2 of 3 Flashcards
(138 cards)
0
Q
Types of Pneumothorax?
A
Traumatic (open vs closed)
Spontaneous
Secondary
Tension
1
Q
Pneumothorax
what is it?
A
Free air within the intra pleural space
2
Q
What causes an open pneumothorax of the traumatic type?
A
Stabbing
3
Q
What causes a closed Traumatic Pneumothorax?
A
Blunt force trauma, or broken rib entering the lungs
4
Q
Rupture of a bleb or bulla (enlarged acinar unit), in response to high negative intrapleural pressure, commonly seen in healthy males 20-40 years old. Patient presents with chest pain and dyspnea with few physical findings…. Dx?
A
Spontaneous Pneumothorax
5
Q
This kind of pneumothorax occurs as a complication of COPD and other lung Dz, especially Emphysema because the alveoli walls are digested by an enzyme making one single big open space, meaning lower overall absorption due to decreased surface area and also decreased compliance. The consequences are more severe given the underlying pathology…
A
Secondary Spontaneous Pneumothorax
6
Q
A check valve effect from a small tear allows air to enter the intrapleural space during inspiration and prevents air from leaving during expiration. Can lead to lung collapse.What type of Pneumothorax?
A
Tension
7
Q
Sx: decreased chest expansion, decreased tactile fremitus, decreased breath sounds, hyper resonance on percussion, contralateral mediastinal and or tracheal shift, severe tachycardia, possibly some cyanosis….
Dx?
A
Tension Pneumothorax
8
Q
Sx:
a few weeks of: SOB/DOE, Angina Pectoris, paroxysmal nocturnal dyspnea, palpitatins, presyncope/syncope, unexplained diaphoresis, symptoms of minor TIAs (strokes), leading up to chest pain that lasts longer than 30 minutes and is not relieved by rest or nitro-glycerine, tablets, but can also be clinically silent, and some older patients only report some dyspnea. Patient now presents with anxiety and mental confusion, nausea and diaphoresis, complains of palpitations, has pallor and possible cyanosis, and insists that they “just don’t feel well” although they can’t tell you why, and aren’t even nauseaus. Sometimes there was no prodrome. What’s the Dx?
A
Myocardial Infarction
9
Q
What’s a myocardial infarction?
A
Myocardial Ischemia with irreversible tissue necrosis
10
Q
Is there necessarily a prodrome to MIs?
A
NO
11
Q
Can an MI occur while sleeping?
A
YES
12
Q
Physical findings of:
Decreased peripheral pulses, heart murmurs on auscultation, irregular tachycardia, pulsus alternans….
Dx?
A
Myocardial Infarction
13
Q
What are the cardinal Sx of Heart Disease and MI?
A
Dyspnea Chest Pain (Pre) Syncope TIAs Fluid Retention (pitting edema) Others (cough or hemoptysis, fatigue, nocturia or polyuria, cyanosis, weight loss, inappropriate diaphoresis)
14
Q
DOE
possible reasons for it?
A
Heart Dz
Lung Dz
Deconditioning
Anemia
15
Q
DOE - when do we figure its most likely heart Dz?
A
When it’s progressive
16
Q
PND - what is it?
A
Paroxysmal Nocturnal Dyspnea
17
Q
What’s PND mostly associated with?
A
It’s the MOST SPECIFIC form of Dyspnea associated with Heart Disease
(more severe)
18
Q
When does PND occur? Why?
A
after being asleep or recumbent for >1hr More fluid returning from lower extremities = venous overload => pulmonary congestion =>Dyspnea
19
Q
What’s Orthopnea?
A
Dyspnea that occurs soon after recumbency
20
Q
Why does orthopnea happen?
A
interstitial fluid return from extremities
=>venous overload
=>pulmonary congestion
=>dyspnea
21
Q
Whats the difference between Paroxysmal Nocturnal Dyspnea and Orthopnea?
A
PND: >1hr after recumbency
Orthopnia: right after recumbency
22
Q
Dyspnea at rest (just hanging out, not recumbent)- what does it mean?
