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Differential Dx > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

persistent dry cough
be on the look for

A

tumor
congestion
hypersensitive airways

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2
Q

productive cough with purulent sputum
be on the look for

A

infection

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3
Q

productive cough with non-purulent sputum
be on the look for

A

nonspecific, indicates airway irritation

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4
Q

rust colored sputum
be on the look for

A

pneumonia

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5
Q

hemoptysis
be on the look for

A

A pathologic condition—infection, inflammation, abscess, tumor, or infarction

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6
Q

dyspnea

A

Usually indicates hypoxemia
Orthopnea: dyspnea when the patient is lying down

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7
Q

cyanosis

A

Bluish color of the skin & mucous membranes (more evident in lips, tongue, gums)
Depends on the O2 saturation of arterial blood & circulating hemoglobin

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8
Q

clubbing

A

Thickening & widening of the terminal phalanges
Typically result of pulmonary disease & resultant hypoxia

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9
Q

altered breathing patterns

A

Changes in the rate, depth, regularity, and effort of breathing
Observe for accessory muscles (SCM, scalenes, etc.)

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10
Q

most common pulmonary pain patterns
increases with ___

A

anterior chest, ribs, upper trap, shoulder, thoracic spine
Also refers to neck, medial arm from shoulder

Usually increases with inspiratory movements

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11
Q

Tracheobronchial Pain
referred to

A

Referred to neck & anterior chest at the same levels as the points of irritation in air passages
Trachea & large bronchi innervated by vagus trunks
Finer bronchi & lung parenchyma have no pain innervation

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12
Q

tracheobronchial pain
caused by

A

inflammatory lesions, irritating foreign materials, tumors

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13
Q

pleural pain

A

Occurs when disease extends to parietal pleura
Sharp, localized pain
Present with pleurisy, pneumonia, pulmonary infarct, tumor, & pneumothorax

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14
Q

Diaphragmatic pleural pain

A

Pain innervation from phrenic nerve & intercostal nerves- ipsilateral pain pattern
Phrenic nerve damage causes ipsilateral diaphragm paresis
Peripheral area irritation referred to costal margins
Central area irritation refers to shoulder & upper trap
common innervation of C5-6

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15
Q

respiratory acidosis can results from

A

Damage to the medulla
Obstruction of airways
Loss of lung surface ventilation
Weakness of respiratory muscles
Overdose of respiratory depressant drugs

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16
Q

s/sx of respiratory acidosis

A

Decreased ventilation
Confusion
Sleepiness and unconsciousness
Diaphoresis
Shallow, rapid breathing
Restlessness
Cyanosis: observable in mucous membranes, fingertips, lips

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17
Q

respiratory alkalosis

A

Results from increased respiratory rate & depth that decreases the amount of available CO2 and hydrogen
Usually caused by hyperventilation
If more severe, can observe muscular tetany and convulsions

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18
Q

s/sx of respiratory alkalosis

A

Hyperventilation
Light-headedness
Dizziness
Numbness & tingling of the face, fingers, & toes
Syncope

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19
Q

COPD

A

Several disorders that have abnormal airway structures (narrowing airways) resulting in obstruction of air exiting & entering the lungs
A leading cause of morbidity & mortality for smokers
Symptom severity depends on how much lung parenchyma has been damaged or destroyed

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20
Q

predisposing factors of COPD

A

Smoking
Air pollution
Occupational exposure (e.g., aerosol pesticides, art materials)
Genetics
Infection
Allergies
Aging
Potentially harmful drugs and chemicals

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21
Q

acute bronchitis s/sx

A

Mild fever from 1-3 days
Malaise
Back and muscle pain
Sore throat
Cough with sputum production, f/b wheezing
Possible progression to laryngitis

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22
Q

acute bronchitis

A

An inflammation of the trachea and bronchi
Short duration
May result from chemical irritation or with viral infections (measles, whooping cough, influenza)

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23
Q

chronic bronchitis

A

“a person with chronic bronchitis is anyone who coughs for at least 3 months/year for 2 consecutive years without having had a precipitating disease”

Prolonged exposure to nonspecific bronchial irritants
Mucous hypersecretion & structural changes in bronchi

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24
Q

s/sx of chronic bronchitis

A

Persistent cough with production of sputum (worse in the morning & evening)
Reduced chest expansion
Wheezing
Fever
Dyspnea/SOB
Cyanosis
Decreased exercise tolerance

