Pulmonary Diseases

Question 1

What is bacterial pneumonia?

Answer 1

An intra-alveolar bacterial infection

Question 2

List 9 pertinent physical findings associated with bacterial pneumonia.

Answer 2

1. Shaking chills
2. Fever
3. Chest pain if pleuritic involvement
4. Cough becoming of purulent, blood streaked or rusty sputum
5. Decreased or bronchial breath sounds, and or crackles
6. Tachypnea
7. Increased WBC count
8. Hypoxemia, hypocapnia initially, hypercapnia with increasing severity
9. CXR confirmation of infiltrate

Question 3

What is viral pneumonia?

Answer 3

Interstitial or intra-alveolar inflammatory process caused by viral agents (influenza, measles, herpes etc.)

Question 4

List 9 pertinent physical findings associated with viral pneumonia.

Answer 4

1. Recent history of upper respiratory infection
2. Fever
3. Chills
4. Dry cough
5. Headaches
6. Decreased breath sounds/crackles
7. Hypoexmia and hypercapnia
8. Normal WBC count
9. CXR confirmation of interstitial infiltrate

Question 5

What is aspiration pneumonia?

Answer 5

Aspirated material causes an acute inflammatory reaction within the lungs.

Question 6

List 12 pertinent physical findings associated with aspiration pneumonia.

Answer 6

1. Sxs begin shorty after aspiration event
2. Cough may be dry at onset, progresses to produce putrid secretions
3. Dyspnea
4. Tachypnea
5. Cyanosis
6. Tachycardia
7. Wheeze and crackles with decreased breath sounds
8. Hypoxemia, hypercapnia in severe cases
9. Chest pain over the involved area
10. Fever
11. WBC count shows varying degrees of leukocytosis
12. CXR initially shows pneumonitis

Question 7

What is tuberculosis? What is incubation period? How long does the primary disease last?

Answer 7

Mycobacterium tuberculosis infection spread by aerosolized droplets from an untreated infected host.

Incubation period: 2-10 weeks
Primary disease lasts 10 days to 2 weeks

Question 8

_____ on appropriate antituberculin drugs renders the host noninfectious.

Answer 8

2 weeks

Question 9

Describe the precautions associated with tuberculosis during the infectious stage.

Answer 9

1. Patient must be isolated from others in a negative pressure room
2. Anyone entering the room must wear a protective TB mask and follow universal precautions
3. If patient leaves negative air pressure room, they must wear a specialized mask to keep from infecting others

Question 10

List 9 pertinent physical findings associated with post primary tuberculosis.

Answer 10

1. Fever
2. Weight loss
3. Cough
4. Hilar adenopathy: enlargement of the lymph nodes surrounding the hilum
5. Night sweats
6. Crackles
7. Hemoptysis: blood streaked sputum
8. WBC shows increased lymphocytes
9. CXR shoes upper lobe involvement and parenchymal fibrosis

Question 11

What is Pott’s disease?

Answer 11

Tuberculous spondylitis

A form of spinal TB that primarily affects the thoracic and upper lumbar vertebrate (can result in increased kyphosis)

Question 12

What is pneumocystis pneumonia (PCP)? In what patient populations is this typically found? (3)

Answer 12

Pulmonary infection caused by a fungus (pneumocystis carinii) in immunocompromised hosts.

1. Patients s/p transplantation
2. Neonates
3. Patient infected with HIV

Question 13

List 7 physical findings associated with pneumocystis pneumonia (PCP).

Answer 13

1. Insidious progressive SOB
2. Nonproductive cough
3. Crackles
4. Weakness
5. Fever
6. Chest x-ray shows interstitial infiltrates
7. Complete blood count shows no evidence of infection

Question 14

What is sarcoidosis?

Answer 14

Multisystem inflammatory disease consisting of granulomas in multiple organs, most often the lungs, skin, lymph nodes, eyes and liver

Question 15

What is required to confirm a diagnosis of sarcoidosis? (3)

Answer 15

1. Radiographic findings
2. Histology with granulomas
3. Exclusion of all other diagnoses

Question 16

List 5 physical findings associated with sarcoidosis.

Answer 16

1. Fever
2. Cough
3. SOB
4. Chest pain
5. Fatigue

Question 17

What is chronic obstructive pulmonary disease (COPD)?

Answer 17

A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs.

Question 18

List 6 physical findings associated with COPD.

Answer 18

1. Increased resistance to airflow
2. Often history of smoking
3. Abnormal breath sounds
4. Use of accessory breathing muscles
5. Increased chest size
6. Dry or productive cough

Question 19

What is asthma?

Answer 19

Increased reactivity of the trachea and bronchi to various stimuli (allergens, exercise, cold)

Manifests by widespread narrowing of the airways due to inflammation, smooth muscles constriction, and increased secretions.

Question 20

List 8 physical findings associated with asthma.

