11. Signs and symptoms of resp disease Flashcards
Name the 6 cardinal signs of resp disease.
- Dyspnoea (breathlessness)
- Cough
- Chest pain
- Wheeze/stridor
- Sputum
- Haemoptysis
Name common non-resp causes of dyspnoea
- myocardial dysfunction, esp LV failure
- anaemia
- obesity
- deconditionig
Name 2 causes of instantaneous onset dyspnoea
- Pulmonary embolism
2. Pneumothorax
Name 5 causes of acute onset dyspnoea (mins-hrs)
- Asthma
- PE
- Pneumonia
- LVF/MI
- Hyperventilation syndrome
Name 2 causes of gradual onset dyspnoea (days)
- Lobar collapse (e.g. Lung cancer)
2. Pleural effusion
Name 3 causes of chronic onset (mths-yrs) dyspnoea.
- COPD
- Idiopathic pulmonary fibrosis
- Bronchiectasis (e.g. Secondary to CF)
What is the pathophysiology of bronchiectasis
Persistent chronic inflammation… loss of elastin in bronchi… dilation of bronchi (restrictive resp disease)
Why is cough a common symptom of resp disease
Is a reflex arc stimulated by mechano-/chemo-Rs in the respiratory epithelium (or oesophagus or diaphragm)
Name possible causes of pleuritic chest pain
- PE
- pneumothorax
- viral/bacterial pleurisy
- pericarditis
Describe the quality, relieving factors and aggravating factors of pleuritic chest pain
- sharp and well localised
- aggravated by chest wall mov. Eg inspiration, coughing
- relieved by sitting forward
What is a wheeze and what is the underlying pathophysiology? Consequently, what are the associated conditions?
High pitched musical sound produced by turbulent flow through narrowed small airways (bronchial SM contraction, oedema and mucus production) - mostly expiratory.
- asthma
- COPD
- bronchiolitis
- sometimes heard in LVF (fluid in airways)
Name 2 possible causes of nocturnal wheeze
- asthma: worse at night as PNS tone is increased causing bronchoconstriction
- LVF: worse at night due to increased venous return to heart and lungs (relieved by sitting up)
What is stridor and how is it caused
A coarse inspiratory wheeze.
Caused by extrathoracic upper airways obstruction:
- epiglottis
- croup
- diptheria
- aspirated foreign bodies
- extrinsic compression, e.g. Large goitre
Why is wheeze heard on exhalation and stridor heard on inspiration?
- wheeze involves intrathoracic small airway narrowing so is worsened by the increased intrapulmonary pressure on expiration
- stridor involves extrathoracic airway narrowing so is worsens by the negative pressure in the lumen on inspiration
Suggest causes of increased sputum production
Infection:
- bronchitis
- pneumonia
- lung abscess
Allergy/irritation:
- smoking/smoke pollution
- acute asthma
- COPD
- lung cancer
- LVF (pink-tinged frothy sputum)
Suggest causes of haemoptysis
- mostly infection: pneumonia, TB…
- lung cancer
- PE
- anticoagulation
- LVF
When might accessory muscles of resp be used - inspiratory vs expiratory
Accessory inspiratory muscles (SCM, scalenes, pec minor, serratus ant) - when adequate pulmonary ventilation cannot be achieved by normal inspiratory efforts (gross overdistention of lungs):
- advanced emphysema
- severe asthma
Accessory muscles of expiration (internal ICs, abdominals)- when elastic recoil of lungs insufficient to empty alveoli or expiratory airway obstruction
- some Ps with emphysema
- some chronic bronchitis
- asthma
Why is barrel chest a sign of emphysema
Loss of elastin in lungs allows chest wall to expand
Where is it normal to here resonance and dullness on percussion
- resonance: above clavicle, between ribs
- dullness: over viscera (heart, liver) and bones/muscles (e.g. Scapula)
What are fine or coarse crackles as sign of
- fine crackles (snapping open of airways or fluid in airways): fibrosis, consolidation and LVF
- coarse crackles (viscid secretions, may reduce after coughing): COPD, bronchiectasis
