/Sx are noted for pulmonary involvement?

A

Pulmonary Review of Systems

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13
Q

PART 2: PATHOLOGIES

A

PART 2: PATHOLOGIES

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14
Q

Pulmonary Pathologies. (12)

A
  1. ) Pneumonia
  2. ) Lung Cancer (Pancoast’s Tumor)
  3. ) Pleurisy
  4. ) Pneumothorax
  5. ) COPD
  6. ) Emphysema
  7. ) Asthma
  8. ) Tuberculosis
  9. ) Systemic Sclerosis Lung Disease
  10. ) Cystic Fibrosis
  11. ) Pulmonary Embolism
  12. ) COVID-19
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15
Q

Pneumonia:

  • Inflammation of the lungs caused by what? (3)
  • Does it affect one or both lungs?
  • Often follows the _______.
  • What are the (3) types of pneumonia?
A
  • Aspiration (foods, fluids, vomit), Inhalation of toxic/caustic chemicals, Bacterial/viral/mycoplasmal infection
  • Can affect 1 or both lungs.
  • flu
  • Hospital, ventilation, and community
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16
Q

Pneumonia Risk Factors. (10)

A
  • Very young, very old***
  • Smoking***
  • Upper respiratory infection***
  • Endotracheal intubation, NG tube***
  • Immunosuppressive therapy ***
  • Air pollution
  • Altered consciousness
  • Recent chest surgery
  • AIDS
  • Aspiration of oral/gastric material
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17
Q

Pneumonia S/Sx. (12)

A
  • Sudden/sharp pleuritic chest pain***
  • Shoulder pain***
  • Hacking, productive cough
  • Dyspnea
  • Tachypnea
  • Cyanosis
  • HA
  • Fever/chills
  • Generalized aches/myalgia
  • Knees may be painful/swollen
  • Fatigue
  • Confusion in older adults
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18
Q

Lung Cancer:

  • Malignancy in epithelium of respiratory tract, grouped into what 2 categories?
  • ____ most commonly diagnosed cancer in men and women.
  • Metastasizes usually to long bones, vertebral column, liver, adrenal glands, and ______.
  • What cancers are more likely to metastasize to the lungs? (5)
  • PMH of lung cancer with new onset of ________ warrants further investigation.
A
  • small cell and non-small cell
  • 2nd
  • brain
  • kidney, breast, pancreas, colon, and uterus
  • back pain
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19
Q

Lung Cancer Risk Factors. (8)

A
  • Greater than 50 yo
  • Tobacco use***
  • Previous tobacco-related cancer
  • Second-hand smoke
  • Low consumption of fruits and vegetables
  • Genetic predisposition
  • Exposure to air pollution, toxic chemicals, fumes, radon gas
  • Previous lung disease
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20
Q

What is the greatest risk factor for lung cancer and accounts for ~82% of deaths?

A

Tobacco use

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21
Q

Lung Cancer S/Sx. (13)

A
  • 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
22
Q

Lung Cancer (Pancoast’s Tumor):

  • What is it?
  • Frequently involve ____ cervical and _____ thoracic nerve.
  • Presents in distribution of ___-___ dermatomes. (loss of hand function, Horner’s syndrome)
  • What is the most common initial symptom?
  • Can mimic ___________.
A
  • Tumor of the lung apex.
  • 8th cervical and 1st thoracic
  • C8-T2 dermatomes
  • sharp (posterior) shoulder pain
  • TOS
23
Q

Pleurisy:

  • What is it?
  • May occur as a result of Pneumonia, TB, lug abscess, flu, SLE/RA, pulmonary infarction.
A

-Inflammation of pleura caused by infection, injury, or tumor.

24
Q

Pleurisy S/Sx. (6)

A
  1. ) Can refer to shoulder, upper trap, neck, lower chest wall or abdomen***
  2. ) Chest pain
  3. ) Cough
  4. ) Dyspnea
  5. ) Fever, chills
  6. ) Tachypnea
25
Q

Pneumothorax:

  • What is it?
  • What is spontaneous pneumothorax?
A
  • Free air in pleural cavity between visceral and parietal pleurae.
  • Air escaped into pleural space from puncture or tear in an internal respiratory structure.
26
Q

Pneumothorax S/Sx. (9)

A
  1. ) Dyspnea***
  2. ) Sudden sharp chest pain
  3. ) Change in respiratory movements
  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
27
Q

COPD:

  • What is it?
  • What are a few disorder that fall under COPD? (3)
  • What is the most common predisposing factor of COPD?
A
  • Refers to a number of disorders that result in a narrowing of the airways obstructing airflow to and from the lungs.
  • Bronchitis, emphysema, and asthma
  • Cigarette smoking
28
Q

Emphysema:

  • May develop after long Hx of chronic _________.
  • Alveolar walls are destroyed causing permanent overdistention of air spaces and loss of normal elastic tension in the lung tissue.
  • Also causes destruction of pulmonary __________.
A
  • chronic bronchitis

- pulmonary capillaries

29
Q

Emphysema S/Sx. (13)

A
  1. ) SOB
  2. ) Dyspnea on exertion
  3. ) Orthopnea
  4. ) Chronic cough
  5. ) Barrel chest***
  6. ) Weight loss
  7. ) Malaise
  8. ) Use of accessory muscles of respiration
  9. ) Prolonged expiratory period
  10. ) Pursed-lip breathing***
  11. ) Increased respiratory rate
  12. ) Peripheral cyanosis
30
Q

Asthma:

  • Reversible ______ lung disease.
  • _______ reaction of the airways to various stimuli.
  • Can be life threatening if not managed.
  • What are the (3) categories of asthma?
A
  • obstructive
  • increased
  • conventional asthma, occupational asthma, exercise-induced asthma
31
Q

Asthma S/Sx.

