compressive vs obstructive atelectasis
compressive has increased tactile fremitus
tactile fremitus in pneumonia vs pleural effusion
pneumonia - increased effusion - decreased
a solitary pul nodule w/ mediastinum widening and atelectasis is seen in which patho
lung cancer
why do we percuss supraclavicular area
Pancoast Tobias tumour (apical lung)
trousseau's syndrome occurs in which patho
lung cancer (vascular syndrome)
neurologic syndromes from lung cancer
eaton-lambert
endocrine syndromes from lung cancer
hypercalcemia, oliguria, Cushing
when is there hoarseness in lung cancer
laryngeal n paralysis from left side tumour
manifestations of lung cancer
asymptomatic
non specific (weight loss, anemia)
pul lesion -> cough, hemoptysis, dsypnea, wheeze, atelectasis
intrathoracic spread -> dysphagia, hiccups, horner's, pleural effusion
extrathoracic spread -> bone, liver, adrenal, brain
paraneoplastic syndrome
lung cancer is divided into
NSCLC (adeno, squamous + large cell carcinoma) and SCLC
risk factors for lung cancer
smoking, carcinogens, copd, women who smoke, black men, HIV, inheritance
ECG w/ increase S1 and T3 pattern is indicate of which patho
pul embolism
signs of pul embolism on xray
Westermark (dilation of pul vessel), Hampton hump (triangular infiltrate)
physical exam in pul embolism
unilateral leg swell, tachycardia, hypotension, consolidation signs of lungs, d-dimer
symptoms of pul embolism
pleuritis chest pain, hemoptysis, back + shoulder + upper abd pain
consequences of pul embolism are primarily
hemodynamic (emboli, resp insufficiency)
patient-related predisoping factors of pul embolism
age, history of prevout VTE, cancer, major surgery, MI, estrogen use
hereditaroy factors for v thromboemebolism are those related to
thrombophilia (AT3, protein C, S)
etiology of pul embolism
DVT -> thromboembolism
DD bw abscess and lobar pneumonia
coarse crackles in abscess
physical findings of lung asbcess
clubbing, consolidation sounds (coarse crackles, decreased sounds), pleural rub
manifestations of lung asbcess
chill, low fever, foul smell sputum, hemoptysis, dyspnea, night sweats
classifcation of lung abscess
primary by aspiration secondary by bronchiectasis, immunocompromised or tumour
patients with mouth diseases, seizures and dysphagia + impaired consciousness are at higher risk of what
lung abscess
pleural effusion
collection of fluid in pleural linings
causes of pleural effusion
congestive hf, malignancy, infections and pul emboli
transudate vs exudate pleural effusion
manifestations of pleural effusion
unilateral + sharp pain, worsens w/ inspiration and cough dyspnea dry cough
xray of pleural effusion
hemidiaphragm elevated
thoracentesis
removal fluid from pleural effusion, diagnostic or therapeutic
therapeutic thoracentesis (+limit)
removes larger amounts pleural effusion to alleviate dyspnea, max 1500ml
putrid odor pleural fluid in effusion suggests
anaerobic empyema
ammonia odor pleural fluid in effusion suggests
urinothorax
black pleural fluid in effusion suggests
aspergillosis
yellow/green pleural fluid in effusion suggests
rheumatoid pleural effusion
bloody pleural fluid in effusion suggests
trauma, malignancy, high amounts is hemothorax
when is pleural effusion considered an exudate
high protein and LDH
pleural fluid ldh levels >1000 IU/L suggests
empyema, malignant effusion or rheumatoid effusion
low pleural fluid glucose in effusion suggests
malignancy, TB or empyema
how to test for TB pleural effusion
acid-fast bacillus stain or ADA (adenosine deaminase)
high triglycerides, chol and milky pleural fluids suggests
chylothorax
in patients with pleural effusion, bronchoscopy is only done when
patient has parenchymal abnormalities or hemopytsis
causes of pleural transudate effusions
congestive heart failure, cirrhosis, nephrotic syndrome
congestive HF causing pleural transudate effusions
biventricular failure causing bilateral effusions, also called hydrothorax
forms of pleural exudative effusions caused by infections
parapneumonic effusion
uncomplicated (pneumonia)
complicated (bacteria, increased neutrophils)
empyema (loculated pus)
causes of empyema
trauma, lung abscess rupture, septic infarction, infection, esophageal rupture
manifestations of parapneumonic effusions
symptoms of effusion (pain, dyspnea, dry cough) with fever
anaerobic bacterial parapneumonic effusion manifestation
weight loss
physical exam of pleural effusion
febrile, tachypnea, tachycardia (looks like SIRS), diaphragm in upper position, dullness, decreased breath sounds + fremitus, tracheal shift
investigations of pleural effusion
increased ESR, leukocytosis
