PD Pulm Pathology (Complete)

PTX

Collection of air in pleural cavity

PTX symptoms

Cough, CP, dyspnea

PTX risk factors

COPD, smoker, thin/tall, hx of trauma

PTX vitals

tachypnea/tachycardia

- O2 sat normal or low

PTX PE

Dependent upon size

- tracheal deviation

- decreased breath sounds on affected side

- decreased TF, hyper-resonance on affected side

- crepitus (SQ emphysema) if large

(if small PTX, exam will be normal

PTX diagnostics

CXR (borders will show the lung tissue, may see a mediastinal shift/deviated trachea

pneumonia definition

Infection of lung parenchyma

(bacterial, fungal, viral)

pneumonia symptoms

Fever, cough, CP (localized), dyspnea

pneumonia risk factors

immuno-compromised

smoker

pneumonia vitals

• tachypnea

• fever

• possible low O2

pneumonia PE

- rales over consolidation

- possible broncho vesicular sounds where vesicular is expected

- dullness to percussion

- increased TF

- positive egophony

pneumonia diagnostics

- CXR

- CBC (lymphocyte = viral, neutrophils = bacterial)

- BMP: check for metabolic issues (elevated glucose or poor kidney fxn)

- respiratory panel

- sputum culture

pulmonary embolism definition

clot that is occluding pulmonary arteries

pulmonary embolism symptoms

pleuritic CP, dyspnea, cough, leg swelling

pulmonary embolism risk factors

postpartum, post-op, fracture (esp long bones), DVT, hypercoagulability

pulmonary embolism vitals

• possibly tachypnea, tachycardia

  • possible low O2 sat

pulmonary embolism exam findings

decreased breath sounds over area of embolism

- possible rales (if lung infarct)

- calf/thigh swelling (if d/t DVT)

diagnostics for PE

Well’s criteria

- D-dimer

- PT/PTT

- V/Q scan

- CTA ** definitive test

- U/S to look for DVT

pleurisy definition

inflammation of parietal pleura

pleurisy symptoms

pleuritic CP, cough, SOB

pleurisy risk factors

underlying illness

pleurisy vitals

bradypnea, tachycardia

- possible low O2 sat

- splinting

- possible tenderness to palpation

- possible adventitious sounds

pleural effusion definition

fluid in pleural cavity

pleural effusion symptoms

CP, SOB, cough, fatigue

(can cause pleuritic chest pain if severe enough)

pleural effusion risk factors

transudative vs. exudative

Transudative: Imbalance in hydrostatic or oncotic pressures → fluid leaks d/t pressures (capillaries are fine)

• congestive heart failure

• cirrhosis

• nephrotic

exudative: Increased capillary permeability or inflammation → fluid leaves b/c there’s damage

• - Infection (pneumonia → empyema)

  - Malignancy

  - Pulmonary embolism

  - Tuberculosis

  - Autoimmune disease

pleural effusion vitals

- tachycardia, tachypnea

- possible fever

- possible low O2 sat

pleural effusion pe

- decreased/no breath sounds over effusion

- possible rales at level of effusion

- dullness to percussion over area

- decreased TF

- no positive special tests

pleural effusion diagnostics

- CXR - blunted/rounded CVA

- thoracic U/S (w/ thoracentesis @ 7-8 ICS

- chest CT (if malignancy suspected

COPD definition

chronic obstruction of trachea-bronchial tree

COPD risk factors

smoking, air pollutants, genetic

COPD vitals

• possible tachycardia

  • decreased diaphragmatic excursion

COPD PE

barrel chest

COPD diagnostics

spirometry = gold standard

CXR

emphysema

loss of lung elasticity and alveoli enlargement

emphysema risk factor

A1A defiiency

emphysema presentation

Dyspnea = most common (rest and exertion), minimal cough, cachexia, pursed lip breathing

emphysema PE

decreased breath sounds

- hyperinflation

- wheezing or rhonchi

- prolonged expiratory phase

chronic bronchitis

primary bronchi inflammation

chronic bronchitis risk factor

older people

chronic bronchitis symptoms

cough, sputum, production, obese, cyanotic

chronic bronchitis PE

decreased breath sounds

- hyperinflation

- wheezing or rhonchi

- prolonged expiratory phase

bronchiectasis

Chronic dilatation of bronchi/bronchioles

bronchiectasis risk factor

Congenital or acquired (CF, infections, immunodeficiency, A1A def)

bronchiectasis symptoms*

Chronic cough, purulent sputum, hemoptysis, CP, dyspnea, weight loss*

bronchiectasis symptoms

• wheezing, rhonchi, rales

bronchiectasis diagnostics

• what is gold standard?

test for CF

- sputum culture

- CXR (tram tracks)

- CT = gold standard

cystic fibrosis

genetic, abnormalities in lung, pancreas, sweat glands (Exocrine)