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25
s/sx of bronchiectasis
Chronic “wet” cough & abundant foul-smelling secretions Hemoptysis (spitting blood) Occasional wheezing sounds Dyspnea Sinusitis– inflammation of paranasal cavities Weight loss Anemia Malaise Recurrent fever and chills Fatigue
26
bronchiectasis
Chronic, progressive type of bronchitis Occurs after infections such as childhood pneumonia Permanent dilation of bronchi and destruction of bronchial walls
27
emphysema
Permanent overdistention of air space and loss of normal elastic tension in the lung tissue Results in air passage obstruction & difficult expiration
28
s/sx of emphysema
SOB Dyspnea on exertion Orthopnea immediately after assuming the supine position Chronic cough Barrel chest Weight loss Malaise Use of accessory muscles of respiration (pec minor, SCM, scalenes) Prolonged expiratory period (with grunting) Wheezing Pursed-lip breathing Increased respiratory rate Peripheral cyanosis
29
asthma
Reversible obstructive lung disease caused by an increased reaction of the airways to various stimuli Chronic inflammatory condition with acute exacerbations Inflammation obstructs airways
30
asthma triggers
Respiratory infections, colds Cigarette smoke Allergic reactions to pollen, mold, animal dander, feather, dust, food, insects Indoor & outdoor air pollutants Physical exertion or vigorous exercise Exposure to cold air or sudden temperature change Excitement, strong emotion, psychologic or emotional stress
31
pneumonia what is it and what is it caused by
Inflammation of the lungs Caused by: Aspiration of food, fluids, or vomitus Inhalation of toxic or caustic chemicals, smoke, dust, or gases A bacterial, viral, or mycoplasmal infection
32
pneumonia risk factors (some)
Age (very young, very old) No prior pneumococcal vaccination Smoking Air pollution Upper respiratory infection (URI) Altered consciousness: alcoholism, head injury, seizure disorder, drug overdose, general anesthesia Endotracheal intubation, nasogastric tube Recent chest surgery Prolonged immobility Immunosuppressive therapy: corticosteroids, cancer chemotherapy Nonfunctional immune system
33
pneumonia s/sx
Sudden/sharp pleuritic chest pain aggravated by chest movement Shoulder pain (referral area) Hacking, productive cough (rust-colored or green, purulent sputum) Dyspnea Tachypnea with decreased chest excursion (affected side) Cyanosis Headache Fever and chills Generalized aches & myalgia Painful & swollen knees possibly Fatigue Confusion in older adult
34
tuberculosis
Bacterial infectious disease transmitted by gram-positive, acid-fast bacillus Mycobacterium tuberculosis Most commonly spread with repeated close contact with an infected person Full course of treatment lasts 6-9 months
35
TB risk factors
Health care workers, especially those working in older hospitals (centralized ventilation), homeless shelters, or extended care facilities Older adults Overcrowded housing & homeless Incarceration US-born non-Hispanic African Americans Immigrants from Southeast & Central Asia, Ethiopia, Mexico, Latin America, Eastern Europe Alcohol or other chemical dependency with resultant malnutrition, debilitation, poor health Infants/ children < 5 years age Reduced immunity or malnutrition & HIV-positive lung cancer or head and neck cancer RA DM and/or end-stage renal disease Hx of GI disease
36
s/sx of TB
Fatigue Malaise Anorexia Weight loss Low-grade fever Night sweats Frequent productive cough Dull chest pain, tightness, or discomfort Dyspnea
37
scleroderma
Restrictive lung disease of unknown etiologic origin Inflammation and fibrosis of many organs Affects skin and the visceral organs
38
s/sx of scleroderma
Dyspnea on exertion Nonproductive cough Peripheral edema (secondary to cor pulmonale) Orthopnea Paroxysmal nocturnal dyspnea Hemoptysis
39
s/sx of lung cancer
Any change in respiratory patterns Recurrent pneumonia or bronchitis Hemoptysis– REFER Persistent cough Change in cough or development of hemoptysis (for a chronic smoker) Hoarseness or dysphagia Dyspnea Wheezing Sharp chest, upper back, shoulder, scapular, rib, or arm pain aggravated by inspiration or accompanied by respiratory SxS Sudden, unexplained weight loss; anorexia; fatigue Chest, shoulder, or arm pain; bone aching, joint pain Atrophy and weakness of the arm and hand muscles Fecal breath odor
40
s/sx of early stage CF
Persistent coughing and wheezing Recurrent pneumonia Excessive appetite, but poor weight gain Salty skin/sweat Bulky, foul-smelling stools
41
s/sx of CF in older children and young adults
Infertility Nasal polyps Periostitis Glucose intolerance
42
possible complications due to CF
Pneumothorax Hemoptysis Right-sided heart failure secondary to pulmonary hypertension
43
