Chapter 15- General Approach Flashcards by Darian Oldham

What are the major symptoms of respiratory disease?

Cough
Sputum
Hemoptysis
Dypsnea (acute, progressive, or paroxymal)
Wheezing
Chest pain
Fever
Hoarseness
Night sweats

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What are some causes of dyspnea?

Airways disease
Parenchymal lung disease
Pulmonary circulation
Chest wall and pleura
Cardiac
Hemotologic 
Noncardiorespiratory

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What are the airways disease causes of dyspnea?

Chronic obstructive lung diseases
Laryngeal disorders
Tracheal obstruction or stenosis
Tracheomalacia

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What are the parenchymal lung disease causes of dyspnea?

Pneumonia
Interstitial lung disease
Obliterative bronchiolitis
Pulmonary edema due to increased vascular permeability (ARDS)
Infiltrative and metastatic malignancies

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What are the pulmonary circulation causes of dyspnea?

Pulmonary thromboembolism
Pulmonary arterial hypertension
Pulmonary arteriovenous malformation

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What are the chest wall and pleura causes of dysnea?

Pneumothorax
Pleural effusion or massive ascites
Pleural tumor
Fractured ribs
Chest wall deformities
Neuromuscular diseases
Bilateral diaphragmatic paresis

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What are the cardiac causes of dyspnea?

Pulmonary edema due to left heart failure
Pericardial effusion or constrictive pericarditis
Intercardiac shunt

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What are the hematologic causes of dyspnea?

Anemia

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What are the noncardiorespiratory causes of dyspnea?

Psychogenic
Acidosis (w/ compensatory respiratory alkalosis)
Midbrain lesion

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What should be done for PE of the chest?

Inspection
Palpation
Percussion
Ausultation

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What does inspection of the chest during PE assess for?

Observation for anxiety, distress, malnutrition, somnolence 
Chest wall shape, deformity
Respiratory rate, depth, and pattern
Paradoxic respiratory motion of chest and abdomen
Retractions
Use of accessory muscles
Pursed-lip breathing
Cyanosis

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What does palpation of the chest during PE assess for?

Tracheal deviation
Chest expansion
Vocal fremitus
Lymphadenopathy
Subcutaneous emphysema

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What does percussion of the chest during PE assess for?

Normal
Dull
or Hyperresonant

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What does auscultation of the chest during PE assess for?

Breath sounds, normal vesicular over periphery and bronchial centrally
Pleural rub
Added sounds: wheezes, crackles
stridor

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What are the physical findings that are common in pulmonary disorders?

Pleural effusion
Consolidation
Pneumothorax
Atelectasis
Bronchospasm
Interstitual fibrosis

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What is the mediastinal displacement in pleural effusion?

Heart is displaced to opposite side

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What is the chest wall movement in pleural effusion?

Reduced over affected area

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What is the vocal fremitus in pleural effusion?

Absent or markedly decreased

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What is the percussion note in pleural effusion?

Dull

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What are the breath sounds associated with pleural effusion?

Absent over fluid; bronchial breath at upper border

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What are the added sounds associated with pleural effusion?

Absent pleural rub may be found above effusion

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What are the voice sounds associated with pleural effusion?

Absent over effusion

Increased with egophony at upper border

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What is the mediastinal displacement in consolidation?

None

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What is the chest wall movement with consolidation?

Reduced over affected area

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What is the vocal fremitus associated with consolidation?

Normal or increased

What is the percussion note in consolidation?

Dull

What are the breath sounds associated with consolidation?

Bronchial

What are the added sounds associated with consilidation?

Crackles

What are the voice sounds associated with consolidation?

Increased with egobronchophony, and whispered pectoriloquy

What is the mediastinal displacement associated with a pneumothroax?

Tracheal deviation to opposite side if under pressure

What is the chest wall movement with pneumothorax?

Decreased over affected area

What is the vocal fremitus associated with pneumothorax?

Absent

What is the percussion note in pneumothorax?

Resonant

What are the breath sounds associated with pneumothorax?

absent or decreased

What are the added sounds associated with pneumothorax?

Absent

What are the voice sounds associated with pneumothorax?