A
Severe cardiac Dz
Also occurs with Chronic Obstructive Pulmonary Dz
23
Q
What does Pulmonary mean?
A
Of or relating to LUNGS :-)
24
What's the Sx of Angina Pectoris?
Levine's Sign (clenched fist over the sternum during attack)
Crushing, gripping and diffuse pain
may radiate to neck, shoulders, arms, jaw, back, and epigastrium
is abrupt
only lasts 2-3 minutes (although it feels like 15+)
*relieved by rest and recumbancy
*relieved by nitro-glycerine tablets*
25
Types of Cardiac Chest Pain:
```
Angina Pectoris
Typical Angina
Atypical Angina
Pericarditis
Refereed Pain Patterns
```
26
What's Syncope?
loss of Conciousness or near loss of it
27
What's a Brachium?
arm, esp: shoulder to elbow
28
What do older patients generally experience during a cardiac attack rather than chest pain?
Syncope or Pre-syncope
29
What's Pericarditis?
Inflammation of the parietal pericardium
30
Sharp or achy pain that radiates, but rarely into the arms. It's exacerbated by inspiration and by recumbency. When auscultated over the heart, it sounds like 2 wet pieces of leather rubbing together.
Dx?
Pericarditis
31
What causes (Pre) Syncope (the actual mechanism, not the Dz)
global reduction of cerebral circulation
32
Types of Syncope
```
Vasovagal
Orthostatic Hypotension
Situational
Recurrent
Cardiogenic
Palpitations
```
33
Which are the benign forms of Syncope?
Vasovagal
Orthostatic Hypotension
Situational
34
What's vasovagal Syncope?
| what's it from?
the common faint
fear/shock/etc.
sudden peripheral vasodilation without compensatory increase in venous return and /or cardia output
35
Sudden peripheral vasodilation without compensatory increase in venous return and/or cardia output.... what's this?
Vasovagal Syncope
36
BP falls 20mm Hg upon standing, heart rate increases... what's this?
Orthostatic Hypotension
37
Excessive vagal tone in response to physiogenic reflexes such as coughing or defecation. Possibly killed Elvis. What is it, and why does it do this?
Situational Syncope
increased intra-abdominal pressure = pressure on the vasovagal nerve
38
This type of syncope is cause for immediate concern:
Reccurrent Syncope
may be Heart Dz, Pulmonary Embolism, CVA, absent seizure, etc
39
This type of syncope has few prodromal symptoms, is often spontaneous, and is associated with palpitations...
Cardiogenic Syncope
40
What are palpitations?
Disagreeable awareness of the heart beat skipping or fluttering
Not specific to Heart Dz
41
Causes of Palpitations?
Stress
Serious Heart Dz
can be benign or really bad
42
What's a TIA?
Transient Ischemic Attack
43
What's Amaurosis Fugax?
transient monocular blindness
44
What's Aphasia?
Loss of expression - written or spoken
45
What's Hemiparesis?
Hemiplegia
46
What's the two types of TIAs?
Carotid Artery
| Vertebrobasilar
47
```
Amaurosis Fugax (transient monocular blindness), aphasia, hemisensory deficit or hemiparesis (fingers/hands or arm/leg/hand+face)
Dx?
```
Carotid Artery TIA
48
Bilateral visual loss (dark or blurred visioin), Ataxia (failure of muscular coordiantion, staggering gait and veering towards one side), crossed motor and sensory deficits, numbness on one or both sides, some combo of: vertigo, syncope, dysarthria (difficult articulation of speech), diplopia (double vision), nausea, dysphagia, drop attack
Dx?
Vertebrobasilar TIA
-person will veer towards side of lesion
49
What's a Transient Ischemic Attack?
Focal neurological deficit of acute onset
50
How soon does a TIA resolve?
24 hours
51
what causes a TIA?
emboli from proximal source such as the heart may be responsible for more than 20%
Carotid: atherosclerosis at carotid bifurcation (usually)
Vertebrobasilar: intra/extra cranial in origin
SLE, Giant Cell Arteritis, Polycythemia can cause some (less common)
52
What's a TIA patient most likely to die of?
