HISTORY AND PE SUMMARY 2

Abnormalities of gas exchange and Increased work of breathing

What are the two general categories of physiological responses that cause increases in ventilation, leading to dyspnea?

Decreased oxygenation, hypoventilation, hyperventilation

Name two types of Abnormalities of gas exchange that cause dyspnea.

Efferent (outgoing) and Afferent (incoming)

What are the two primary types of signals whose interaction results in dyspnea?

Afferent information from the receptors throughout the respiratory system

What type of information projects directly to the sensory cortex to contribute to primary qualitative sensory experiences of dyspnea?

Airway obstruction, Abnormal alveoli, Restrictive chest and lung disease, Abnormal pulmonary circulation, Oxyhemoglobin deficiency, Abnormal respiratory stimuli, Decreased FiO2

Name two categories of mechanisms that cause dyspnea.

Larynx and Trachea

What category of airways are susceptible to obstruction by infections, angioedema, trauma, foreign body, or tumors of the neck?

Bronchi and Bronchioles

What category of airways are susceptible to obstruction by bronchitis, asthma, extensive bronchiectasis, bronchial stenosis, retrosternal goiter, or aspirated foreign body?

Alveolar filling, Mechanically compressed, Alveolar distraction

What are the three categories of abnormal alveoli that cause dyspnea?

Pulmonary edema, pulmonary infiltrations (pneumonia, carcinoma), pulmonary hemorrhage

Name two types of conditions that cause Alveolar filling.

Atelectasis, pneumothorax, hydrothorax

Name two types of conditions that cause Mechanically compressed alveoli.

Pulmonary thromboemboli and infarction, Pericardial tamponade, Pulmonary artery stenosis, Arteriovenous shunts, Arteriolar stenosis

Name two types of conditions associated with Abnormal pulmonary circulation causing dyspnea.

Anemia, Carbon monoxide poisoning (Carboxyhemoglobinemia), Methemeglobineamia, Cyanide

Name two types of conditions associated with Oxyhemoglobin deficiency causing dyspnea.

Pain from respiratory movements, Hyperventilation syndrome, Secondary respiratory alkalosis

Name two types of Abnormal respiratory stimuli that cause dyspnea.

Paroxysmal Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea (PND)

Name two subtypes of Dyspnea.

Acute, Subacute, Chronic

What are the three classifications of Cough based on duration.

< 3 weeks

What duration classifies Acute Cough?

3 to 8 weeks

What duration classifies Subacute Cough?

8 weeks

What duration classifies Chronic Cough?

Infectious, Neoplastic, Inflammatory/Immune, Vascular, Mechanical/Trauma, Congenital, Endocrine, Metabolic/Toxic, Neurologic

Name two categories of Cough Etiology.

Bronchial Circulation

What high pressure circuit is the source of massive hemoptysis in 90% of cases?

TB, bronchiectasis, and tumor/carcinoma

What are the top three causes of Massive Hemoptysis?

Pulmonary vasculature, Lung parenchyma, Mediastinal disease, Pleura and pleural space

Name two potential sources of Chest Pain.

Pneumothorax, Pleuritis/serositis, Pleural effusion

Name two etiologies of Pleuritic Chest Pain.

Increase in ventilation

What is the consequence observed in response to abnormalities of gas exchange or increased work of breathing?

Decrease in oxygenation

What specific abnormality of gas exchange causes dyspnea?

Increase in work of breathing

What factor, caused by changes in respiratory mechanics or anxiety, leads to dyspnea?

Increased intensity of dyspnea

What is the effect when the feed-forward and feedback messages do not match?

Increase in pulmonary capillary pressure

What physiological event is associated with Paroxysmal Dyspnea?

Increased anterior-posterior (AP) diameter

What structural change is characteristic of Barrel-chest deformity, secondary to COPD?

Lateral displacement of the trachea

What structural change is seen in cases such as pneumothorax, atelectasis, and pleural effusion?

Ipsilateral

What is the direction of tracheal deviation in Atelectasis?

Contralateral

What is the direction of tracheal deviation in Massive pleural effusion and Tension Pneumothorax?

Increase

What change in tactile fremitus is caused by Consolidation?

Decrease or absence

What change in tactile fremitus is caused by blockage of the airways, sound screens of fluid/air, or fibrosis of pleura?

Flatness, dullness, resonance, hyperresonance, tympany

Name two categories of percussion notes.

High

What pitch characterizes Flatness and Tympany percussion notes?

Low

What pitch characterizes Resonance and Hyperresonance percussion notes?

Loud

What intensity characterizes Resonance and Tympany percussion notes?

Very loud

What intensity characterizes Hyperresonance percussion notes?

Large pleural effusion

What disease condition is associated with the Flatness percussion note?

Lobar pneumonia

What disease condition is associated with the Dullness percussion note?

Emphysema, pneumothorax

Name two disease conditions associated with the Hyperresonance percussion note?

Large pneumothorax

What disease condition is associated with the Tympany percussion note?

Decreased or asymmetric diaphragmatic excursion

What change may indicate paralysis or emphysema?

Normal breath sounds, Adventitious sounds, Transmitted Voice Sounds

What are the three types of breath sounds?

Vesicular, Bronchovesicular, Bronchial, Tracheal

Name two categories of Normal Breath Sounds

.

Crackles / Rales, Rhonchi, Stridor, Wheezing

Name two types of Adventitious sounds.

Discontinuous

What is the duration characteristic of Crackles?

Continuous

What is the duration characteristic of Rhonchi and Wheezing?

Decrease or absence

What change in breath sounds can mean air or fluid in or around the lungs, increased thickness of the chest wall, over-inflation, or reduced airflow?

Crackles

What type of adventitious breath sound is associated with Congestive heart failure and Pneumonia?

