chest and lung exam and pulm pathology

cough HPI

onset, dry/moist, frequency, regularity, pitch, quality, sputum, associated sx, ACE inhibitors

SOB HPI

onset, pattern severity, associated sx, pillows with sleep, comfort, activity, inhale/exhale, tx efforts, DOE

chest pain HPI

onset, duration, description, associated sx

pleuritic chest pain

worsening with deep breath

wheezing HPI

onset, frequency, timing, associated sx

hemoptysis HPI

onset, frequency, quality, associated sx

fever/chills HPI

onset, frequency, associated sx

weight loss HPI

onset, duration, quality, associated sx

daytime sleepiness, snoring HPI

excessive daytime sleepiness/fatigue, snoring, witnessed apnea, awakening with choking sensation, morning HA

undx OSA HPI

new onset afib, large neck circumference, uncontrolled HTN, enlarged uvula, obesity, hx of CVA

pulm pshx/hospitalization questions

thoracic trauma/surgery, hospitalization for pulm disorders

pulm pmhx questions

chronic pulm disease, supp oxygen/ventilation assist device

pulm vax/screening questions

strep pneumo, flu, covid, low dose CT for smokers

pulm fhx questions

asthma, eczema, CF, clotting disorders, emphysema, bronchiectasis

pulm social hx questions

tobacco/nicotine, home/occupational chemical exposure, alcohol, drugs

bradypnea

<12 breaths/min

tachypnea

>20 breaths/min

hyperventilation

>20 breaths/min deep breathing

cheyne stokes breathing

varying periods of increasing depth interspersed with apnea

kussmal breathing

rapid, deep, labored breathing

biot breathing

irregularly interspersed periods of apnea in a disorganized sequence of breaths

atelectasis mechanism

collapse of lung tissue creates vacuum effect and pulls trachea towards collapse

finger clubbing conditions

COPD, lung cancer

lung fibrosis mechanism

volume loss due to scarring contracts lung

pneumonectomy mechanism

missing lung space pulls structures inward

tension pneumo mechanism

air under pressure in pleural space pushes mediastinum

massive pleural effusion mechanism

fluid buildup exerts pressure to push trachea

large tumor/mass mechanism

space occupying lesion displaces structures away

hemothorax mechanism

blood in pleural space increases pressure

decreased/absent fremitus

obesity, obstruction, COPD, pleural effusion, fibrosis, air PTX

asymmetric decreased fremitus

unilateral pleural effusion, PTX

asymmetric increased fremitus

unilateral PNA, lobar PNA, neoplasm, tumor

continuous breath sounds

prolonged sounds heard throughout respiratory cycle caused by airflow through narrowed/obstructed airways

discontinuous breath sounds

brief, intermittent, nonmusical sounds like crackles/rales heard during inspiration

wheeze

musical noise often heard continuously during inspiration or expiration but louder with expiration

rhonchi

loud, low, coarse sounds like a snore often heard continuously during inspiration/expiration

rhonchi cleared with coughing

suggestive of mucus accumulation along trachea/large bronchi

pleural friction rub

dry, rubbing, grating during inspiration/expiration loudest over lower lateral anterior surface

crackles/rales

either high pitched/discrete at end of inspiration or loud, bubbly noise during inspiration

continuous breath sounds

asthma, COPD, bronchitis, foreign body aspiration, croup

discontinuous lung sounds

pulmonary edema/fibrosis, pneumonia, atelectasis

bronchophony

spoken words heard indistinctly but with consolidation is distinct

whispered pectoriloquy

whisper 99

egophony

spoken “eee” sounds like “ay” with nasal quality from compressed lung below pleural effusion

pneumonia sx

acute/subacute fever, dyspnea, cough, rigors, sweats, chills, chest discomfort, SOB, palpitations, pleurisy, hemoptysis, fatigue, myalgia

pneumonia PE

altered breath sounds/crackles, dull to percussion, bronchial breath sounds, tachycardia, tachypnea, hypoxemia, rhonchi, increased TF

pneumonia pmhx

immunocompromised, diabetes, smoking, COPD, advanced age, hospitalizations, surgery