Heart Disease
53
Right Sided Heart Failure?
Blood backs up in the veins
---> systemic edema, esp in lower limbs
54
Left Sided Heart Failure?
Blood backs up in the lungs
- > pulmonary edema
- > SOB
- --> eventually => R-Sided H failure
55
Backwards Heart Failure?
The ventricle is not pumping out all the blood that comes into it.
systemic or pulmonary Edema
56
Forward Heart Failure?
Heart not pumping out enough blood for body.
a) Less blood to kidneys
=> K conserve salt/ water
=> excess fluid retention and edema
b) Less blood to organs
=> weakness, fatigue
57
What differentiates Cardiogenic Edema?
Soft and Pitting
Lower Extremities (if patient can walk)
Associated with peripheral edema, weight gain, bloating, liver or spleen hypertrophy causing abdominal pain, vomiting, diarrhea, jaundice
Can also se distention of jugular or chest wall capillary beds
58
What are the Non-Specific Sz of Heart Dz?
```
Cough or Hemoptysis
Fatigue
Nocturia or Polyuria
Cyanosis
Weight Loss (especially if also accumulating fluid in the abdomen)
Inappropriate Diaphoresis
```
59
Why is inappropriate diaphoresis associated with Heart Dz?
Sympathetic Nervous compensation for reduced cardiac output
60
what is CHF?
Congestive Heart Failure
61
What are the two types of Congestive Heart Failure?
```
Mitral Regurgitation (Insufficiency)
Mitral Valve Prolapse
```
62
What causes MR (Mitral Regurgitation/Insufficiency)?
Deformation of the valve annulus or cusps (or both)
| Changes in the chordae tendinae/ papillary muscles (or both)
63
What are the two biggest issues seen with Mitral Regurgitation (MR)/ Insufficiency?
```
Pulmonary Hypertension (Left BACKward Failure)
Reduced Cardiac Output (Left FORward Failure)
```
64
Chronic cough and exertional dyspnea, PND, orthopnea, distended neck veins, rales, peripheral edema, and painful hepatic congestion:
Dx?
Pulmonary Edema
65
Chronic Cough plus Exertional Dyspnoea
| Dx?
Pulmonary Hypertension
66
Pulmonary Hypertension plus Pulmonary Edema
| Dx?
Left Backwards Heart Failure from Mitral Regurgitation (Insufficiency)
67
Left ventricle may be decompressed into the left atrium during ejection. Inefficiency causes the left ventricle to become enlarged and hypertrophic and may eventually become non-compliant, giving Sx of reduced cardiac output (decreased exercise tolerance with very little exertion, severe fatigue and weakness)... what is this?
Left Forwards Failure from Mitral Regurgitation (MR) / Insufficiency
68
What is Mitral Valve Prolapse?
Abnormal systolic displacement of one or both of the mitral valve leaflets superior and posterior into the left atrium
69
What is MVP?
Mitral Valve Prolapse
70
Who does MVP (Mitral Valve Prolapse) usually affect?
17% of young women and girls
| Slightly more females than males
71
Chest pain, palpitations, easy fatigue-ability and exercise intollerance, dyspnea, dizziness with pre-syncope Sx, orthostatic hypotension, vascular flushing and cold extremities, anxiety and panic attacks, irritable bowel syndrome, sleep disturbances, headache, arrhythmias.
Dx?
MVP - Mitral Valve Prolapse
72
Complications of MVP?
```
MVP complications (Mitral Valve Prolapse):
MVR (esp for men/old/HTN/obese)
Infective endocarditis
cerebrovascular accidents (strokes)
sudden death (esp during exercise)
```
73
Who is MVP most dangerous for?
Men - because in women it tends to be benign, but in men, it tends to be a Sx of something much worse.
74
Cardinal Sn/Sx of Respiratory Dz?
*Excessive Nasal Secretions --- beware head trauma
*Cough - non productive vs productive
Hemoptysis
Dyspnea
Pulmonary Chest Pain -- Superficial vs Deep
75
Non Productive Coughs can indicate which Dz?