what used to be the most common cause of pleural effusion
tb
hemothorax
collection of blood within pleural cavity
etiology of hemothorax
trauma, hematologic disorders, pleural malignancies, aorta rupture, TB
manifestations of hemothorax
low BP, fainting, anemia
classification of pneumothorax
simple spontaneous pneumothorax (tall thin smokers) secondary pneumothorax (from lung disease, AIDS) iatrogenic pneumothorax (ventilation, biopsy) traumatic pneumothorax (rib fracture)
which part of lungs are involved in simple spontaneous pneumothorax
right lung
mannifestations of pneumothorax
sudden dyspnea, tachycardia, hypotension, cyanosis, JVD
chest radiography in pneumothorax
confirms it, linear shadow, small ones only evident in expiration
acute bronchitis
acute inflammation of mucous membrane lining upper airways lasting 10 d
etiology of acute bronchitis
respiratory tract viruses
what should be asked in taking history of patient with bronchitis
recent cold, exposure to allergens, smoking, family history of lung disease
manifestations of acute bronchitis
cough, sputum production, upper respo tract symptoms, general chills or fever, angina
cough in acute bronchitis
starts dry, then becomes productive (yellow/green sputum)
examination of acute bronchitis
unremarkable
what lung sound may be present in acute bronchitis
stridor, ronchi or wheezes
why is a chest x-ray done in patients with acute bronchitis
to rule out pneumonia
chronic bronchitis
cough with sputum expectoration for >3m during a period of 2 consecutive yrs
how does chronic bronchitis progress
progressive airflow limitation w/ emphysema -> COPD
etiology of chronic bronchitis
smoking, pollution, infections
classification of chronic bronchitis
simple (mucoid sputum production) chronic mucopurulent (persistent purulent sputum) chronic bronchitis w/ obstruction
chronic bronchitis with obstruction must be distinguished from
chronic infective asthma
manifestations of chronic bronchitis
chronic cough (worse in mornings), sputum hyperproduction, frequent resp infections, dyspnea, wheezing, fatigue
physical exam of chronic bronchitis
blue boater or pink puffer
signs of blue boater
overweight, increased resp + heart rate, use of accessory m, cyanosis, clubbing, cor pulmonale
signs of cor pulmonale causing chronic bronchitis
peripheral edema (in blue boater)
thorax exam in blue boater chronic bronchitis
barrel chest, decreased fremitus, hyper resonant percussion, decreased breath sounds w/ crackles + wheezes
spirometry has obstructive pattern in which pathos
chronic bronchitis (COPD), asthma
emphysema
abnormal permanent air spaces enlargement, marked by decreased respiratory function; associated with smoking or chronic bronchitis or old age
etiology of emphysema
smoking, alpha-antitrypsin deficiency, infections
classification of emphysema
panlobular centrilobular
manifestations of emphysema
pink puffer, progressive dyspnea, wet cough
exam of emphysema
tachypnea + tachycardia, accessory m, warm cyanosis, exophthalmos, injected conjunctivas, clubbing
chest of emphysema
barrel chest, decreased wall movements + fremitus, hyperresonant auscultation
xray in emphysema
diaphragm flattened (translucent)
COPD
chronic bronchitis + emphysema, preventable + reversible
risk factors for COPD
genetics, smoke, pollution
symptoms of COPD
progressive dyspnea, productive cough, recurrent pul infections, cardiac/respo failure w/ edema, hepatomegaly, exopthalmus, jvd
types of copd
blue bloaters -> chronic bronchitis pink puffers -> emphysema
what investigations makes diagnosis for COPD
spirometry
copd vs asthma
asthma is reversible, copd is not asthma onset in childhood while copd in midlife copd is progressive
asthma bronchiale
chronic inflammatory disorder of airways causing recurring episodes of wheezing, breathlessness, chest tightness and coughing (at night)
family history of what is in patients w/ asthma
allergy, sinusitis, rhinitis, asthma
evidence of resp distress
tachypnea, tachycardia, diaphoresis, accessory m use, orthopnea, cyanosis, pulsus paradoxus
pulsus paradoxus
fall in systolic bp in inspiration, during acute asthma attack
chest exam in asthma
hyperinflated chest, decreased fremitus + breath sounds, expiratory wheezing, hyperresonance
types of asthma
allergenic, exercise induced, nocturnal, drug induced, cough-variant
non-allergic asthma is related to what
viral infections or chronic bronchitis
severity levels of asthma
mild/intermittent, mild/persistent, mod/severe
resp failure
syndrome where lung unable to meet metabolic demands of body, from failure of tissue oxygenation + failure of CO2 homeostasis.
resp failure is defined as PaO2 + PaCO2 value