Clinical Medicine V
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each of the black spaces below before clicking
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| 3 classic symptoms of lung disease, and major causes of each | show 🗑
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| differential for cough mostly at night | show 🗑
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| show | infection/inflammation
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| show | ACUTE: pneumococcal pneumonia; CHRONIC: bronchitis, TB
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| differential for cough associated with fever/chills | show 🗑
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| differential for seasonal cough | show 🗑
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| show | GERD, post-nasal drip (allergies), bronchitis, asthma, ACE-I usage
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| causes of cough with abnormal CXR | show 🗑
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| differentiate between hemoptysis and hematemesis | show 🗑
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| differential for hemoptysis associated with fever, chills, weight loss | show 🗑
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| show | infarct (PE), vasculitis, pneumonia
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| show | bronchitis
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| differential for massive (100 - 600 mL) hemoptysis | show 🗑
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| differential for SOB | show 🗑
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| differential for dyspnea with lying down | show 🗑
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| differential for DOE | show 🗑
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| show | infection
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| differential for dyspnea with wheezing | show 🗑
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| differential for dyspnea with pleuritic chest pain | show 🗑
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| differential for PND | show 🗑
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| classic association of barrel chest | show 🗑
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| show | overworked diaphragm (e.g. from COPD) > intercostal muscles take over; now instead of diaphragm contracting during inspiration (pushing abdomen out), moves up: abdomen moves IN during INspiration - sign of respiratory failure, needs mechanical ventilation
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| key components of pulmonary physical exam | show 🗑
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| show | accumulation of deoxyhemoglobin in the cutaneous vessels, or congenital heart disease leading to Eisenmenger's physiology (R > L shunting)
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| causes of peripheral cyanosis | show 🗑
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| show | moving toward side of lower lung volume (e.g. alectasis, consolidation with obstruction); moving away from side of massive pleural effusion or tension pneumothorax
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| use of accessory muscles: general implication | show 🗑
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| implication of decreased inward retraction of intercostal muscles during expiration | show 🗑
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| implication of increased outward bulging of intercostal muscles | show 🗑
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| show | massive pleural effusion (pushes on lungs from outside, preventing lungs from filling)
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| show | rounding of distal phalanx, nail floating on finger: chronic hypoxia, due to shunts (congenital heart disease), liver disease, endocarditis, chonic renal insufficiency, etc. that causes distal deposition of megakaryote fragments usually filtered by lung
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| show | asymmetric expansion of one side of chest wall during inspiration; due to unilateral diaphragmatic paralysis, pneumothorax, bronchial obstruction
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| show | obstruction in bronchi (blocks sound - e.g. atelectasis from mucous plugging, consolidation w/CLOSED bronchus), displacement of lung away from chest wall (pneumothorax, massive pleural effusion) or diaphragmatic paralysis (no air entering that lung field)
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| implications of asymmetric increased fremitus | show 🗑
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| causes of dullness to percussion | show 🗑
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| causes of hyperresonance on percussion | show 🗑
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| implications of impaired diaphragmatic excursion | show 🗑
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| manifestations of lung consolidation with closed bronchus | show 🗑
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| manifestations of lung consolidation with open bronchus | show 🗑
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| show | hyperresonance to percussion
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| show | decreased inward retraction/bulging intercostal muscles during expirat. (more positive P on lungs from pleural fluid), contralateral tracheal deviation, splinting, decreased fremitus, dullness to percussion, focally decreased breath sounds +/- pleural rub
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| bronchophony: definition, pathophysiology | show 🗑
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| present and absent breath sounds in diseased lung | show 🗑
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| show | COPD, asthma, foreign body, consolidation, pneumothorax, pleural effusion; all interrupt sound impulse traveling through bronchi and alveoli to chest wall due to bronchial/alveolar disease process
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| show | (besides obesity) COPD, diffuse restrictive/obstructive lung diseases = generalized lung disease interrupting sound impulse traveling through bronchi and alveoli
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| describe stridor, and pathophysiology | show 🗑
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| describe rhonchi, and pathophysiology | show 🗑
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| show | continuous high frequency noise in both inspiration and expiration; caused by COPD, asthma, foreign body with obstruction, hypersensitivity pneumonitis, external airway compression
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| describe crackles (rales), and pathophysiology | show 🗑
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| differential for fine crackles | show 🗑
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| patients that may think they have crackles, but don't | show 🗑
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| show | creaky sound heard throughout respiration, caused by pleural inflammation - LOUDER during inspiration (unlike rhonchi, all over lungs and = during inspiration and expiration); etiologies include pleural effusion, TB, cancer
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| differential for "rust-colored" sputum | show 🗑
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student55555