Week 6: Thorax/Lungs Flashcards Preview

530 Health Assessment > Week 6: Thorax/Lungs > Flashcards

Flashcards in Week 6: Thorax/Lungs Deck (22)
Loading flashcards...
1

What are the various lung cancer screening recommendations? 

USPSTF: annual screening for current smokers/those who have quit within the last 15 years if they smoked an average of 1 pack of cigarettes for 30 years and are aged 55-79

American cancer society: annual screening, through age 74

2

What are the cardiovascular etiologies of chest pain and how do they present? (4)

  1. Angina: mild to moderate; pressing, squeezing, tight, heavy, occasionally burning; closed fist; may occur during exercise/activity and resolve with rest
  2. MI: pressing, squeezing, tight, heavy, occasionally burning; severe pain
  3. Pericarditis: severe sharp, knifelike
  4. Aortic dissection: very severe, ripping, tearing

3

What is the pulmonary etiology of chest pain and how does it present?

Pleuritic pain: severe, sharp knifelike

4

What are the GI/other etiologies of chest pain and how do they present? (4)

  1. GERD: mild to severe burning, may be squeezing
  2. Diffuse esophageal spasm: mild to severe squeezing
  3. Costochondritis: variable level stabbing, sticking or dull, aching; can reproduce with ROM of upper extremities, point tenderness
  4. Anxiety, panic disorder: variable level stabbing, sticking or dull, aching

5

What are the various etiologies for dyspnea and how would these present?  (9)

  1. Left-sided heart failure: cough, orthopnea, paroxysmal nocturnal dyspnea, wheezing
  2. Chronic bronchitis: chronic productive cough, recurrent respiratory infections, wheezing
  3. COPD: cough with scant mucoid sputum
  4. Asthma: wheezing, cough, chest tightness
  5. Diffuse interstitial lung diseases: weakness, fatigue, cough less common
  6. PNA: pleuritic pain, cough, sputum, fever
  7. Spontaneous pneumothorax: pleuritic pain, cough
  8. Acute pulmonary embolism: often no associated symptoms; retrosternal oppressive pain if massive occlusion; pleuritic pain, cough, syncope, hemoptysis, and/or unilateral leg swelling and pain from instigating DVT; anxiety
  9. Anxiety with hyperventilation: sighing, lightheadedness, numbness or tingling of the hands and feet, palpitations, chest pain

6

What are the etiologies for cough and hemoptysis associated with acute inflammation and how do they present? (4)

  1. Laryngitis: dry cough, may become productive
    • Associated symptoms: acute fairly minor illness with hoarseness viral rhinosinusitis
  2. Acute bronchitis: cough, dry or productive
    • Associated symptoms: acute often viral illness without fever or SOB; burning retrosternal discomfort
  3. Mycoplasma and viral pneumonias: dry hacking cough, may become productive of mucoid sputum
    • Associated symptoms: acute febrile illness, often with malaise, headache and possibly dyspnea
  4. Bacterial pneumonias: sputum is mucoid or purulent, thick, may be blood streaked, diffusely pinkish or rusty
    • Associated symptoms: acute illness with chills, often high fever, dyspnea and chest pain

7

What are the etiologies for cough and hemoptysis associated with chronic inflammation and how do they present? (7)

  1. Postnasal drip: chronic cough, sputum mucoid or purulent
    • Associated symptoms: postnasal discharge may be seen in posterior pharynx, associated with allergic rhinitis with or without sinusitis
  2. Chronic bronchitis: chronic cough; sputum mucoid to purulent, may be blood-streaked or even bloody
    • Associated symptoms: often with recurrent wheezing and dyspnea and prolonged history of tobacco use
  3. Bronchiectasis: chronic cough, sputum purulent, often copious and foul-smelling; may be blood-streaked or bloody
    • Associated symptoms: recurrent bronchopulmonary infections common; sinusitis may coexist
  4. Pulmonary tuberculosis: cough, dry or with mucoid or purulent sputum; may be blood-streaked or bloody
    • Associated symptoms: early, no symptoms, later anorexia, weight loss, fatigue, fever and night sweats
  5. Lung abscess: sputum purulent and foul-smelling; may be bloody
    • Associated symptoms: usually from aspiration PNA with fever and infection from oral anaerobes and poor dental hygiene; often with dysphagia or episode of impaired consciousness
  6. Asthma: cough, at times with thick mucoid sputum, especially near the end of an attack
    • Associated symptoms: episodic wheezing and dyspnea, cough may occur alone; often with a history of allergies
  7. GERD: chronic cough, especially at night or early in the morning
    • Associated symptoms: wheezing, especially at night, early morning hoarseness and repeated attempts to clear the throat; heartburn and regurgitation

8

What is the etiology for cough and hemoptysis related to cancer and how does it present?