Absent

What is the mediastinal displacement with atelectasis?

Ipsilateral shift

What is the chest wall movement in atelectasis?

Decreased over affected area

What is the vocal fremitus is atelectasis?

Variable

What is the percussion note in atelectasis?

Dull

What are the breath sounds associated with atelectasis?

Absent or diminished

What are the added sounds associated with atelectasis?

Crackles may be heard

What are the voice sounds associated with atelectasis?

Absent

What is the mediastinal deviation with bronchospasm?

None

What is the chest wall movement with bronchospasm?

Decreased symmetrically

What is the vocal fremitus found in bronchospasm?

Normal or decreased

What is the percussion tone in bronchospasm?

Normal or decreased

What are the breath sounds associated with bronchospasm?

Broncovesicular

What are the added sounds associated with bronchospasm?

Wheezing

What are the voice sounds associated with bronchospasm?

Normal or decreased

What is the mediastinal displacement with interstitial fibrosis?

None

What is the chest wall movement in interstitial fibrosis?

Decreased symmetrically

What is the vocal fremitus in interstitial fibrosis?

Normal or increased

What is the percussion note in interstitial fibrosis?

Normal

What are the breath sounds associated with interstitial fibrosis?

Bronchovesicular

What are the added sounds associated with interstitial fibrosis?

End-inspiratory cracked unaffected by cough or posture

What are the voice sounds associated with interstitial fibrosis?

Normal

On physical exam of a patient you find chest wall movement is reduced over the affected area, vocal fremitus is absent (or markedly decreased), percussion note is dull, bronchial breath at the upper border on auscultation, and increased egophany at the upper border. On chest xray you find the heart is displaced to the opposite side. What pulmonary disorder is the most likely diagnosis?

Pleural effusion

On physical exam you find chest wall movement is reduced over the affected area, vocal fremitus is normal (or increased), dull percussion note, bronchial breath sounds and crackles heard on auscultation, and increased voice sounds with egobronchophony and whispered pectoriloquy. On chest xray you see no mediastinal displacement. What pulmonary disorder is the most likely diagnosis?

Consolidation

On physical exam you find chest wall movement to be decreased over the affected area, vocal fremitus is absent, resonant percussion sounds, and absent or decreased breath sounds. On chest xray you find tracheal deviation to the opposite side due to tension. What pulmonary disorder is the most likely diagnosis?

Pneumothorax

On physical exam you find chest wall movement to be decreased over the affected area, vocal fremitus to be variable, dull percussion noite, absent or diminished breath sounds, crackles heard on auscultation, and absent voice sounds. Chest xray indicates an mediastinal displacement of an ipsilateral shift. What pulmonary disorder is the most likely diagnosis?

Atelectasis

On physical exam you find chest wall movements to be decreased symmetrically, normal or decreased vocal fremitus, normal or decreased percussion note, on auscultation you hear bronchovesicular breath sounds and wheezing, and voice sounds are normal or decreased. Chest xray does not show a mediastinal displacement. What pulmonary disorder is the most likely diagnosis?

Bronchospasm

On physical exam you find chest wall movements to be decreased symmetrically, normal or increased vocal fremitus, normal percussion note, auscultation results in bronchovesicular breath sounds, and end-inspiratory crackles that are unaffected by cough or posture, and normal voice sounds. Chest xray does not show a mediastinal displacement. What pulmonary disorder is the most likely diagnosis?

Interstitial fibrosis

What is paraoxysmal nocturnal dyspnea usually associated with?

CHF

What is the most common causes of cough? (there are 3)

postnasal drip asthma GERD

What are 3 lung issues that can cause chest pain?

pleural disease pulmonary vascular disease musculoskeletal pain precipitated by coughin

what are the 2 categories of breath sounds?

Bronchial | Vesicular

What are bronchial breath sounds?

heard over central airways and are louder and coarser than vesicular, longer inhaled component

What are vesicular breath sounds?

heard at the periphery and base of lungs, longer expiratory component and are much softer

What is a Hamman crunch?

crunching sound timed with cardiac cycle; heard with pneumomediastinum

What does an ABG give info about?

oxygenation and acid-base status