Wheeze

What type of adventitious breath sound is associated with Asthma and Congestive Heart Failure (CHF)?

Stridor

What type of adventitious breath sound is associated with Epiglottitis and Foreign bodies?

Rhonchi

What type of adventitious breath sound is associated with Bronchitis?

Increase in loudness and distinctiveness

What change in transmitted voice sounds is associated with consolidation, atelectasis, or fibrosis?

Bronchophony, Whispered Pectoriloquy, Egophony

Name two types of Transmitted Voice Sounds.

Decreased vocal fremiti

What physical finding is usually suggestive of effusion?

Knife-like or shooting pains

What type of pain is produced by inflammation of the pleura (pleuritis)?

Bright red or pink

What color characterizes the blood in Hemoptysis sputum?

Brown to black

What color characterizes the blood in Hematemesis sputum?

Liquid or clotted appearance

What type of appearance characterizes the blood in Hemoptysis sputum?

Frothy

What is the characteristic appearance of Hemoptysis sputum?

Coffee ground appearance

What is the characteristic appearance of Hematemesis sputum?

Alkaline pH

What pH characteristic distinguishes Hemoptysis sputum?

Acidic pH

What pH characteristic distinguishes Hematemesis sputum?

Lung Disease

What disease category is associated with Hemoptysis in history?

Gastric or hepatic disease

What disease category is associated with Hematemesis in history?

Asphyxia possible

What severe consequence is possible in Hemoptysis?

Asphyxia unusual

What severe consequence is unusual in Hematemesis?

Acute RTI, Acute exacerbation of COPD, pneumonia, and pulmonary embolism

What are the causes of Acute Cough?

Post-infectious cough, bacterial sinusitis, asthma

What are the causes of Subacute Cough?

Tuberculosis, Upper airway cough syndrome, Asthma, Gastroesophageal reflux cough

What are the causes of Chronic Cough?

Apical, posterior, anterior, lateral, medial, posterior, anterior basal, lateral basal, medial basal, superior

Name two segments in the Right Lung listed in the lung segment mnemonics?

Apico-posterior, superior lingular, inferior lingular, anterior, anteromedial basal, lateral basal, posterior basal, superior

Name two segments in the Left Lung listed in the lung segment mnemonics?

COPD – Emphysema

What disease is suggested by progressive dyspnea in a smoker with CXR showing hyperinflated lungs and a downward diaphragm (Case 1)?

Pneumothorax

What disease is suggested by sudden dyspnea after lifting weights, with CXR showing a collapsed right lung (Case 2)?

Pulmonary congestion with acute MI

What pathology is suggested by sudden dyspnea, chest pain, and orthopnea in a hypertensive, diabetic patient, with CXR showing hazy, bilateral, fluffy, perihilar infiltrates (Case 3)?

Pleural Effusion

What disease is suggested by progressive dyspnea, weight loss, and afternoon fever, with CXR showing a white pointed portion (meniscus sign) and a compressed lung (Case 4)?

TB

What disease is the likely etiology of the fluid in Pleural Effusion when associated with weight loss and afternoon fever (Case 4)?

Acute RTI, Acute exacerbation of COPD, pneumonia, and pulmonary embolism

Name two diseases that are common causes of Acute Cough (duration <3 weeks).

Post-infectious cough, bacterial sinusitis, asthma

Name two diseases that may cause Subacute Cough (duration 3 to 8 weeks).

Tuberculosis (TB)

What is possibly the #1 cause of Chronic Cough (duration >8 weeks) in the Philippines?

Upper airway cough syndrome, Asthma, Gastroesophageal reflux cough (GERC)

Name two common diseases that cause Chronic Cough.

Pneumonia, bronchiectasis, lung abscess, sinusitis, pharyngitis, laryngitis

Name two Infectious etiologies of cough.

Lung cancer, laryngeal cancer

Name two Neoplastic etiologies of cough.

Inhaled allergens, asthma, chronic bronchitis, vasculitis

Name two Inflammatory/Immune etiologies of cough.

CHF, pulmonary embolism, and infarction

Name two Vascular etiologies of cough.

Inhaled foreign bodies, aspiration, mediastinal mass, lymphadenopathy

Name two Mechanical/Trauma etiologies of cough.

Tracheoesophageal fistula, mediastinal teratoma

Name two Congenital etiologies of cough.

Substernal thyroid

What Endocrine condition is listed as a cause of cough?

Tobacco smoking, ACE inhibitors

Name two Metabolic/Toxic causes of cough.

Gastroesophageal reflux (GERD), tympanitic membrane irritation

Name two Neurologic causes of cough.

Lung Cancer

What disease is suspected in a 42/M smoker with dry cough for 3 months and weight loss, characterized by a pulmonary mass (Case 5)?

Bacterial Pneumonia

What disease is suggested by one week of cough productive of yellowish phlegm, and fever (Case 6)?

TB, bronchiectasis, and tumor/carcinoma

What are the top three causes of Massive Hemoptysis?

Bronchitis, Bronchiectasis, Aspergilloma, Tumor, TB, Lung abscess, Emboli, Coagulopathy, Autoimmune disease, alveolar hemorrhage, arteriovenous malformation, Mitral stenosis, Pneumonia

Name two diseases that are causes of Massive Hemoptysis (BATTLE CAMP mnemonic).

Aspergilloma

What fungal disease is suggested by massive hemoptysis in a patient previously treated for PTB, with CXR showing a fungus ball on the apex of the R lung (Case 7)?

Acute pulmonary embolism

What pulmonary vasculature pathology can cause chest pain?

Pulmonary hypertension and cor pulmonale

What chronic pulmonary vasculature pathology can cause chest pain?