-
Functional respiratory inquiry
SPACED
- Smoking (pack years), SOBOE, sputum production (mucus, pus, blood)
- Pain (pleuritic, bony/ MSK), Pigeons
- Asthma (wheeze, nocturnal/morning cough), atopy, alpha 1 antitrypsin
- Cough, CXR (known abnormalities)
- Exercise tolerance (quantify), environmental exposures
- Dyspnea (provocative and palliative factors)
-
flat percussion
large pleural effusion
-
dull percussion
consolidation
-
hyperresonant percussion
emphysema
pneumothorax
-
describe an approach to evaluation of quality of CXR
- start by checking name and date on film
- note orientation and adequacy of penetration
- 2 views needed to localize lesions
- heart size and mediastinal size should be assessed on a posteroanterior (PA) view (not >50%)
- assess rotation by looking at relationship of the sternoclavicular joints to the midline
- note upright vs. supine
-
ABC's of CXR interpretation
Airway: trachea and mainstem bronchi
Breathing: lung fields, fissures, costophrenic angles, peribronchial changes, pleural changes (thickening, effusion)
Circulation: vasculature in the lungs, pulmonary artery and aortic knuckle, left ventricle, heart size, hila
Soft tissues and skeleton: bilateral breast shadows in females, subcutaneous emphysema, midiastinal enlargement, ribs, clavicle humerus
-
DDx for SOB
- Vascular: PE, CHF (pulmonary edema, large pleural effusion, ascites), acute coronary syndrome
- Infectious: Pneumonia
- Trauma: pneumothorax, FB aspiration
- Metabolic: DKA
- Idiopathic/Iatrogenic: Exacerbation of COPD/asthma, massive atelectasis
- Neoplastic: large pleural effusion, significant ascites
- Substance abuse and psych: anxiety (dx of exclusion)
-
DDx for SOBOE
- Vascular: CHF
- Infectious: TB
- Autoimmune/Allergic: sarcoidosis
- metabolic: anemia, asbestosis
- idiopathic/iatrogenic: COPD, massive atelectasis, pulmonary fibrosis, abdominal distension
- Neoplastic: large pleural effusions
-
treatment of COPD includes
- bronchodilators
- inhaled steroids
- cardiac medications
-
describe COPD
- includes several dz entities: chronic bronchitis, emphysema, asthma, bronchiectasis
- progressive airway obstruction with acute exacerbations
- FEV1/FVC decreases as severity increases
- may result in cor pulmonale
- most pts have a combo of chronic bronchitis and emphysema (not just one or the other)
-
|
|