pulmonary embolism
Pulmonary vascular obstruction from: Displaced thrombus (DVT most common cause) Air bubble Fat globule Clump of bacteria Amniotic fluid Vegetations on heart valves that develop with endocarditis Other particulate matter
44
PE rule out criteria
Age < 50 years Heart rate < 100 bpm Oxyhemoglobin saturation >/= 95% No hemoptysis No estrogen use No prior DVT or PE No unilateral leg swelling No surgery or trauma requiring hospitalization within the past 4 weeks
45
s/sx of PE
Dyspnea Pleuritic (sharp, localized) chest pain Diffuse chest discomfort Persistent cough Hemoptysis– REFER Apprehension, anxiety, restlessness Tachypnea– increases RR Tachycardia Fever
46
s/sx of cor pulmonale
Peripheral edema (bilateral LEs) Chronic cough Central chest pain Exertional dyspnea or dyspnea at rest Distention of neck veins Fatigue Wheezing Weakness
47
cor pulmonale
Emergency cardiac condition from sudden dilation of the right ventricle due to PE
48
pulmonary arterial hypertension
Vasoconstriction of pulmonary arterial vascular bed Can lead to eventual right-sided heart failure
49
risk factors of pleurisy
Pneumonia TB Lung abscess Influenza Systemic lupus erythematosus RA Pulmonary infarction
50
types of pleurisy
Dry: fluid between pleural layers not changed Wet: abnormal increase of fluid between pleural layers Purulent pleurisy: if fluid becomes infected & pus forms
51
s/sx of pleurisy
Pain distributions Ipsilateral shoulder, upper trap, neck, lower chest wall, abdomen Cough Dyspnea Fever, chills Tachypnea
52
causes of pneumothorax
Pulmonary disease Trauma (with perforation of chest wall; ex: stab wound) Scuba diving (arterial gas embolism) Overexertion Sx/ medical procedures involving chest wall or thorax
53
s/sx of pneumothorax
Dyspnea Change in respiratory movements (affected side) Sudden, sharp chest pain (upper & lateral thoracic wall with referral to ipsilateral shoulder, across chest, abdomen) Increased neck vein distention Weak and rapid pulse (>100 bpm) Fall in blood pressure Dry, hacking cough Shoulder pain Sitting upright is most comfortable
54
cardiac valvular disease s/sx
Easy fatigue Dyspnea Palpitation Chest pain Pitting edema Orthopnea or paroxysmal dyspnea Dizziness and syncope **all increase with workload
55
rheumatic fever what is it and what are common symptoms
Infection caused by streptococcal bacteria Rheumatic heart disease: chronic condition due to scarring & deformity of heart valves Most common symptoms: fever & joint pain
56
endocarditis caused by what
Heart infection Causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valve Caused by bacteria entering bloodstream remotely (e.g. skin infection, oral infection)
57
endocarditis risk factors
High risk: Previous valvular damage Injection drug users Postcardiac surgical presentations Congenital & degenerative heart disease Invasive diagnostic procedures
58
s/sx with endocarditis
Arthralgia Arthritis MSK symptoms Low back/sacroiliac pain Myalgia Petechiae/splinter hemorrhage Constitutional symptoms Dyspnea, chest pain Cold and pain in the extremities
59
s/sx of fibrillation (damage to heart muscle cells)
Subjective report of palpitations Sensations of fluttering, skipping, irregular beating or pounding, heaving action Dyspnea Chest pain Anxiety Pallor, fatigue Dizziness, light-headedness, fainting Nervousness Cyanosis
60
sinus tachycardia
Abnormally rapid heart rate (>100 bpm) Physiologic response to stressors (e.g., hypotension)
61
s/sx of sinus tachycardia
Palpitation Restlessness Chest discomfort or pain Agitation Anxiety and apprehension
62
sinus bradycardia
Sinus node discharges at a rate < 60 bpm May be normal in athletes or young adults
63
s/sx sinus bradycardia
Sudden onset of weakness, sweating, nausea, pallor, vomiting, and distortion or dimming of vision Reduced pulse rate Syncope
64
raynaud's phenomenon what is it and what are triggers
Intermittent episodes during which small arteries or arterioles in extremities constrict, causing temporary pallor and cyanosis of the digits and change in skin temperature Triggers: Cold temperature Strong emotion
65
s/sx of raynauds phenomenon
Pallor in the digits Cyanotic, blue digits Cold, numbness, pain of digits Intense redness of digits
66
s/sx of superficial venous thrombosis
Subcutaneous venous distention Palpable cord Warmth, redness Indurated (hard)
67
s/sx deep venous thrombosis what do you use to dx this
Unilateral tenderness or leg pain Unilateral swelling (>3 cm difference in leg circumference) Warmth Discoloration wells criteria
68
chronic venous disorders are identified by
Chronic swollen limbs Thick, coarse, brownish skin around the ankles Venous stasis ulceration
69

Differential Dx (3 decks)

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