CF symptoms

• infants vs. adulthood

Infants: meconium ileum, respiratory symptoms, failure to thrive

Adulthood: GI symptoms

CF PE

- often w/ nasal polyps, headaches, epistaxis

- hyperinflation of the lungs (barrel chest)

- significant adventitious sounds

- low body mass (absorption)

bronchial obstruction risk factors

FB, tumor, airway swelling

bronchial obstruction symptoms

cough, dyspnea, choking, wheezing

bronchial obstruction vitals

- possible hypotension, tachycardia, tachypnea, low O2 sat

bronchial obstruction PE

decreased breath sounds on affected side

- can cause decreased lung expansion

- hyper-resonance on affected side if percussing when exhaling

- special tests negative

asthma

narrowed airways

asthma risk factors

exposure to triggers, family Hx, atrophy (usually in younger patients)

asthma symptoms

cough, SOB, wheezing

asthma vitals

possible tachycardia, tachypnea, low O2 sat

asthma PE

- generalized wheezing

- decreased lung sounds

- negative special tests

- percussion/TF = symmetric

tuberculosis

exposure to droplets of mycobacterium

tuberculosis risk factors

Latent vs active

- active: primary vs reactivated

HIV, immunocompromised, prison, nursing home, foreign born

TB symptoms

• primary vs. reactivated

Primary: asymptomatic, immunocompromised, children, middle/lower lobes

- Reactivated: adult, symptomatic, apices

- cough, fever, weight loss, night sweats, hemoptysis, CP, fatigue

TB vitals

• fever, weight loss

TB diagnostics

• latent vs. symptomatic

Latent: PPD, Quantiferon, T-spot

Symptomatic: IGRA, CXR, sputum culture

acute bronchitis

Inflammation of bronchial tubes (large airway) d/t viral infection

acute bronchitis symptoms

Cough (+/- sputum), wheezing, dyspnea, fatigue

acute bronchitis PE

rhonchi or wheezing (generalized)

- negative special tests

- no dullness to percussion

lung cancer

Malignant neoplasm arising from epithelium (bronchi, bronchioles, alveoli)

Non small cell or small cell

lung cancer risk factors

Smoking, occupational exposure, radiation, family hx

lung cancer symptoms

Cough, CP, fatigue, anorexia, cachexia, weight loss

- symptoms are gradual and ongoing

lung cancer vitals

hypo or hypertension

- possible tachycardia, tachypnea, low O2 sat

lung cancer PE

- possible adventitious sounds

- possible broncho-vesicular sounds where unexpected

- possible dullness to percussion

TB diagnostic

tissue confirmation/biopsy

atelectasis

Collapse of lung parenchyma

(compressive vs obstructive vs micro-atelectasis vs contraction

atelectasis symptoms

• depends on severity

  • cough, dyspnea, fever

atelectasis vitals

tachycardia, tachypnea, fever

atelectasis PE

- usually not generalized, and typically found in the left lower lobe

- possible rales (only in affected area)

(not often a Dx, more so something else that caused this)

Pulmonary hypertension

Increased PAP (>20mmHg)

Primary = no underlying cause

Secondary = known condition increases work of right heart

Pulmonary hypertension symptoms

dyspnea, cough, exertional CP, edema

Pulmonary hypertension PE

- mild: possible louder closure of pulmonic valve

- moderate: lift along LSB

- severe: tricuspid or pulmonic regurg, S3/S4 of RV, JVD, HJR, edema, hypotension, diminished pulses

URI (childhood)

appears ill

no lower airway abnormalities

no adventitious sounds

asthma (childhood)

wheezing (Expiratory)

pneumonia (children)

rales

upper airway obstruction (children)

stridor, rhonchi

croup

inflammation of larynx (viral, often parainfluenza)

croup symptoms

Cough (harsh, barking seal), fever, runny nose

- cough = worse @ night

- cold air helps

croup age

1-3 years

croup PE

- Labored breathing

- stridor = common

- restless, irritable

- ill-appearing

(oftentimes treated outpatient)

Bronchiolitis (child)

Inflammation of small airways → hyperinflation of lungs

(viral - RSV, adenovirus, parainfluenza)

bronchiolitis (child)

Lethargy, poor feeding

- runny nose (bad b/c obligate nose breathers) / congested

bronchiolitis (child) risk factor

infants less than 6 months = common

bronchiolitis (child) PE

rapid,short breathes

- retractions

- diminished breath sounds

- wheezing, rales, rhonchi possible

(tend to be hospitalized)

hemoptysis

TB and bronchiectasis

thoracentesis

use during pleural effusion

T7-8 intercostal space AKA T7 intercostal space (Which is above the 8th rib) (inferior tip of the scapula)

avoids major organs and is safer