Week 6: Thorax/Lungs Flashcards
What are the various lung cancer screening recommendations?
USPSTF: annual screening for current smokers/those who have quit within the last 15 years if they smoked an average of 1 pack of cigarettes for 30 years and are aged 55-79
American cancer society: annual screening, through age 74
What are the cardiovascular etiologies of chest pain and how do they present? (4)
- Angina: mild to moderate; pressing, squeezing, tight, heavy, occasionally burning; closed fist; may occur during exercise/activity and resolve with rest
- MI: pressing, squeezing, tight, heavy, occasionally burning; severe pain
- Pericarditis: severe sharp, knifelike
- Aortic dissection: very severe, ripping, tearing
What is the pulmonary etiology of chest pain and how does it present?
Pleuritic pain: severe, sharp knifelike
What are the GI/other etiologies of chest pain and how do they present? (4)
- GERD: mild to severe burning, may be squeezing
- Diffuse esophageal spasm: mild to severe squeezing
- Costochondritis: variable level stabbing, sticking or dull, aching; can reproduce with ROM of upper extremities, point tenderness
- Anxiety, panic disorder: variable level stabbing, sticking or dull, aching
What are the various etiologies for dyspnea and how would these present? (9)
- Left-sided heart failure: cough, orthopnea, paroxysmal nocturnal dyspnea, wheezing
- Chronic bronchitis: chronic productive cough, recurrent respiratory infections, wheezing
- COPD: cough with scant mucoid sputum
- Asthma: wheezing, cough, chest tightness
- Diffuse interstitial lung diseases: weakness, fatigue, cough less common
- PNA: pleuritic pain, cough, sputum, fever
- Spontaneous pneumothorax: pleuritic pain, cough
- Acute pulmonary embolism: often no associated symptoms; retrosternal oppressive pain if massive occlusion; pleuritic pain, cough, syncope, hemoptysis, and/or unilateral leg swelling and pain from instigating DVT; anxiety
- Anxiety with hyperventilation: sighing, lightheadedness, numbness or tingling of the hands and feet, palpitations, chest pain
What are the etiologies for cough and hemoptysis associated with acute inflammation and how do they present? (4)
- Laryngitis: dry cough, may become productive
- Associated symptoms: acute fairly minor illness with hoarseness viral rhinosinusitis
- Acute bronchitis: cough, dry or productive
- Associated symptoms: acute often viral illness without fever or SOB; burning retrosternal discomfort
- Mycoplasma and viral pneumonias: dry hacking cough, may become productive of mucoid sputum
- Associated symptoms: acute febrile illness, often with malaise, headache and possibly dyspnea
- Bacterial pneumonias: sputum is mucoid or purulent, thick, may be blood streaked, diffusely pinkish or rusty
- Associated symptoms: acute illness with chills, often high fever, dyspnea and chest pain
What are the etiologies for cough and hemoptysis associated with chronic inflammation and how do they present? (7)
- Postnasal drip: chronic cough, sputum mucoid or purulent
- Associated symptoms: postnasal discharge may be seen in posterior pharynx, associated with allergic rhinitis with or without sinusitis
- Chronic bronchitis: chronic cough; sputum mucoid to purulent, may be blood-streaked or even bloody
- Associated symptoms: often with recurrent wheezing and dyspnea and prolonged history of tobacco use
- Bronchiectasis: chronic cough, sputum purulent, often copious and foul-smelling; may be blood-streaked or bloody
- Associated symptoms: recurrent bronchopulmonary infections common; sinusitis may coexist
- Pulmonary tuberculosis: cough, dry or with mucoid or purulent sputum; may be blood-streaked or bloody
- Associated symptoms: early, no symptoms, later anorexia, weight loss, fatigue, fever and night sweats
- Lung abscess: sputum purulent and foul-smelling; may be bloody
- Associated symptoms: usually from aspiration PNA with fever and infection from oral anaerobes and poor dental hygiene; often with dysphagia or episode of impaired consciousness
- Asthma: cough, at times with thick mucoid sputum, especially near the end of an attack
- Associated symptoms: episodic wheezing and dyspnea, cough may occur alone; often with a history of allergies
- GERD: chronic cough, especially at night or early in the morning
- Associated symptoms: wheezing, especially at night, early morning hoarseness and repeated attempts to clear the throat; heartburn and regurgitation
What is the etiology for cough and hemoptysis related to cancer and how does it present?
- lung cancer: cough, dry to productive; sputum may be blood-streaked or bloody
- Associated symptoms: commonly with dyspnea, weight loss, history of tobacco use
What are the cardiovascular etiologies for cough/hemoptysis and how do they present? (2)
- Left ventricular failure or mitral stenosis: often dry, especially on exertion or at night; may progress to the pink frothy sputum of pulmonary edema or frank hemoptysis
- Associated symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea
- Pulmonary embolism: dry cough, at times with hemoptysis
- Associated symptoms: tachypnea, chest or pleuritic pain, dyspnea, fever, syncope, anxiety; factors that predispose to DVT
How does cough/hemoptysis look on exam when related to irritating particles, chemicals or gases?
- variable, may be latent period between exposure and symptoms
- Associated symptoms: eyes, nose and throat may be affected
What exam findings would the FNP expect in the patient with pneumonia?
(General sx, percussion, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)
- General sx: pleuritic pain, cough, sputum, fever
- Percussion: Dull over airless area
- Breath sounds: bronchial over involved area
- Adventitious sounds: late inspiratory crackles over involved area
- Tactile fremitus/transmitted voice sounds: increased over involved area
What exam findings would the FNP expect in the pediatric patient with pneumonia?
- crackles, rhonchi, cough, wheeze, dyspnea, tachypnea
- Abnormal work of breathing plus abnormal findings on auscultation are the best findings for ruling out PNA (fever, tachypnea, dyspnea, and increased WOB)
- PNA is a clinical diagnosis may be present before findings on CXR
What exam findings would the FNP expect in the patient with COPD?
(General sx, chest x-ray, percussion, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)
- General sx: emphysema or chronic bronchitis
- Chest x-ray: hyperinflation (10+ ribs visible)
- Percussion: hyper resonant
- Breath sounds: decreased to absent with delayed expiration
- Adventitious sounds: none or crackles, wheezes, rhonchi
- Tactile fremitus/transmitted voice sounds: decreased
What exam findings would the FNP expect in the patient with atelectasis?
(Percussion, trachea location, breath sounds, tactile fremitus/transmitted voice sounds)
- Percussion: Dull over airless area
- Trachea: may be shifted toward involved side
- Breath sounds, tactile fremitus, transmitted voice sounds: usually absent
What exam findings would the FNP expect in the patient with pleural effusion?
(Chest x-ray, percussion, trachea location, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)
- Chest x-ray: blunting
- Percussion: dull
- Trachea: shifted toward the unaffected side in large effusion
- Breath sounds: decreased to absent, bronchial breath sounds may be heard near top of a large effusion
- Adventitious sounds: none, possible pleural rub
- Tactile fremitus/transmitted voice sounds: decreased to absent but may be increased toward the top of a large effusion
