Pulmonary History Lecture

Question 1

4 cardinal symptoms of pulmonary disease

Answer 1

Chest pain
Dyspnea
Cough
Audible respiratory sounds

Question 2

Levine sign

Answer 2

Closed fist over chest

Indicates cardiac problem

Question 3

If a patient points at their chest pain with one finger what does this indicate?

Answer 3

Musculoskeletal problem

Question 4

If a patient points at their chest pain with open hand moving from chest to epigastrum what does this indicate?

Answer 4

GI problem

Question 5

What is lung pain?

Answer 5

• Either irritation of pleura
• Muscle pain from coughing
• Lungs have no pain fibers!

Question 6

How is cardiac pain described?

Answer 6

Crushing, squeezing, pressure

Question 7

Cardiac chest pain is a/w:

Answer 7

SOB
Diaphoresis
Radiation to left arm, neck, jaw

Question 8

6 dermatome pain

Answer 8

• Cardiac pain radiated to the left arm

- Can be a/w NV, syncope, palpitations, hypotension

Question 9

Coronary insufficiency

Answer 9

Myocardial ischemia

Question 10

Chest pain of coronary insufficiency

Answer 10

• Often triggered by exertion/stress
• Can occur following large meal
• Myocardial demand increases, coronaries can’t meet demand –> chest pain

Question 11

Pericardial chest pain

Answer 11

• Steady substernal pain worsened by breathing, swallowing, hiccuping, lying recumbent
• Has elements of cardiac & pleuritic pain
• Pain is improved by sitting or leaning forward

Question 12

Pleuritic chest pain

Answer 12

• Sharp
• Inspiration
• Shallow breathing bc of pain
• May be d/t pleurisy (inflammation vs. infection)
• A/w sudden coughing

Question 13

Sudden onset of sharp chest pain esp w/hx of trauma:

Answer 13

• Rib fracture
• PTX
• No trauma (costochondritis, herpes zoster)

Question 14

Esophageal or GI related chest pain

Answer 14

• Burning
• A/w meals
• Relieved by antacids or H2 antagonists
• Ulcers, gastritis, GERD

Question 15

Dyspnea

Answer 15

• “Air hunger”

- Need circumstances: at rest? with exertion and how much exertion?

Question 16

Associated symptoms of dyspnea

Answer 16

Swelling of ankles
Cough
Wt loss
Wheezing
Cyanosis

Question 17

Paroxysmal nocturnal dyspnea (PND)

Answer 17

Air hunger that awakens pt from sleep

“Run to the window for air”

Question 18

Cardiac PND

Answer 18

Dry non-productive cough

Question 19

Pulmonary PND

Answer 19

Productive cough w/improvement on expectoration

Question 20

Sudden onset of dyspnea could indicate:

Answer 20

PE or PTX

Question 21

Seasonal or situational dyspnea could indicate:

Answer 21

Allergy/asthma

Occupational exposure to irritants

Question 22

MC causes of coughing

Answer 22

URI

Smoking

Question 23

Causes of chronic cough:

Answer 23

Tobacco related chronic bronchitis
Post nasal drip
Occult asthma
GERD

Question 24

How to calculate pack years

Answer 24

of packs per day multiplied by # of years

Question 25

What drugs can cause chronic dry cough?

Answer 25

ACE Inhibitors

Beta blockers

Question 26

Types of sputum

Answer 26

Clear/mucoid
Purulent
Putrid
Rusty/blood stained

Question 27

Clear and mucoid sputum indicates:

Answer 27

Inhaled irritant (not infected)

Question 28

Purulent sputum indicates:

Answer 28

Infection like PNA, bacterial bronchitis

Question 29

Putrid sputum indicates

Answer 29

Anaerobic process - lung abscess, bronchiectasis

Question 30

If hemoptysis is present, rule out:

Answer 30

• Aspirated blood from epistaxis, UGI bleed

- Overlooked oral or gingival lesion

Question 31

What is the MC cause of hemoptysis in the US?

Answer 31

Acute bronchitis

Question 32

Non pulmonary sources of cough:

Answer 32

Heart disease
GERD
ENT disorders
Neurologic disease

Question 33

Stridor is usually the hallmark of:

Answer 33

Large airway (trachea, bronchus) obstruction