| What are the most common clinical presentations in lung disease patients? | Cough (most common) and dyspnea
Hemoptysis and chest pain are less common (more for cardio) |
| How to assess the dyspnea of a presenting patient? | Determine time course, if acute (<days) [could be caused by airway (bronchospasm), parenchyma (pleural edema, respiratory tract infection), pleura (pneumothorax) and vascular (emboli)]
If subacute (days till 3 weeks) [airway (exacerbation), parenchyma (infectious, Wegne's, pneumonia, cyrptogenic), neuromuscular (Guillain-Barre, myasthenia), pleura (pleural disease or effusion)]
If Chronic (>3 weeks) [airway (asthma and COPD), parenchyma (multiple disease with slow progression causing fibrosis)] |
| How to assess cough in patient presenting with respiratory disease? | See if dry or productive, sputum suggests airway disease (asthma, bronchitis, excess bronchiactasis |
| How to assess hemoptysis? | Can be due to airway, parenchyma or vasculature, most commonly due to bronchitis (coughing causes bruising of airway)
Can be neoplasm (inflammatory) or localized (TB, pneumonia) or diffuse (goodpasture's hemosiderosis).
Could be vascular (pulmonary emboli and AV malformation) |
| How to assess chest pain? | From parietal pleura, usually affected with inspiration, pleural neoplasm, inflammatory disorder, parenchymal disorders (pneumonia/ emboli) |
| What are other things necessary to see in history of pt? | Smoking history (pack year, how many packs per day * nb of years of smoking / second hand smoking)
Occupation (inorganic dust (asbestos), organic (pollen)))
Contact with infectious persons (TB)
Comorbidities (RA, neoplasm, AIDS)
Meds (radiation, chemo, b-blockers, ACEi)
Family history (asthma, CF, a1 antitrypsin) |
| What are the inspection targets in assessing a pt? | Evaluate rate and pattern of breathing.
Tachy/ bradypnea/ agonal breathing.
Use of accessory muscles, paradoxical breathing, asymmetric expansion, chest wall deformities (scoliosis) |
| What are the palpation targets in assessing a pt? | See breathing symmetry, and transmission of vibratory sounds (decrease in case of obstruction or pleura effusion , increased in case of consolidation) |
| What are the percussion targets in assessing a pt? | Normal lungs: resonant
Pneumothorax: Hyperresonance (like drum)
Consolidation/ effusion: Dullness |
| What are the auscultation targets in assessing a pt? | Evaluate breath sounds.
Normal: vesicular, decreased in obstruction, increased in consolidation (bronchophony)
Rales/ Crackles (interstitial lung disease or filled alveoli)
Wheezes (more prominent in expiration, narrowing of airways (spasm, obstruction, wall edema))
Rhonchi (gharghara, fluid moving in airway)
pleural rub (abnormal rubbing of pleura)
stridor (flow in narrowed upper airway like croup/ laryngeal edema) |
| What are key points to look for in PE of a pt? | Palpating adenopathies, clubbing (chronic lung diseases, right to left heart shunt, IBD, liver disease), see systemic disease signs (SLE, sarcoidosis) |
| What are the chest imaging techniques used in pt with respiratory disease? | CXR typical (cheap and revealing) but more for outer lesions, for airway more bronchoscopy.
we see infiltrations, pleural disease, hilum and mediastinum...
we can also use a CT for more sensitivity for small lesions.
Chest US is also used bed side (in ICU, out patients) for pleural fluid/ pneumothorax/ pneumonia...
other imagings may be used (PET, MRI, angiography) |
| What is the use of respiratory function test (RFT)? | Spirometry, evaluates obstruction and spasms, lung volume giving an idea for fibrosis and pneumonia (restrictive) |
