Phys Di II - Exam 1 Chest + lungs (diseases)

Epiglottitis

acute life-threatening infection involving the epiglottis and surrounding tissue

Sore throat, difficulty swallowing, muffled voice, fever

Drooling and Stridor

Croup (laryngeal bronchitis)

viral infection MC in 1.5-3 yo children

upper resp. symptoms, mild fever, labored breathing, retractions, hoarseness

Harsh barking cough and Stridor

Adult version of croup

laryngitis

Diaphragmatic hernia (MC on Left)

bowel sounds in chest

Cystic fibrosis

autosomal recessive disorder of exocrine glands in lungs, pancreas, sweat glands

thick mucous, clogged bronchi, bronchiectasis, malabsorption

Rhonchi, Salty sweat, Barrel chest

Tracheomalacia

lack of rigidity/floppiness of trachea

benign and self-limited with increasing age

noisy breathing (wheezing)

Stridor is ____ in respiratory tree and wheezing is ____ in respiratory tree

high; low

Bronchiolitis

bronchiolar inflammation leading to hyperinflation

MC in infants <6 months due to RSV

Tachypnea, retractions, cyanosis, wheezing, decreased breath sounds

Grunting, Hyperresonant percussion, Decreased tactile fremitus

Asthma (reactive airway disease)

small airway obstruction due to inflammation and hyperreactive airways

Edema, mucus secretion, bronchoconstriction, dyspnea epsiodes

Tachypnea, coughing, wheezing, hypoxemia

Atelectasis

incomplete expansion of lung at birth or collapsed lung

compression/obstruction resulting in resorption of air (post-operative)

Decreased tactile fremitus, deviated trachea, dull percussion

Epidemiology of Atelectasis

not a distinct disease entity, rather an associated condition or sequela

Obstructive atelectasis

bronchial occlusion and postenotic air resorption (tumor, mucus plug)

Compressive atelectasis

intrathroacic process that prevent expansion of the lung (pneumothorax, pleural effusion)

Adhesive atelectasis

surface tension of the alveoli is so hight that they collapse

Atelectasis can result from scarring due to

tuberculosis

Imaging signs (modality of choice) for atelectasis

radiographs

Differential diagnosis of atelectasis

pneumonia, pleural effusion, tumor

Bronchitis

inflammation of large airways

Acute - MC viral “chest cold”

Chronic - MC smoking

Rhonchi + wheezing during exhalation, occasional crackles

E-Cigarette or Vaping injury

respiratory failure w/low blood oxygen levels w/acute lung inflammation

dyspnea, chest/abdominal pain and NON-PRODUCTIVE COUGH

tachypnea, tachycardia, fever, hypoxemia

Pleurisy (pleuritis) - “creaking pirate ship”

inflammation of visceral and parietal pleura

secondary to PE, infection, CT disease (lupus)

Chest pain during breathing, friction rub, rapid shallow respirations, decreased breath sounds

Pleural effusion

excessive nonpurulent fluid in pleural space

Caused by: HF, infecion, renal insufficiency, CT disease, neoplasm

cough, dyspnea, pleuritic chest pain

Dull percussion, decreased tactile fremitus, decreased breath sounds

Transudative pleural fluid (protein poor)

fluid that accumulates as a result of imbalance in hydrostatic and oncotic pressure

**HF or nephrotic syndrome

Exudative pleural fluid (protein rich)

local capillary pleural membrane permeability or lymphatic blockage

**localized inflammation or malignant processes

History of a pleural effusion pt should focus on

differentiating pulmonary etiologies from cardiovascular and other causes of effusion

In a physical exam procedure of pleural effusion, the clinician should pay particular attention to

chest exam, specifically dull percussion b/c it is sensitive and specific for effusion

MC causes of pleural effusion

HF, bacterial pneumonia, pulmonary embolism

What chest radiography should be performed if suspected pleural effusion

posteroanterior and lateral

If the chest radiography is inconclusive, you should perform

CT for effusions, pleural fluid/thickening

Ultrasound b/c more accurate than auscultation and x-ray

Aspiration of pleural fluid is indiciated when

underlying cause of effusion is unknown

Signs/ Symptoms and Etiology that suggest pleural effusion

Ascites - cirrhosis

Distended neck veins/Dyspnea on exertion/Orthopnea/Peripheral edema - HF

Hemoptysis/Hepatosplenomegaly/Lymphadenopathy - malignancy

Sensitivity and Specificity (accuracy) of commone clinical findings for diagnosing pleural effusion

