Screening for Pulmonary
Diseases
Sign And Symptoms of pulmonary diseases
1. Pleuritic pain (exacerbated by respiratory movement involving the
diaphragm, such as deep breathing, coughing, sneezing, laughing.
2. Pain on palpation (musculoskeletal origin).
3. Pain with changes in position (musculoskeletal) ; pain that is worse when
lying down and improves when sitting up or leaning forward is often
pleuritic in origin).
Pleural pain
Sharp localized pain , aggravate with inspiration……auto splinting
Diaphragmatic pain
Sharp pain at lumber and shoulder
Which one is most important risk factor for
pulmonary disease?
• Dust
• Smoking
• Diet
• Alcohol
Pulmonary physiology
• Ventilation , Respiration
• Breathing center …Medulla ……Pons
• Chemoreceptor….responds to increase carbon dioxide and decrease in PH
in cerebrospinal fluid.
• Central…..Medulla
• Peripheral …Carotid ….Aorta
Acid base regulation
• PH 7.35-7.45
• Less than acidosis….more than alkalosis
• Life cannot be sustained if PH below 7 & or above 7.8
• ABGs
ABG Values Panic values
PH 7.35-7.45 7.20 -7.6
Pco2 35-45mmHg 20 or 70
HCO3 22-26mEq/L 10 or 40
Po2 75-100mmHg 40
O2 saturation 96-100% 60%
Respiratory Acidosis
Decrease ventilation …..increase CO2 , hydrogen ,carbonic acid
Potassium leaks out of cells …hyperkalemia …..cardiac arrest
Pathologies
Damage to medulla , neoplasm , COPD , pneumonia , Pneumothorax ,
poliomyelitis , spinal cord injury ,GBS
Clinical Signs and Symptoms
Decreased ventilation
Confusion
Sleepiness and unconsciousness
Diaphoresis
Shallow, rapid breathing
Restlessness
Cyanosis
Respiratory Alkalosis
• Increase rate and depth of respiration ….decrease the CO2 and hydrogen
• Hyperventilation ...Anxiety , Pain ,Cerebral trauma
Hyperventilation
Lightheadedness
Dizziness
Numbness and tingling of the face, fingers, and toes
Syncope (fainting)
• Sudden weight loss complaint suggests which
kind of pathology in pulmonary system?
• Bronchitis
• Pleural effusion
• Bronchiogenic carcinoma
• All of above
COPD or COLD
• Abnormal airways structure resulting in obstruction of air in
and out of lungs.
• Obstructive bronchitis
• Emphysema
• Asthma
• Common in smokers
• Other factor
• In chronic bed ridden patients , which of the
following condition would most likely to develop
and later on leading to death of the patient
• Pleural effusion
• Pneumonia
• Cystic fibrosis
• Secretions
• A functional cough can mobilize the secretion
from which of the following areas of airway
• Alveolar level
• Main bronchus
• Bronchioles
• Trachea
Bronchitis
Acute
• Inflammation of bronchi
• Self limiting
• Allergy or viral
• Mild fever from 1 to 3 days
• Malaise
• Back and muscle pain
• Sore throat
The most common disease of upper respiratory
tract is ???
The most common disease of lower respiratory
tract is ???
Chronic bronchitis
• Cough for 3 months per year for 2 consecutive years
• Persistent cough with production of sputum
• (worse in the morning and evening than at midday)
Reduced chest expansion
Wheezing
Fever
• Dyspnea (shortness of breath)
• Cyanosis (blue discoloration of skin and mucous membranes)
• Decreased exercise tolerance
Emphysema
• Permanent over distension of air spaces and loss of normal elastic
tension in lung tissue
Types
• Centrilobular …upper lung region …alveolar intact
• Panlobular …more distal alveolar wall…lower lung …smokers
• Paraseptal………Alveoli in lower lobes of lungs
• Irreversible
• Cough uncommon
• Barrel chest
• Exercise not improve pulmonary function but cvs fitness
Emphysema
• Shortness of breath
• Dyspnea on exertion and Orthopnea
• Chronic cough
• Weight loss
• Malaise
• Use of accessory muscles of respiration
• Wheezing
• Pursed-lip breathing
• Increased respiratory rate
• Peripheral cyanosis
• A person having emphysema a primary
pathology, which title suits such patient?
• Pink puffers
• Blue bloaters
• Pink bloaters
• Blue puffers
Inflammatory or infectious disease
Asthma
• Reversible obstruction
• Chronic with acute exacerbation
• Increase reaction to various stimuli
• Life threatening if not treated well
Two components ….allergy response and inflammation
• Exercised induced asthma
• Status asthmaticus
Factors That may Trigger Asthma
• Respiratory infections, colds
• Cigarette smoke
• Allergic reactions to pollen, dust, food, insects
• Indoor and outdoor air pollutants
• Physical exertion or vigorous exercise
• Exposure to cold air or sudden temperature change
• Excitement or strong emotion, psychologic or emotional stress
• What is the difference between ventilation
and respiration ???
Pneumonia
Inflammation of lungs caused by
• Aspiration of fluids , vomits ,foods
• Inhalation of toxic
• Bacterial , viral
• Primary or secondary
• Fever , chill , sweat , pleuritic chest pain , cough , sputum , dyspnea etc
Pneumonia
• Sudden and sharp pleuritic chest pain
• Aggravated by chest movement
• Shoulder pain
• Productive cough
• Dyspnea
• Tachypnea
• Cyanosis
• Headache
• Fever and chills
• Fatigue
TB
• Bacterial infection…mycobacterium tuberculosis
• Fatigue
• Anorexia
• Weight loss
• Low-grade fevers (especially in late afternoon)
• Night sweats
• Frequent productive cough
• Dull chest pain, tightness, or discomfort
• Dyspnea
• chest pain that is relieved by lying on the
involved side indicate which system
involvement, This position is called ?
• Resting
• Splinting
• Auto splinting
• Protected
Neoplastic disease
• Lung cancer ….bronchogenic carcinoma
Malignancy in the epithelium of the lungs
• Small cell carcinoma
• Squamus cell carcinoma
• Adenocarcinoma
• Large cell carcinoma
Risk factor
• Smoking or other tobacco use
• More than 25 per day 20 fold more risk
• Previous tobacco-related cancer
• Passive (environmental) smoke
• Genetic predisposition
• Exposure to asbestos, uranium
• Previous lung disease (e.g., COPD, pulmonary fibrosis, sarcoidosis)
• What is cor pulmonale , which side of heart
involve?
• Right
• Left
• Both
• None
Cystic fibrosis
• Inherited disease of exocrine glands
• Digestive and respiratory tract
• Persistent cough
• Sweating
Pneumothorax
• Tension pneumothorax
• Pleurisy
