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62 Cards in this Set
- Front
- Back
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what are impt things to elicit in H&P
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1. deformity in chest wall
2. occupational hx 3. personal hx 4. family hx 5. recent travel |
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what is an impt evaluation?
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sputum and entire health status
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what are signs and sx of pulmonary pathology?
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*Dyspnea
*Cough *hemoptysis *clubbing *adventitous lung sounds *transmitted voice sounds |
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what are some causes of dyspnea?
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1. chronic bronchitis
2. emphysema 3. asthma 4. spontaneous pneumothorax 5. diffuse interstitial lung dz 5. acute pulmonary embolism |
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what is next question to ask when CC is identified as dyspnea?
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is it slow or progressive?
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which causes of dysnea are gradual ?
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-chronic bronchitis
-emphysema -diffuse interstitial lung dz |
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what are some causes of sudden dyspnea
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- asthma
-spontaneous pneumothorax -acute pulmonary embolism |
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what is diffuse interstitial lung dz caused by?
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infiltration of cells, fluid and collagen into interstitial spaces b/w alveoli
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what causes spontaneous pneumothorax?
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a sudden onset of dyspnea due to leakage of air into pleural space
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what causes acute pulmonary embolism?
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sudden occlusion of pulmonary artery
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what are some causes of cough and hemoptysis?
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I.acute inflammation
*laryngitis *tracheobronchitis *bacterial pneumococcal *klebsiella II. chronic inflammation *chronic bronchitis *bronchiectasis |
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what is next question to ask about cough?
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is it dry or productive?
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what is a cause of dry cough?
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-laryngitis
-tracheobronchitis |
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what are causes of productive cough?
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*mycoplasma and viral pneumonia
*bacterial pneumonia ~pneumococcoal ~klebsiella *chronic bronchitis *bronchiectasis |
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how can you differentiate dx based on sputum?
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mycoplasma has stringy, clear, mucoid sputum
-pneumococcal pneumonia has mucoid or purulent, pinkish, or yello/green sputum -klebsiella has sticky red and jellylike sputum -chronic bronchitis has mucoid to purulent/yellow-green sputum -bronchiectasis has foul smelling, copious sputum |
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what are some additional causes of cough and hemoptysis?
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*pulmonary TB
*lung abscess *asthma |
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what conditions cause foul smelling sputum?
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1. bronchiectasis
2. lung absess |
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what conditions cause dry cough?
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1. laryngitis
2. mycoplasma and viral pneumonia 3. pulmonary TB |
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what conditions cause mucoid, purulent cough?
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1. mycoplasma and viral pneumonia (mucoid only)
2. pneumococcal bacterial pneumonia 3. chronic bronchitis 4. asthma (mucoid only) 5. pulmonary TB |
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what causes a sticky red, jellylike sputum?
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klebsiella pneumonia
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what is clubbing?
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when lose angle of nail bed
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what are causes of clubbing?
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1. lung cancer
2. cystic fibrosis 3. interstitial lung dz 4. idiopathic pulmonary fibrosis 5. sarcoidosis 6. lipoid pneumonia 7. empyema 8. pleural mesothelioma 9. pulm artery sarcoma 10. cryptogenic fibrosing alveolitis 11. pulm metastases |
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what are adventitious lung sounds?
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crackles, wheezes, rhonchi and stridor, pleural rub
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what is indicated if you hear a crackle early inspiratory?
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chronic bronchitis
or asthma |
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what is indicated inf you hear crackles midinspiratory and expiratory?
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bronchiectasis
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what is indicated if you hear crackles late inspiratory?
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interstitial dz( fibrosis)
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what could stridor be assoc with?
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foreign body occlusion
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what are transmitted voice sounds?
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a. bronchophony
b. egophony c. whispered pectoriloquy all should normally be negative |
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what is bronchophony?
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loud and clear
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what is egophony?
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"ee" changes to "ay"
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what is bronchophony?
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can hear 99 loud and clear
(should be a bit muffled) |
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what is whispered pectoriloquy?
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you hear the sound loud and clear (shouldn't)
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what are special techniques to assess resp fxn
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*FEV1
*local pain and tenderness |
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what does an FEV1 longer than 6 seconds indicate?
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obstructive dz (chronic bronchitis or emphysema)
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what does local pain and tenderness indicate?
