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Flashcards in Pulmonary H&P Deck (22):
1

dyspnea -definition:

-difficult, labored, uncomfortable breathing
-subjective based on what patient is doing

2

dyspnea - etiology:

-high level of ventilation perceived centrally
-length-tension dissociation of respiratory muscles
-modified by attention, experience, emotional state, and personality traits

3

dyspnea - history- what to ask:

-type of onset: rapid or gradual
-activity level that causes dyspnea: exertion, walking, bathing, changing clothes, talking, rest, position change
-what else aggravates the symptoms or alleviates:exposures, weather change, medications, posture
-are symptoms progressing or improving? determine severity even though its subjective!

4

Dyspnea - rapid onset associations:

-asthma -exacerbation
-left ventricular failure -pulmonary edema
-pulmonary embolism
-pneumothorax
-foregin body aspiration
-hyperventilation
-pneumonia-hours to days

5

Onset over 1-2 hours with wheeze=

-asthma
-left ventricular failure (MI, Vasc disease)

6

OVer hours/days with fever +/- sputum=

-pneumonia
-acute bronchitis

7

dyspnea with hyperventilation=

-acidosis
-poisoning
-hyperventilation syndrome

8

immediate +/- pain=

-pnuemothorax
-pulmonary embolismm
-foreign body aspiration

9

dyspnea- gradual onset associations:

-COPD
-interstitial lung disease
-pneumoconiosis
-chronic or recurrent pulmonary embolism
-deconditioning
-neuromuscular disease
-Chronic CHF

10

wheezing definition:

-high pitched sounds, inspiratory or expiratory
-airflow obstruction due to either airway narrowing or secretions
-site of obstruction determines if worse during inspiration or exhalation
-inspiratory wheezes + STRIDOR usually mean= upper airway site
-expiratory wheezes=intrathoracic

11

Pulmonary chest pain:

-pleuritic-sharp, stabbing pain
-aggravated by deep breath or cough
-severe, usually short duration (hours to 2 days)
-inflammation or irritation of parietal pleura
-mediastinal pain-pressure or heaviness due to acte pulmonary HTN or stretching of mediastinal structures
-patients with pleuritic chest pain like to lie on the SIDE THAT HURTS

12

persistent cough more common in which gender?

-females

13

cough physiology:

-rapidly adapting irritant receptors most numerous on posterior tracheal wall, carina, and branches of large airways
-other sites that elicit cough=tympanic membrane, auditory canals, paranasal sinuses, diaphragm, pleura, pharynx, pericardium, and stomach

14

What to ask about a cough:

-onset: acute or chronic?
-sputum production
-duration
-associated symptoms
-aggravating factors: acitvity, posture, food, exposures
-factors that help cough

15

classification of cough:

1) acute-less than 3 weeks
2) subacute-3-8weeks
3) chronic->8 weeks

16

Acute cough common etiologies:

-viral and bacterial infections (esp viral URI=common cold, sinusitis)
-acute aspiration
-pulmonary embolism
-congestive heart failure

17

chronic productive cough can be:

-chornic bronchitis
-bronchiectasis
-CF

18

chronic non-productive cough due to:

-upper airway cough syndrome (PNDS) - post nasal drip
-asthma
-GERD
-exclude ACEI induced cough

19

other causes f chronic cough:

-eosinophilic bronchitis
-postviral cough
-chronic bronchitis -productive
-bronchiectasis-producitve

20

upper airway cough syndrome causes:

-allergic rhinitis
-perennial non allergic rhinitis
-vasomotor rhinitis
-sinusitis

21

MOST COMMON of the less common causes of chronic cough

occupational asthma

occult aspiration of object in kids

22

upper airway cough tx?

steroid