Medical Semiology II

5.0(3)
studied byStudied by 45 people
learnLearn
examPractice Test
spaced repetitionSpaced Repetition
heart puzzleMatch
flashcardsFlashcards
Card Sorting

1/125

flashcard set

Earn XP

Description and Tags

Study Analytics
Name
Mastery
Learn
Test
Matching
Spaced

No study sessions yet.

126 Terms

1
New cards
compressive vs obstructive atelectasis
compressive has increased tactile fremitus
2
New cards
tactile fremitus in pneumonia vs pleural effusion
pneumonia - increased
effusion - decreased
3
New cards
a solitary pul nodule w/ mediastinum widening and atelectasis is seen in which patho
lung cancer
4
New cards
why do we percuss supraclavicular area
Pancoast Tobias tumour (apical lung)
5
New cards
trousseau's syndrome occurs in which patho
lung cancer (vascular syndrome)
6
New cards
neurologic syndromes from lung cancer
eaton-lambert
7
New cards
endocrine syndromes from lung cancer
hypercalcemia, oliguria, Cushing
8
New cards
when is there hoarseness in lung cancer
laryngeal n paralysis from left side tumour
9
New cards
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
10
New cards
lung cancer is divided into
NSCLC (adeno, squamous + large cell carcinoma) and SCLC
11
New cards
risk factors for lung cancer
smoking, carcinogens, copd, women who smoke, black men, HIV, inheritance
12
New cards
ECG w/ increase S1 and T3 pattern is indicate of which patho
pul embolism
13
New cards
signs of pul embolism on xray
Westermark (dilation of pul vessel), Hampton hump (triangular infiltrate)
14
New cards
physical exam in pul embolism
unilateral leg swell, tachycardia, hypotension, consolidation signs of lungs, d-dimer
15
New cards
symptoms of pul embolism
pleuritis chest pain, hemoptysis, back + shoulder + upper abd pain
16
New cards
consequences of pul embolism are primarily
hemodynamic (emboli, resp insufficiency)
17
New cards
patient-related predisoping factors of pul embolism
age, history of prevout VTE, cancer, major surgery, MI, estrogen use
18
New cards
hereditaroy factors for v thromboemebolism are those related to
thrombophilia (AT3, protein C, S)
19
New cards
etiology of pul embolism
DVT -> thromboembolism
20
New cards
DD bw abscess and lobar pneumonia
coarse crackles in abscess
21
New cards
physical findings of lung asbcess
clubbing, consolidation sounds (coarse crackles, decreased sounds), pleural rub
22
New cards
manifestations of lung asbcess
chill, low fever, foul smell sputum, hemoptysis, dyspnea, night sweats
23
New cards
classifcation of lung abscess
primary by aspiration
secondary by bronchiectasis, immunocompromised or tumour
24
New cards
patients with mouth diseases, seizures and dysphagia + impaired consciousness are at higher risk of what
lung abscess
25
New cards
pleural effusion
collection of fluid in pleural linings
26
New cards
causes of pleural effusion
congestive hf, malignancy, infections and pul emboli
27
New cards
transudate vs exudate pleural effusion
transudate - ultrafiltrates of plasma in pleura from hydrostatic and oncotic forc imbalance,
28
New cards
manifestations of pleural effusion
unilateral + sharp pain, worsens w/ inspiration and cough
dyspnea
dry cough
29
New cards
xray of pleural effusion
hemidiaphragm elevated
30
New cards
thoracentesis
removal fluid from pleural effusion, diagnostic or therapeutic
31
New cards
therapeutic thoracentesis (+limit)
removes larger amounts pleural effusion to alleviate dyspnea, max 1500ml
32
New cards
putrid odor pleural fluid in effusion suggests
anaerobic empyema
33
New cards
ammonia odor pleural fluid in effusion suggests
urinothorax
34
New cards
black pleural fluid in effusion suggests
aspergillosis
35
New cards
yellow/green pleural fluid in effusion suggests
rheumatoid pleural effusion
36
New cards
bloody pleural fluid in effusion suggests
trauma, malignancy, high amounts is hemothorax
37
New cards
when is pleural effusion considered an exudate
high protein and LDH
38
New cards
pleural fluid ldh levels >1000 IU/L suggests
empyema, malignant effusion or rheumatoid effusion
39
New cards
low pleural fluid glucose in effusion suggests
malignancy, TB or empyema
40
New cards
how to test for TB pleural effusion
acid-fast bacillus stain or ADA (adenosine deaminase)
41
New cards
high triglycerides, chol and milky pleural fluids suggests
chylothorax
42
New cards
in patients with pleural effusion, bronchoscopy is only done when
patient has parenchymal abnormalities or hemopytsis
43
New cards
causes of pleural transudate effusions
congestive heart failure, cirrhosis, nephrotic syndrome
44
New cards
congestive HF causing pleural transudate effusions
biventricular failure causing bilateral effusions, also called hydrothorax
45
New cards
forms of pleural exudative effusions caused by infections
parapneumonic effusion
- uncomplicated (pneumonia)
- complicated (bacteria, increased neutrophils)
- empyema (loculated pus)
46
New cards
causes of empyema
trauma, lung abscess rupture, septic infarction, infection, esophageal rupture
47
New cards
manifestations of parapneumonic effusions
symptoms of effusion (pain, dyspnea, dry cough) with fever
48
New cards
anaerobic bacterial parapneumonic effusion manifestation
weight loss
49
New cards
physical exam of pleural effusion
febrile, tachypnea, tachycardia (looks like SIRS), diaphragm in upper position, dullness, decreased breath sounds + fremitus, tracheal shift
50
New cards
