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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?