PMHx+PE Conditions in Common Respiratory Disorders

PMHx: Left-Sided Heart Failure (HF)

timing
dyspnea→progress slowly/rapidly

provoking factors

• exertion

• lying flat

pallitative factors

• rest

• sitting up

• may become persistent

associated sxs

• often cough

• orthorpnea

• paroxysmal nocturnal dyspnea

• sometimes wheezing

PMH/SH/FH

• PMHx heart dx/predisposing RFs

PMHx: Spontaneous Pneumothorax

timing
dyspnea→sudden onset

provoking factors
none

pallitative factors
none

associated sxs

• pleuritic chest pain

• cough

PMHx/SHx/FHx
often:

• previously healthy young adult

• adult+emphysema

• smoking hx

PMHx: Acute Pulmonary Embolism (PE)

timing
dyspnea+tachypnea→sudden onset

provoking factors
exertion

pallitative factors

• rest

• (although) may become persistent

associated sxs

• (maybe) none

• pleuritic chest pain

• cough

• syncope

• hemoptysis

• DVT→UL leg pain

PMHx/SHx/FHx

• postpartum

• recent surgery

• prolonged bed rest

• hip fracture

• DVT

• hypercoagulable states

PMHx: Chronic Bronchitis

timing
chronic productive cough→slowly preogrssive dyspnea

provoking factors

• exertion

• inhaled irritants

• respiratory infxns

pallitative factors

• expectoration

• rest

• dypnea may be persistent

associated sxs

• chronic productive cough

• recurrent respiratory infxns

• wheezing may develop

• clubbing

PMHx/SHx/FHx

• smoking hx

• air pollutants

• recurrent respiratory infxns

PMHx: COPD

timing
slowly progressive dyspnea→relatively mild cough later

provoking factors
exertion

pallitative factors

• rest

• dyspnea maybe persistent

associated sxs
cough+scant mucoid production

PMHx/SHx/FHx

• smoking hx

• air pollutants

• maybe familial

PMHx: Asthma

timing

• acute episodes

• separated by sx-free periods

• nocturnal episodes→common

provoking factors
variable

pallitative factors
separation from aggravating factors

associated sxs

• wheezing

• cough

• tightness

PMHx/SHx/FHx

• environmental conditions

• may be FHx

PMHx: Diffuse Interstitial Lung Disease

timing

• dyspnea→progressive

• varies in its rate of development with the cause

provoking factors
exertion

pallitative factors

• rest

• dyspnea may become persistent

associated sxs
often:

• weakness

• fatigue

• cough

• less common than other lung dxs

PMHx/SHx/FHx

• varied

• exposure to trigger substance

PMHx: Pneumonia (PNA)

timing

• acute illness

• timing→varies with the causative agent

provoking factors

• exertion

• smoking

pallitative factors

• rest

• dyspnea may become persistent

associated sxs

• pleuritic chest pain

• cough

• sputum

• fever

PMHx/SHx/FHx
varied

PMHx: Pulmonary Tuberculosis (TB)

timing

• variable

• latent+active dx

provoking factors
exertion

pallitative factors

• rest

• dyspnea may persist

associated sxs

• early→no sxs

later:

• anorexia

• weight loss

• fatigue

• night sweats

• fever

• cough

• purulent sputum

• blood-tinged

PMHx/SHx/FHx

• high-risk pts

• immunocompromised

PE: Normal

PP

• tracheobronchial tree+alveoli→open

• pleurae→thin+close together

• mobility of the chest wall→unimpaired

percussion→resonant

trachea→midline

breath sounds→vesicular

added sounds
none

tactile fremitus+voice sounds
“normal”

PE: Left-Sided Heart Failure (HF)

PP

• increased pressure in pulmonary Vs→congestion+interstitial edema
  -around the alveoli

• bronchial mucosa may become edematous

percussion→resonant

trachea→midline

breath sounds→vesicular

added sounds

• late inspiratory crackles→in dependent portions of the lungs

• possibly wheezes

tactile fremitus+voice sounds
“normal”

PE: Chronic Bronchitis

PP

• bronchi chronically inflamed+productive cough

• airway obstruction may develop

percussion→resonant

trachea→midline

breath sounds→vesicular

added sounds

• none

• inspiration→scattered coarse crackles

• possible wheezes

tactile fremitus+voice sounds
“normal”

PE: Lobar Pneumonia (PNA)

PP
alveoli filled with infxd/inflamed fluid

percussion→dull over area

trachea→midline

breath sounds→bronchial over area

added sounds
late inspiratory crackles over area

tactile fremitus+voice sounds

• increased

• egophany+bronchophony+whispered pectoriloquy→positive

PE: Atelectasis

PP
mucus plug obstructs bronchial air flow→affected alveoli colapse→airless

percussion→dull over area

trachea→may be shifted to involved side

breath sounds→bronchial plug persists→usually absent

added sounds
none

tactile fremitus+voice sounds
bronchial plug persists→usually absent

PE: Pleural Effusion

PP
fluid accumulates in pleural space→separates air-filled lung from chest wall→blocks the transmission of breath sounds

percussion→dull

trachea→shifted towards unaffected side

breath sounds

• decreased

• absent

• bronchial

added sounds

• none

• crackles

• pleural rub

tactile fremitus+voice sounds
decreased→absent

PE: Pneumothorax (PTX)

PP

percussion→hyperresonant

trachea→tension PTX→shifted towwards unaffected side

breath sounds

• decreased

• over pleural air→aobsent

added sounds

• none

• possibel pleural rub

tactile fremitus+voice sounds
decreased

PE: COPD

PP
distal air spaces enlarge→lungs become hyperinflated
-slowly progressive dx
-chronic bronchitis may precede/follwo COPD development

percussion→diffusely hyperresonant

trachea→midline

breath sounds

• decreased

• absent

• delayed expiration

added sounds

• none

• crackles

• wheeze

• rhonchi

tactile fremitus+voice sounds
decreased

Asthma

PP

• during attacks: bronchial hyperresponsiveness+underlying inflammation→airflow decreases+lungs hyperinflate→reversible airflow obstruction

• widespread

percussion→resonant→diffusely hyperresonant

trachea→midline

breath sounds

• vesicular

• obscured

added sounds

• wheezes

• possible crackles

tactile fremitus+voice sounds
decreased