  • Listen for: (6)
  • Look for: (5)
A

Listen for:

  1. ) Wheezing
  2. ) Irregular breathing with prolonged expiration
  3. ) Noisy, difficult breathing
  4. ) Episodes of dyspnea
  5. ) Clearing the throat
  6. ) Cough with or without sputum

Look for:

  1. ) Skin retractions (between the ribs)
  2. ) Hunched-over body position
  3. ) Pursed-lip breathing
  4. ) Nostrils flaring
  5. ) Unusual pallor or unexplained sweating
32
Q

What are some factors that may trigger asthma? (7)

A
  • 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
33
Q

Tuberculosis:

  • What is it?
  • Most often involves the lungs; however, _________ TB may affect the kidneys, bone growth plates, lymph nodes, and meninges.
  • Rare, but TB may affect _________ and ________ (Potts Disease).
A
  • Bacterial infectious disease usually spread by airborne droplets from actively infected person.
  • extrapulmonary TB
  • hip joints and vertebrae
34
Q

TB S/Sx. (9)

A
  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
35
Q

TB Risk Factors (7)

A
  • Health care workers
  • Older adults
  • Overcrowded housing
  • Alcohol or chemical dependency
  • Infants and children <5
  • Reduced immunity/malnutrition
  • RA, DM, end stage renal disease, GI disease
36
Q

Systemic Sclerosis Lung Disease (Scleroderma):

  • Characterized by ________ and _______ of many organs.
  • ___________ lung disease of unknown etiologic origin.
  • Lungs 2nd most common organ targeted.
  • Causes interstitial fibrosis.
A
  • inflammation and fibrosis

- Restrictive lung disease

37
Q

Sleroderma S/Sx. (7)

A
  1. ) Dyspnea on exertion
  2. ) Nonproductive cough
  3. ) Peripheral edema
  4. ) Orthopnea
  5. ) Paroxysmal nocturnal dyspnea
  6. ) Hemoptysis
  7. ) Skin changes typically precede visceral alterations***
38
Q

In scleroderma, what can happen due to the abnormal build-up of fibrous tissue in the skin?

A

Skin tightens so severely that the fingers curl and lose their mobility.

39
Q

Cystic Fibrosis:

  • What is it?
  • Usually manifests in _____________.
A
  • Inherited disease of exocrine glands (defective copy of CFTR) causing salt to accumulate in cell lining in lungs and digestive tissues.
  • early childhood
40
Q

Cystic Fibrosis S/Sx. (6)

A
  1. ) Exertional dyspnea with decreased exercise tolerance***
  2. ) Tachypnea
  3. ) Sustained chronic cough with mucus production and vomiting
  4. ) Barrel chest
  5. ) Use of accessory muscles for respiration
  6. ) Cyanosis and digital clubbing
41
Q

Pulmonary Embolism:

  • Associated with high _______/_______.
  • Are deaths associated to PE preventable?
  • What is the most common cause?
  • PE related mortality estimated at __-__%.
A
  • morbidity/mortality
  • More than 50% of PE-related deaths are preventable
  • Proximal DVTs
  • 5-20%
42
Q

Pulmonary Embolism Risk Factors. (7)

A
  • Hx of PE/DVT
  • Immobility
  • Hx of abdominal/pelvic surgery
  • Total hip/knee replacement
  • Late-stage pregnancy
  • Lower limb fractures
  • Malignancy of pelvis or abdomen
43
Q

Pulmonary Embolism Clinical Manifestations:

  • What are the (3) most common presentations of PE?
  • What are some others?
A
  1. ) Dyspnea
  2. ) Tachypnea
  3. ) Pleuritic chest pain (intensified w/ deep respiration and cough)

-Persistent cough, apprehension/anxiety, tachycardia, palpitations

44
Q

PE Wells Criteria:

  • Low =
  • Moderate =
  • High =
A
  • Low = 0-2
  • Moderate = 3-6
  • High = >6
45
Q

COVID-19:

  • Caused by Severe Acute Respiratory Syndrome Coronavirus 2 (_________).
  • Transmission may occur __-__ days prior to patient becoming symptomatic, individuals may be overall __________.
  • What patients are at high risk for Covid-19?
A
  • SARS-CoV-2
  • 2-10 days, asymptomatic
  • older, male, at least 1 comorbidity, higher severity of illness scores, elevated D-dimer levels, lymphocytopenia
46
Q

Covid-19 S/Sx. (11)

A
  • Fever or chills
  • Cough
  • SOB
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • N/V/D
47
Q

What are the Covid-19 warning signs that require immediate medical attention? (6)

A
  • 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
48
Q

Clues to Screening for Pulmonary Involvement:

  • Hx of _________
  • 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 __________
  • Pain ________ by spinal motions or alterations of position
  • ______ symptoms with recumbency
  • Presence of pulmonary S/Sx
  • Autosplinting decreases pain
  • Older person with ________/_________
A
  • smoking
  • palpation
  • unchanged
  • increased
  • shoulder pain/confusion
49
Q

What are the (2) guidelines for immediate medical attention?

A
  • Abrupt onset of dyspnea with weak and rapid pulse and fall in BP
  • Symptoms of inadequate ventilation
50
Q

Guidelines for MD Referral:

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

S7- Differential Diagnosis (15 decks)

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