Asymmetric chest expansion - 74% (sens) + 91% (spec)

Reduced vocal resonance - 76% (sens) + 88% (spec)

Reduced vocal fremitus - 82% (sens) + 86% (spec)

Empyema

purulent exudative fluid collected in pleural space

Caused by: infected adjacent tissue from pneumonia

fever, tachypnea, cough, chest pain, dyspnea

Dull percussion, absent tactile fremitus, decreased breath sounds

Lung abscess (unilateral)

well circumscribed fluid containing cavity w/air fluid interface

Caused by: aspiration of food or infection

Dull percussion, pleural friction rub, decreased breath sounds, PRODUCTIVE/purulent cough, foul-smelling sputum

Pneumonia (unilateral)

inflammatory response of bronchioles and alveoli (parenchyma)

fever, tachypnea, tachycardia

PRODUCTIVE cough, pleuritic chest pain, dyspnea, chills, rigors

Crackles, rhonchi, dull percussion, increased tactile fremitus, vocal resonance louder

Bronchovesciular sounds - alveoli are filled w/fluid

Bloody sputum is typically associated with what type of pneumonia and influenza

bacterial

Influenza

viral infection of lung w/interstitial inflammation and necrosis

cough, fever, malaise, headache, sore throat

Crackles, rhonchi, wheezes, tachypnea

COVID-19

viral infection from SARS-CoV2

transmitted via respiratory secretions

Crackles, wheezes, rhonchi, tachypnea

What disease is typically asymptomatic in the latent period

tuberculosis

Tuberculosis

chronic infectious disease begins in lung by can spread

transmitted via coughing and sneezing, traveling to endemic regions

fever, blood streaked cough, weight loss, night sweats

Pneumothorax (gas in pleural cavity)

Caused by: trauma, spontaneous rupture of bleb

Mediastinal shift, tracheal deviation, hyperresonant percussion, decreased tactile fremitus, decreased breath sounds

Tension pneumothorax

increasing pressure in pleural space

Hemothorax (blood in plerual cavity)

Caused by: trauma or medical procedures

Tachycardia and hypotension

Dull percussion, decreased tactile fremitus, decreased breath sounds

Hemopneumothorax (air and blood in pleural cavity) acts like

pleural effusion

Lung cancer (bronchogenic carcinoma)

malignant tumor that evolves from bronchial epithelial structures

can develop pneumonia or pleural effusion

dull percussion, increased tactile fremitus, decreased breath sounds

Pulmonary embolism

RF: age, DVT, surgery, heart disease, cancer, bed rest

pleuritic chest pain (hurts when actively breathing), fever, hypoxia, tachycardia

Pulmonary embolism is difficult to diagnose, what two tests are used

Wells PE prediction rule

D-dimer test

Wells PE prediction rule

score <2 = low risk PE (7%)

score 2-6 = intermediate risk PE

score >6 = high risk PE (>45%)

If the Wells PE prediction rule shows an intermediate risk, what are your next steps

order a D-dimer test

D-dimer test

protein fragment from blood clot formation and breakdown

If the Wells PE prediction rule shows a high risk, what are your next steps

straight to the ER

Cor pulmonale

acute/chronic condition involving right sided HF

Associated w: COPD, asthma, cystic fibrosis, bronchiectasis

Pulmonary edema (fluid in airways) (bilateral)

Cardiogenic (MC) - HF leading to backup of circulation in lungs

Non-cardiogenic - altitude sickness, lung transplant, foreign body

dyspnea, tachypnea, pink frothy sputum, hypoxemia

Crackles (lower lung fields), dull percussion, increased tactile fremitus

COPD (emphysema, bronchiectasis, chronic bronchitis)

cough, excessive sputum production, dyspnea, cyanosis, clubbing

smokers at greatest risk

Emphysema

lungs lose elasticity and alveoli enlarge

MC due to smoking

Dyspnea, barrel chested, decreased breath sounds, crackles, wheezes, rhonchi, hyperresonant percussion, decreased tactile fremitus

Bronchiectasis

chronic dilation of bronchi/bronchioles

Caused by: repeated pulmonary infections and bronchial obstruction

cough w/large amounts of sputum, hemoptysis, tachypnea, clubbing, crackles, rhonchi

Bronchiectasis is frequently with

cystic fibrosis

Chronic bronchitis

large airway inflammation

Caused by: chronic irritant exposure

MC >40 yo