investigations of pleural effusion
increased ESR, leukocytosis
51
New cards
what used to be the most common cause of pleural effusion
tb
52
New cards
hemothorax
collection of blood within pleural cavity
53
New cards
etiology of hemothorax
trauma, hematologic disorders, pleural malignancies, aorta rupture, TB
54
New cards
manifestations of hemothorax
low BP, fainting, anemia
55
New cards
classification of pneumothorax
simple spontaneous pneumothorax (tall thin smokers)
secondary pneumothorax (from lung disease, AIDS)
iatrogenic pneumothorax (ventilation, biopsy)
traumatic pneumothorax (rib fracture)
56
New cards
which part of lungs are involved in simple spontaneous pneumothorax
right lung
57
New cards
mannifestations of pneumothorax
sudden dyspnea, tachycardia, hypotension, cyanosis, JVD
58
New cards
chest radiography in pneumothorax
confirms it, linear shadow, small ones only evident in expiration
59
New cards
acute bronchitis
acute inflammation of mucous membrane lining upper airways lasting 10 d
60
New cards
etiology of acute bronchitis
respiratory tract viruses
61
New cards
what should be asked in taking history of patient with bronchitis
recent cold, exposure to allergens, smoking, family history of lung disease
62
New cards
manifestations of acute bronchitis
cough, sputum production, upper respo tract symptoms, general chills or fever, angina
63
New cards
cough in acute bronchitis
starts dry, then becomes productive (yellow/green sputum)
64
New cards
examination of acute bronchitis
unremarkable
65
New cards
what lung sound may be present in acute bronchitis
stridor, ronchi or wheezes
66
New cards
why is a chest x-ray done in patients with acute bronchitis
to rule out pneumonia
67
New cards
chronic bronchitis
cough with sputum expectoration for >3m during a period of 2 consecutive yrs
68
New cards
how does chronic bronchitis progress
progressive airflow limitation w/ emphysema -> COPD
69
New cards
etiology of chronic bronchitis
smoking, pollution, infections
70
New cards
classification of chronic bronchitis
simple (mucoid sputum production)
chronic mucopurulent (persistent purulent sputum)
chronic bronchitis w/ obstruction
71
New cards
chronic bronchitis with obstruction must be distinguished from
chronic infective asthma
72
New cards
manifestations of chronic bronchitis
chronic cough (worse in mornings), sputum hyperproduction, frequent resp infections, dyspnea, wheezing, fatigue
73
New cards
physical exam of chronic bronchitis
blue boater or pink puffer
74
New cards
signs of blue boater
overweight, increased resp + heart rate, use of accessory m, cyanosis, clubbing, cor pulmonale
75
New cards
signs of cor pulmonale causing chronic bronchitis
peripheral edema (in blue boater)
76
New cards
thorax exam in blue boater chronic bronchitis
barrel chest, decreased fremitus, hyper resonant percussion, decreased breath sounds w/ crackles + wheezes
77
New cards
spirometry has obstructive pattern in which pathos
chronic bronchitis (COPD), asthma
78
New cards
emphysema
abnormal permanent air spaces enlargement, marked by decreased respiratory function; associated with smoking or chronic bronchitis or old age
79
New cards
etiology of emphysema
smoking, alpha-antitrypsin deficiency, infections
80
New cards
classification of emphysema
panlobular
centrilobular
81
New cards
manifestations of emphysema
pink puffer, progressive dyspnea, wet cough
82
New cards
exam of emphysema
tachypnea + tachycardia, accessory m, warm cyanosis, exophthalmos, injected conjunctivas, clubbing
83
New cards
chest of emphysema
barrel chest, decreased wall movements + fremitus, hyperresonant auscultation
84
New cards
xray in emphysema
diaphragm flattened (translucent)
85
New cards
COPD
chronic bronchitis + emphysema, preventable + reversible
86
New cards
risk factors for COPD
genetics, smoke, pollution
87
New cards
symptoms of COPD
progressive dyspnea, productive cough, recurrent pul infections, cardiac/respo failure w/ edema, hepatomegaly, exopthalmus, jvd
88
New cards
types of copd
blue bloaters -> chronic bronchitis
pink puffers -> emphysema
89
New cards
what investigations makes diagnosis for COPD
spirometry
90
New cards
copd vs asthma
asthma is reversible, copd is not
asthma onset in childhood while copd in midlife
copd is progressive
91
New cards
asthma bronchiale
chronic inflammatory disorder of airways causing recurring episodes of wheezing, breathlessness, chest tightness and coughing (at night)
92
New cards
family history of what is in patients w/ asthma
allergy, sinusitis, rhinitis, asthma
93
New cards
evidence of resp distress
tachypnea, tachycardia, diaphoresis, accessory m use, orthopnea, cyanosis, pulsus paradoxus
94
New cards
pulsus paradoxus
fall in systolic bp in inspiration, during acute asthma attack
95
New cards
chest exam in asthma
hyperinflated chest, decreased fremitus + breath sounds, expiratory wheezing, hyperresonance
96
New cards
types of asthma
allergenic, exercise induced, nocturnal, drug induced, cough-variant
97
New cards
non-allergic asthma is related to what
viral infections or chronic bronchitis
98
New cards
severity levels of asthma
mild/intermittent, mild/persistent, mod/severe
99
New cards
resp failure
syndrome where lung unable to meet metabolic demands of body, from failure of tissue oxygenation + failure of CO2 homeostasis.
100
New cards
resp failure is defined as PaO2 + PaCO2 value
PaO2