Answer 20

1. Wheezing cough
2. Increased secretions
3. Dyspnea
4. Increased accessory muscle use
5. Anxiety
6. Tachycardia and tachypnea
7. Hypoxemia and hypocapnia
8. Cyanosis

Question 21

What is cystic fibrosis?

Answer 21

A genetically inherited disease characterized by thickening of secretions of all exocrine glands, leading to obstruction (i.e. pulmonic, pancreatic, GI)

Question 22

List 3 clinical signs of cystic fibrosis.

Answer 22

1. Menconium ileus
2. Frequent respiratory infections
3. Inability to gain weight despite adequate caloric intake

Question 23

What testing is needed to confirm a diagnosis of cystic fibrosis?

Answer 23

Postnatally by a blood test indicated trypsinogen

OR

Positive sweat electrolyte test

Question 24

List 6 physical findings associated with cystic fibrosis.

Answer 24

1. Onset of sxs usually in early childhood
2. Frequent respiratory infections
3. Inability to gain weight
4. Rales, wheezing
5. Production of large amounts of mucoid or purulent sputum
6. May have hemoptysis

Question 25

What is bronchiectasis?

Answer 25

A chronic congenital or acquired disease characterized by abnormal dilation of bronchi and excessive sputum production.

Question 26

What is respiratory distress syndrome?

Answer 26

Respiratory distress due to atelectasis caused by insufficient surfactant in premature lungs

Question 27

List 7 physical findings associated with respiratory distress syndrome.

Answer 27

1. Respiratory distress 2. Crackles 3. Tachypnea 4. Hypoxemia 5. Cyanosis 6. Accessory muscle use 7. Expiratory grunting, flaring nares

Question 28

What is bronchogenic carcinoma?

Answer 28

Tumor that arises from the bronchial mucosa that can cause obstruction of compression of the airway, blood vessels or nerves.

Question 29

What are the 2 most frequent causal agents of bronchogenic carcinoma?

Answer 29

Smoking and occupational exposures are the most frequent causal agents

Question 30

List 8 pertinent physical findings associated with bronchogenic carcinoma.

Answer 30

1. Unexplained weight loss 2. Hemoptysis 3. Dyspnea 4. Weakness 5. Fatigue 6. Wheezing 7. Pneumonia with productive cough due to airway compression 8. Hoarseness with compression to the laryngeal nerve

Question 31

What is the difference between a rib fracture and a flail chest?

Answer 31

Fracture of the ribs usually due to blunt trauma | Flail chest is 2 or more fractures in 2 or more adjacent ribs

Question 32

List 5 pertinent physical findings of a rib fracture/flail chest.

Answer 32

1. Shallowing breathing 2. Splinting due to pain (especially with deep inspiration or cough) 3. Crepitation during ventilation over the flail site 4. Paradoxical movement of a flail section during ventilation (inspiration, the flail section is pulled inward; exhalation, the flail moves outward) 5. Confirmation by CXR

Question 33

What is the difference between a pneumothorax and a hemothorax?

Answer 33

Pneumothorax: Air in the pleural space, usually through a lacerated visceral pleura from a rib fracture or ruptured bullae Hemothorax: Blood in the pleural space usually from a laceration of the parietal pleura

Question 34

List 8 physical findings associated with a pneumothorax and/or a hemothorax .

Answer 34

1. Decreased or absent breath sounds 2. Dry cough 3. Tracheal and mediastinal shift away from side of injury 4. Local or referred pain 5. Respiratory distress 6. Confirmation by CXR 7. Increased tympany with mediate percussion (pneumo) 8. Possible signs of blood loss (hemo)

Question 35

What is a lung contusion?

Answer 35

Blood and edema within the alveoli and interstitial space due to blunt chest trauma with or without rib fractures

Question 36

What is pulmonary edema?

Answer 36

Excessive seepage of fluid from the pulmonary vascular system into the interstitial space; may eventually cause alveolar edema

Question 37

List 5 physical findings associated with pulmonary edema.

Answer 37

1. Cough with pink, frothy secretions 2. Crackles 3. Tachypnea 4. Dyspnea 5. Hypoxemia

Question 38

What is pleural effusion?

Answer 38

Excessive fluid between the visceral and parietal pleura caused mainly by increased pleural permeability to proteins from inflammatory diseases

Question 39

List 5 physical findings associated with pleural effusion.

Answer 39

1. Decreased breath sounds over effusion 2. Mediastinal shift away from large effusion 3. Breathlessness with large effusions 4. CXR shows fluid in the pleural space in gravity dependent areas of the thorax if > 300 mL 5. Pain and fever only if pleural fluid is infected (empyema)

Question 40

What is atelectasis?

Answer 40

Collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilatory cycle, bronchial obstruction/compression, low tidal volumes, or neurologic insult

Question 41

List 5 physical findings associate with atelectasis.

Answer 41

1. Decreased breath sounds 2. Dyspnea 3. Tachycardia 4. Increased temperature 5. CXR with platelike streaks