Pulmonary Emphysema
Viral or Mycoplasma Pneumonia
Athsma
76
Productive Coughs can be a Sx/Sn of which types of Dz?
Chronic Bronchitis
Bacterial Pneumonia
Lobar Pneumonia
URTI (Upper Respiratory Tract Infection such as Bronchitis)
77
What does sticky and clear sputum indicate?
Possible Bronchiole infection
78
What does sticky and white or grey sputum indicate?
Possible Chronic Bronchitis
79
What does translucent green or yellow sputum indicate?
Possible Acute Bronchitis
80
What does Yellow, Green, and Purulent sputum indicate?
Possible Bacterial Infection
81
What does Pink and Frothy sputum indicate?
Possible Pulmonary Edema
82
What does Foul Odoured sputum indicate?
Possible Bronchiectasis, Lung Abscess
83
What is Hemoptysis?
Expectoration of Frank Blood
84
Causes of Hemoptysis?
> 100 causes
* Chronic Bronchitis
* Tuberculosis / Bronchiectasis
* Bronchogenic Carcinoma
* Left Ventricular Failure
* Mitral Valve Stenosis
* Trauma
* Lung Dz
* Lungs just damaged from coughing ---- most common
85
Types of Superficial Pulmonary Chest Pain?
Thoracic Cage --- skin/ribs/cartilage/intercostals/nerves
Pleuritic Pain --- inflammatory or non inflammatory
Neuro Muscular System
Muscular
Atelectasis
Pneumothorax
Diaphragm issues
86
Superficial Pulmonary Chest Pain that is neuro-muscular in origin will have which defining Sn?
aggravated by moving/coughing/breathing
87
Superficial Pulmonary Chest Pain of Muscular origin (not neuro muscular) will have which defining characteristic?
aggravated by deep palpation
88
Pulmonary Chest pain from either Atelectasis or Pneumothorax will have which defining characteristics?
Very sharp, very well localized
89
Superficial Pulmonary Chest pain that is caused by diaphragm issues will have which defining characteristics?
Travels via 5th and 6th intercostal nerves (thorax)
| Pain from posterior diaphragm can refer to the thoracic spine like kidney or pancreatic pain
90
What kinds of pain may refer to the thoracic spine?
Kidney
Pancreatic
Diaphragm
91
What's the phrenic nerve's route (vertebrae)?
C3-5
92
What's deep pulmonary chest pain like?
poorly localized unless from trachea and larger bronchi
less easily aggravated
raw, burning, substernal pain
aggravated by coughing
93
What kind of pain can mimmic a heart attack?
Pulmonary emboli
94
What kind of pain may mimic angina pectoris?
Pulmonary Hypertension
95
Where are Bronchial or tracheal breath sounds auscultated
Over the trachea and larger bronchioles
96
What are normal bronchial breath sounds like?
Harsh and loud
louder during expiration
Darth Vader
97
What are Vesicular breath sounds like?
soft, low pitched, breezy
| louder during inspiration
98
Where do you auscultate vesicular breath sounds?
over:
lung parenchyma
terminal bronchioles
99
What are bronchivesicular sounds?
combo of bronchial and vesicular
100
Where are bronchovesicular sounds auscultated?
parasternally
101
What are the main two types of abnormal breath sounds?
Rales / Crackles
| Ronchi
102
What are the types of Rales / Crackles?
Basilar Rales
| Coarse Rails
103
What are discontinuous sounds or crackles heard over the lungs associated with?
air passing through fluid
104
What are Basilar Rales associated with?
Pulmonary Edema from CHF
105
What are Coarse Rales associated with?
they are the loud crackles associated with the *resolution* of lobar pneumonia
106
Are Ronchi Discontinuous or Continuous sounds?
Continuous
107
Are Rales discontinuous or continuous sounds?
Discontinuous
108
What are the two types of Ronchi?
Monophonic Wheeze
| Pleural Friction Rub
109
what's a monophonic wheeze associated with?
occlusion of airway at solitary site (tumor/marble/etc)
110
what's a pleural friction rub associated with?
