Chapter 305 - Approach to the Patient with Disease of the Respiratory System Flashcards
The diseases of the respiratory system fall into three main categories. Name them and choose which one is the most frequent. Can you give examples of specific disease that might fall into more than one of the previous categories?
(1) Obstructive lung disease, which is the most frequent
(2) Restrictive disorders
(3) Abnormalities of the vasculature
“Although many specific diseases fall into these major categories, both infective and neoplastic processes can affect the respiratory system and result in myriad pathologic findings, including those listed in the three categoreies above.”
What are the cardinal symptoms of respiratory disease?
Dyspnea and cough.
Patients might describe dyspnea differently, which can be suggestive of different pahotological processes. Make the correspondence between the expression used to describe dyspnea and what disease it might suggest: (a) “Chest tightness”; (b) “inability to get a deep breath”; (c) “air hunger”.
(a) , (b) - Pulmonary obstrutive diseases
(c) - Congestive heart failure
Dyspnea on exertion is an early symptom of underlying lung or heart disease.
True or False?
True.
In evaluating dyspnea on exertion there are two aspects that should be thoroughly investigated. What are those?
Determine the degree of exertion that causes dyspnea and/or adaptation of the patient to a new level of activity to accomodate their progressive limitation. The second aspect is fundamental since many patients limit their activity and do not complain about symptoms on exertion, simply because they limit their activity.
What is the cutoff for chronic cough?
More than 8 weeks.
Name the “nonrespiratory” causes of cough.
Gastrointestinal diseases (such as gastroesophageal reflux), cardiac diseases as well as psicogenic causes.
Which diseases are associated with chronic cough?
Obstructive lung diseases, particularly asthma and chronic bronchitis, aswell as gastroesophageal reflux, postnasal drip and intesticial pulmonary fibrosis.
The cough is usually productive in idiopathic pulmonary fibrosis.
True or False?
False.
“Diffuse parenchymal diseases, including intersticial pulmonary fibrosis, frequently present as a persistent, nonproductive cough.”
Pulmonary hypertension can be the cause of chest discomort.
True or False?
True.
Pulmonary chronic diseases might occur with left heart failure symptoms, due to cor pulmonale.
True or False?
False.
Cor pulmonale is due to overload to the right side of the heart.
Smoking habits might be associated with different lung diseases. Name four examples.
“Chronic Obstructive Pulmonary Disease and bronchogenic lung cancer but also a variety of diffuse parenchymal lung diseases (e.g., desquamative intersticial pneumonitis and pulmonary Langerhans cell histiocytosis).”
What should the physical examination should focus on if you suspect rheumatologic or autoimmune diseases with respiratory involvement?
Question should focus on joint pain or swelling, rashes, dry eyes, dry mouth, or constitutional symptoms.”
How do you distinguish pneumonia from pleural effusion on thoracic physical examination?
Palpation is a useful tool since tactile fremitus will be inscreased in the first and diminished in the former.
How do you distinguish pneumothorax from pleural effusion on thoracic physical examination?
Percussion is a useful tool in this setting since the sound will be hyper-resonant in the first and dull in the former.
