Symptoms And Signs of Pulmonary Pathology

Key Symptoms of Pulmonary Disease

dypsnea (number one)

determined primarily by efferent motor drive to respiratory muscles
also by feedback from lungs and respiratory muscles via afferent nerves
dypsnea is NOT a primary reflection of PO₂ or PCO₂ (may even be inversely related)
obstructive lung disease: worse in cold air, smoke, irritants, varies with season
restrictive lung disease: exertional; not dependant on cold or irritant exposure
pulmonary vascular disease: exertional dyspnea, history of predisposing factors

Lung Exam

breath sounds:

low sounds normally (high filtered out)
normaly garbled speech at chest wall
fluid filled: high sounds not filtered, speech clear at chest wall (sound transmits)

wheezes: made by air passing though narrowed airways - obstructive lung disease

could be caused by: edema in walls, smooth muscle spasm, secretion accumulation, collapse

rales: crackling sound made by rapidly opening alveoli - heart failure, restrictive lung disease

rhonchi: less specific sound; not at end inspiration; from fluid in large airways

percussion:

Cardiac Exam

gallops: S3 caused by increased diastolic filling; indicates heart failure

murmurs: could be valve insufficiency

engorgement of veins of neck, pedal edema: indicators of systemic venous pressures

Lab Testing

pulmonary function test: most important results are FEV1/FVC and TLC

TLC reduced in restrictive disease, higher in obstructive lung disease from increased FRC

stiffening of lung reduces expansion and reduces lung volumes (FEV1/FVC normal)
restrictive and obstructive diseases both cause V/Q inequalities
pulmonary vascular diseases cause V/Q inequality, but normal pulmonary function test

exercise testing: measure oxygen consumption, ventilation, HR, anaerobic threshold

normally VO₂ is proportional to VCO₂
at anaerobic threshold, VCO₂ outpaces VO₂ because bicarbonate buffering is outpaced
cardiac disease hits anaeribic threshold early
lung disease hits maximum voluntary ventilation first (MVV is reduced)