  • lung cancer: cough, dry to productive; sputum may be blood-streaked or bloody
    • Associated symptoms: commonly with dyspnea, weight loss, history of tobacco use

9

What are the cardiovascular etiologies for cough/hemoptysis and how do they present? (2)

  • Left ventricular failure or mitral stenosis: often dry, especially on exertion or at night; may progress to the pink frothy sputum of pulmonary edema or frank hemoptysis
    • Associated symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea
  • Pulmonary embolism: dry cough, at times with hemoptysis
    • Associated symptoms: tachypnea, chest or pleuritic pain, dyspnea, fever, syncope, anxiety; factors that predispose to DVT

10

How does cough/hemoptysis look on exam when related to irritating particles, chemicals or gases?

  • variable, may be latent period between exposure and symptoms
  • Associated symptoms: eyes, nose and throat may be affected

11

What exam findings would the FNP expect in the patient with pneumonia?

(General sx, percussion, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)

  • General sx: pleuritic pain, cough, sputum, fever
  • Percussion: Dull over airless area
  • Breath sounds: bronchial over involved area
  • Adventitious sounds: late inspiratory crackles over involved area
  • Tactile fremitus/transmitted voice sounds: increased over involved area

12

What exam findings would the FNP expect in the pediatric patient with pneumonia?

 

  • crackles, rhonchi, cough, wheeze, dyspnea, tachypnea
  • Abnormal work of breathing plus abnormal findings on auscultation are the best findings for ruling out PNA (fever, tachypnea, dyspnea, and increased WOB)
  • PNA is a clinical diagnosis may be present before findings on CXR

13

What exam findings would the FNP expect in the patient with COPD?

(General sx, chest x-ray, percussion, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)

  • General sx: emphysema or chronic bronchitis
  • Chest x-ray: hyperinflation (10+ ribs visible)
  • Percussion: hyper resonant
  • Breath sounds: decreased to absent with delayed expiration
  • Adventitious sounds: none or crackles, wheezes, rhonchi
  • Tactile fremitus/transmitted voice sounds: decreased

14

What exam findings would the FNP expect in the patient with atelectasis?

(Percussion, trachea location, breath sounds, tactile fremitus/transmitted voice sounds)

  • Percussion: Dull over airless area
  • Trachea: may be shifted toward involved side
  • Breath sounds, tactile fremitus, transmitted voice sounds: usually absent

15

What exam findings would the FNP expect in the patient with pleural effusion?

(Chest x-ray, percussion, trachea location, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)

  • Chest x-ray: blunting
  • Percussion: dull
  • Trachea: shifted toward the unaffected side in large effusion
  • Breath sounds: decreased to absent, bronchial breath sounds may be heard near top of a large effusion
  • Adventitious sounds: none, possible pleural rub
  • Tactile fremitus/transmitted voice sounds: decreased to absent but may be increased toward the top of a large effusion

16

What exam findings would the FNP expect in the patient with asthma?

(General sx, percussion, trachea location, breath sounds, adventitious sounds, tactile fremitus/transmitted voice sounds)

  • General sx:  wheezing, cough, chest tightness, prolonged expiration
  • Percussion: resonant to diffusely hyperresonant
  • Breath sounds: obscured by wheezes
  • Adventitious sounds: wheezes, possibly crackles
  • Tactile fremitus/transmitted voice sounds: decreased

17

How does asthma look on exam in a pediatric patient?

dyspnea, chest tightness, retractions


18

What exam technique is used to assess for a rib fracture? What would you expect on exam for a positive rib fracture?

 

Exam technique: compression of the chest in the AP plane

Findings: local pain and tenderness; pain along the midaxillary line

 

19

How does croup present on exam?

stridor, seal-like cough, hoarseness, prolonged inspiration; worse at night and better during the day

 

20

What are the various locations in which retractions can occur? 

  • Supraclavicular retractions
  • Intercostal retractions
  • Substernal retractions
  • Subcostal retractions

21

What is different about the pediatric thorax and lung exam as compared to the adult? (9)

  • Periodic respirations (periods of apnea) common in newborns
  • Infants are obligate nose breathers until 4 months old
  • Foreign body aspiration: dyspnea
  • Wheezes and rhonchi common in infants
  • Hoover's sign-seesaw breathing
  • Tactile fremitus more suggestive of consolidation in peds as better transmission in children
  • Prolonged inspiration: croup
  • Prolonged expiration: asthma
  • Easier to see retractions in infants

22

What are the pediatric cutoffs for bradypnea? Tachypnea?

  • Infant
    • Brady: 30
    • Tachy: 60
  • Early childhood
    • Brady: 20
    • Tachy:40
  • Late childhood
    • Brady: 15
    • Tachy: 25
  • Adolescent
    • Brady: 12
    • Tachy: 20