Auscultated Crackle emanating form the site of pleural effusion
111
What might you find upon inspection when looking at a patient with Respiratory Dz?
Effort of respiration
Shape of Thorax is off
Thoracic Excursion is greater than or less than 3-5 cm
Respiration rate is off
112
What shapes of Thorax are Abnormal?
```
Ovoid/ barrel Chest
Pectus Excavatum (Funnel Chest)
Pectus Carinatum (Pigeon Chest)
Kyphoscoliosis (upper body pushed to one side)
```
113
What's the normal respiration rate for a newborn?
30-40 breaths per minute
114
what's the normal breath rate for a 2-5 year old?
24-28 breaths per minute
115
What's the normal breath rate for an adult?
12 to 20 breaths per minute
116
What does a moderate barrel chest tend to indicate?
Late Chronic Bronchitis
117
What does a severe barrel chest tend to indicate?
Late Pulmonary Emphysema
118
What is Kernig's Sign?
supine patient may flex the hip on the involved side attempting to relieve pain
Renal Pathology
119
What are some signs of Renal Pathology?
```
Kernig's Sign (flexes hip on that side)
Thoracolumbar Pain/ Tenderness
Systemic Chills and Fever
Murphy's Punch
Heel Jar Test
```
120
What's Murphy's Punch?
percuss the kidney on the NON affected side with firm force. An inflamed kidney will be REALLY painful even though punch was on opposite side
121
What's the Heel Jar Test?
With patient supine, strike heel pads with an open palm to elicit the symptomatic pain.
122
What's Tactile Fremitus?
perceptible vibration over the lung field when talking. Only works if airways are open.
123
What's Decreased Tactile Fremitus a sign of?
Pulmonary Emphysema
| Pleural Pathologies
124
What does increased tactile fremitus indicate?
Consolidation - lobar pneumonia
125
Why does Percussion precede Auscultation?
so that you can knock the gross stuff loose so that you can hear it rattle around better
126
What general condition results in hyper resonant notes on percussion over the lung field?
decreased lung tissue density
127
What does hyper resonant percussion over the lung field indicate for specific conditions?
Emphysema
| Tubercular Cavitation
128
What general condition makes a dull note on percussion over the lung field?
Increased lung tissue density
129
What does a dull note on percussion over the lung fields indicate?
Bacterial Lobar Pneumonia
| Pleural Effusion
130
Clinically significant DOE, objective evidence of reduced airflow that is not explained by infiltrative lung disease or by pre-existing heart disease.... Dx?
COPD
131
What are the types of COPD?
```
Chronic Bronchitis
Pulmonary Emphysema
Asthma
Bacterial Lobar Pneumonia
Obstructive Atelectasis
Pneumothorax
Pleural Effusion
Neoplastic Tumors
```
132
persistent, mucus producing cough on most days for over 3 months, of two or more successive years. Smoker or chronically exposed to lung irritants, early childhood lung Dz or severe allergies, deficient immune system, partial broncial obstruction from mucus hyper secretion, prone to athsma attacks, secondary structural changes like loss of cilia, eventual hypoxemia and pulmonary hypertension with the potential for right sided heart failure. Painless. Moderate barrel chest, DOE, productive mucoid hack with clear white sputum, prolonged inhaling and exhaling times, overweight, edema, jugular vein distension or hepatomegaly, eventual digital clubbing, blue bloater. Dx?
Chronic Bronchitis.
133
Blue Bloater is associated with which Dz?
Chronic Bronchitis
134
Does Chronic Bronchitis hurt?
No
135
Digital clubbing or hypertrophy of soft tissues of the terminal phalanges.... what's it from and what's it associated with?
Chronic hypoxemia
| Chronic Bronchitis
136
Rhonchi and rales over most or all of the lung fields, bronchiolar constriction producing wheezes, consolidation of certain lobes possibly exaggerating breath sounds.... associated with?
Chronic bronchitis
137
What are some complications of Chronic Bronchitis?
```
less O2 = hypoxia
=>abnormal blood gasses
=> R-Sided Heart Failure
=> Recurrent Lung Infections
=> Lung Cancers
```
