Week 7 Flashcards
(22 cards)
Pleural Pain
pleura rub when breathing
- Thoracic Excursion: guarded, shallow breathing may be observed d/t pain with inspiration (thoracic excursion isn’t specifically decreased)
Pleural Effusion
fluid trapped in pleural space; no air exchange in the fluid filled pleural space
- *Auscultation: decreased or absent breath sounds over affected area
- Tactile fremitus: decreased
- Percussion: dull
- Thoracic Excursion: decreased on affected side if one sided
Typical Pneumonia (Lobar)
alveoli are filled with thick fluid
- *Auscultation: crackles over area of consolidation (fluid+RBCs+WBCs)
*Tactile fremitus: increased
*Percussion: dull
Thoracic Excursion: maybe decreased IF large enough consolidation on one side
*Other: egophony (E sounds like A), bronchophony (“1,2,3” louder, more clear), whispered pectoriloquy (whispering is louder, more clear)
egophony
E sounds like A
bronchophony
1,2,3” louder, more clear
whispered pectoriloquy
whispering is louder, more clear
Pulmonary Embolism
airways are open and clear, blood clot in lung vessel(s)
- Vital signs: tachycardia, tachypnea
Pneumothorax
air is trapped in the pleural space
- *Auscultation: decreased or absent breath sounds over affected area
- Tactile fremitus: decreased
- Percussion: hyperresonance over affected area
- Thoracic Excursion: decreased on affected side
Asthma
*Auscultation: wheezing – especially end expiratory
SEVERE Asthma
lungs hyperinflated (air is trapped) w/ airways severely obstructed
- *Auscultation: silent chest (air flow is so restricted you don’t even hear wheezing)
- Tactile fremitus: decreased
- Percussion: hyperresonant diffusely
- Thoracic Excursion: possibly decreased bilaterally
Chronic Bronchitis
large airways have a lot of mucous causing partial obstruction of airflow
- Auscultation: Scattered rhonchi; crackles, wheezes possible – may clear with coughing
Emphysema
alveoli are destroyed, permanent air trapping
- *Auscultation: decreased breath sounds throughout lung fields; maybe coarse breath sounds
- Tactile fremitus: decreased
- Percussion: hyperresonant (diffusely)
- Thoracic Excursion: possibly decreased bilaterally
A diagnosis of pleurisy (the condition) is best made when:
life-threatening causes of pleuritic chest pain are ruled out
Chest radiography (chest x-ray) is recommended for all patients with pleuritic chest pain. What evidence is this recommendation based on?
consensus, disease-oriented evidence, usual practice, expert opinion, or case series
Which of the following triggers is NOT a typical aggravating factor for pleuritic chest pain?
a. inspiration
b. emotional upset
c. coughing
d. talking
e. sneezing
*B. emotional upset
Wells rule (aka Wells criteria) is a validated clinical decision making tool useful in diagnosing which of the following conditions?
a. Pulmonary embolism
b. COPD
c. Pneumothorax
a. pulmonary embolism
Chest radiography may be helpful in diagnosing all of the following causes of pleurisy EXCEPT:
a. pneumonia
b. pneumothorax
c. pericarditis
d. pulmonary embolism
e. myocardial infarction
*E. myocardial infarction
Pleuritic chest pain that has an acute onset (symptoms develop over minutes to hours) is suggestive of which of the following causes?
a. Emphysema
b. Pneumothorax
c. pleuritis
pneumothorax
- MI, pulmonary embolism, and trauma also have an acute onset
What is the most likely diagnosis in a patient who presents with acute onset of pleuritic chest pain and dyspnea with elevated heart rate and respiratory rate but no abnormal heart or lung sounds?
pulmonary emobolism
What is the most likely diagnosis in a patient with pleuritic chest pain that began a couple weeks ago and is accompanied by fatigue, weight loss, low-grade fever, and chronic cough?
tuberculosis
Treatment for pleurisy involves managing pain and targeting the underlying cause. What is the first line recommendation for treating pleuritic chest pain?
NSAIDs
If a patient presents with pleuritic chest pain and also complains of fever and joint pain, you should consider all of the following causes EXCEPT:
a. viral pleurisy
b. lupus Incorrect
c. rheumatoid arthritis
d. Familial Mediterranean fever
*A. viral pleurisy