CURB 65

confusion, BUN ≥ 19, RR ≥30, SBP <90/DBP ≤60, age ≥65

MCC of CAP

strep pneumo

2nd MCC of CAP

h. flu

MCC of CAP in COPD

h. flu

MC atypical PNA

mycoplasma pneumo

atypical PNA onset

gradual

CAP onset

sudden

PNA with GI sx

legionella pneumophila

HIV PNA sx

CAP sx, cough, SOB, fever, hemoptysis, fever, chills

HIV PNA PE

crackles, tachycardia, tachypnea, hypoxemia, rhonchi, dull to percussion

TB PNA RF

immigrants/migrants, overcrowded housing, homelessness

TB PNA sxx

malaise, anorexia, weight loss, fever, night sweats, chronic cough that progresses to blood streaked

TB PNA PE

apical rales, increased TF over apicies, ill appearing, malnourished, tachypnea, tachycardia

histoplasmosis PNA social hx

chicken coops, farm buildings

histoplasmosis PNA sx

malaise, fever, weight loss, cough, DOE, rash, rales, hypotension

acute bronchitis HPI

1-3 wk cough, dyspnea, no/low fever, sore throat, HA

acute bronchitis PE

expiratory wheezes, rhonchi

transudative pleural effusion

imbalance of oncotic and hydrostatic pressure

exudative pleural effusion

inflammatory process with decreased lymphatic drainage

pleural effusion sx

dyspnea MC, cough, pleuritic chest pain

pleural effusion PE

dull to percussion, decreased TF, diminished breath sounds, pleural rub

spontaneous PTX

primary with no cause, COPD, menstruation related, traumatic

tension PTX

positive air pressure pushes lungs and trachea to other side

PTX sx

pleuritic unilateral chest pain, dyspnea at rest

PTX PE

absent TF, no BS, hyperresonant

asthma

reversible obstruction of airways

asthma RF

atopy, fhx, air pollution, obesity, tobacco smoke, low SES

asthma triggers

allergens, tobacco smoke, infections, exercise, stress, cold, GERD

asthma med triggers

non cardio selectivve beta blockers, aspirin, NSAIDs

asthma CP

episodic wheezing, SOB, chest tightness, cough, worse sx at night/early morning

asthma PE

pulsus paradoxus, tachycardia, accessory breathing, wheezing, pursed lips, decreased BS, nasal polyps, eczema

COPD emphysema sx

dyspnea, barrel chest, decreased fremitus, cachectic, pursed lips

COPD bronchitis sx

DOE, rales, crackles, rhonchi, wheezing, cyanosis

COPD PFT result

severe VQ mismatch

OSA clinical manifestations

daytime sleepiness, snoring, observed apnea, dry mouth, HTN

OSA PE

maybe normal, systemic/pulm HTN, R HF, oropharynx narrowed, increased neck/waist circumference, high mallampati score

idiopathic pulmonary fibrosis PE

clubbing, fine crackles, diffuse opacities with honeycombing on CT

sarcoidosis RF

Black females 20-40 y/o

sarcoidosis sx

cough, dyspnea, CP, fatigue, malaise, fever, maculopapular rash, blurred vision, erythema nodosum

sarcoidosis PE

lofgren’s syndrome, heerfordt syndrome, lupus perino

lofgren’s syndrome

erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia, fever, parotitis, uveitis, malaise

heerfordt syndrome

parotid swelling, uveitis, chronic fever, facial nerve palsy

lupus perino

raised discoloration on face that looks like frost bite

pneumoconiosis

inhalation of various substances that can cause fibrosis of the lungs

pneumoconioses

silicosis, coal worker’s berylliosis, byssinosis, asbestosis

pulmonary embolism RF/hx

personal VTE hsx, estrogen, surgery, thrombophilia, active malignancy, immobilization, virchow’s triad

pulmonary embolism sx

acute SOB, pleuritic chest pain, tachycardia, unilateral leg swelling, hemoptysis, syncope, hypotension

squamous cell carcinoma

from bronchial epithelium, present as intraluminal mass centrally located with hemoptysis

adenocarcinomas

from mucus glands/epithelial cells within/distal to terminal bronchioles

present as peripheral nodules/masses

MC lung cancer

adenocarcinoma

lung cancer sx

(MC asymptomatic), weight loss, new cough or change in chronic cough, hemoptysis, pain, pleural effusion, change in voice, shoulder pain

COPD bronchitis

COPD emphysema

pathology?