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fractured rib,
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what are some dx findings of asthma:
inspection? Percussion? Palpation? PErcussion? Auscultation |
inspection=increased inflation and accessory muscle use to breath
palpation=decreasedexpansion and fremitus percussion=increased resonance and decreased diahragm auscultation=prolonged expiration and wheezing |
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what are some dx findings of pneumothorax
inspection? Palpation? Percussion? Auscultation? |
inspection=lag on affected side and trachea shifted away(tension)
palpation=decreased or absent fremitus percussion=increased resonance ausculation=absent breath sounds on affected side |
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what are dx findings of pneumonia?
inspection? palpation? percussion? auscultation? |
inspection=insignificant
palpation=increased fremitus due to fluid percussion=dullness due to fluid auscultation=bronchial breath sounds, possible crackles and + voice sounds |
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what is a HUGE risk factor to ask about when assessing d?
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smoking!!!
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what fraction of americans age 12 and older smoke?
what is smoking linked to? what is ratio of deaths caused by smoking? what is the Four A approach |
1/4 of americnas smoke
it is linked to pulmonary, CV< and neoplastic dz accounts for 1 in 5 deaths Four A's are 1. ask 2. advise 3. assist 4. arrange |
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Thin, Anxious
Alert, Oriented Dyspnea, Tachypnea Pt in tripod position to help improve breathing . Use of accessory muscles Pursed lips on expiration what does this symptom set indicate? |
Emphysema
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Perisitent Productive dry cough
Yellow, white, or green phlegm for atleast 3 months of the year for more than 2 yrs Wheezing Breathlessness what does this symptom set indicate? |
chronic bronchitis
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Meconium Ileus
Pancreatitis Pansinusitis Cholelithiasis Exocrine gland dysfxn Whites Childhood dz Child tastes salty what does this symptom set indicate? |
cystic fibrosis
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Dry Cough
Chest discomfort or pain SOB Blacks what does this sx set indicate |
sarcoidosis
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Severe rapid onset of dyspnea (occurs 12-48 hrs after initiating event)
Hypoxemia Diffuse pulmonary infiltrates leading to respiratory failure Labored breathing Tachypnea Rales, rhonchi, wheezing what does this sx set sound like? |
ARDS (respiratory distress syndrome)
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Cough
Fever SOB hx reveals they are an industrial worker |
silicosis
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Dyspnea
Inspiratory crackes Non-productive cough Cyanosis Clubbing Pleuritic pain Pleural effusion Pulmonary htn History of asbestosis atleast 10 yrs prior |
asbestosis
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Fever
Dyspnea Drynonproductive cough Hepatosplenomegaly patient is HIV+ what does this sound like? |
PCP
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Fever
Cough Dyspnea Hemoptysis a homeless man |
TB
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Student
Malaise Soar throat Cough Headache Pleuritic chest pain Symptoms ↑ Scant sputum what does this sound like? |
mycoplasma pneumonia
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Most common cause of CAP in ICU Elderly,
AC in vents Air conditioner |
legionella pneumonia
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Abrupt onset
Fever Chills Cough with purulent sputum Pleuritic chest pain Tachycardia Tachypnea Signs of consolidation: course rales, bronchial breath sounds, tactile fremitus |
strep pneumonia
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Develops >48hrs after hospital admission
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HAP
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Pruritus
Flat topped wheals |
urticaria
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Abrupt onset of swelling
Face Hands Feet involved 85 % of time |
angioedema
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SOB
Chest tightness Wheezing what is this classic for? |
asthma
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Chest pain on affected side
Dyspnea Respiratory failure Mild tachycardia (small pneumo) ↓breath sounds, ↓ tactile fremitus, hyperresonance (large pneumo |
pneumothorax
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Develops rapidly
Dyspnea- wheezing, stridor Urticaria how do you tx? |
anaphylactic shock
epi pen 1:1000 .3-.5 cc |
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Young, tall, thin smoker male
Decreased breath sounds |
spontaneous pneumothorax
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COPD
Asthma CF TB (normally starts at apices) Infiltrative lung dz (pneumocystic pneumo) Malignancy anyone who has these dz's are at an increased risk of what? |
secondary pneumothorax
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Thoracentesis
Pleural Bx Subclavian line placement Percutaneous lung bx Bronchoscopy Transbronchial bx +- pressure mechanical ventilation if patient has this in Hx think what? |
iatrogenic pneumothorax
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Trauma
Pulmonary Infarct Neoplasms TB *Not Pneumonia what does this sound like? |
hemothorax
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