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Respiratory Unit > 11.2 Signs And Symptoms Of Respiratory Disease > Flashcards

11.2 Signs And Symptoms Of Respiratory Disease Flashcards

1
Q

How do we approach a patient presenting with respiratory problems in primary consultation?

A

Full history - symptoms/signs/onset/duration/exacerbating and alleviating factors
Clinical examination
Further investigations

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2
Q

What are the cardinal signs that indicate respiratory disease?

A 
Breathlessness
Coughing (productive/non-productive) 
Production of sputum (colour/amount)
Haemoptysis 
Added sounds - wheeze/stridor
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3
Q

What is dyspnoea?

A

Subjective awareness of increased effort of breathing

Symptom rather than a sign, but may be objective evidence i.e. raised RR, accessory muscle use

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4
Q

What non-respiratory conditions can cause breathlessness?

A

Anaemia
HF
obesity

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5
Q

What questions should be asked about dyspnoea?

A

Progression
Onset, timing and duration
Precipitating factors
Severity ( what has it affected - walking/talking)

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6
Q

What might cause chest pain?

A

Mediastinal structures (ACS - acute coronary syndrome/Pericarditis/Oesophagitis/GORD/Aortic dissection)

Pleura (Infection (causing pleurisy)/ Pneumothorax/ Pulmonary embolism (causing infarct))

Chest wall (Rib fracture/ Costochondritis/ Shingles (varicella zoster))

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7
Q

What might cause sudden onset dyspnoea?

A

Pneumothorax

PE

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8
Q

What might cause dyspnoea that develop over hours to days?

A

Infection
Pneumonia
Deterioration of Chronic lung disease

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9
Q

What might cause dyspnoea that comes and goes?

A

Asthma

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10
Q

What should be asked about chest pain?

A

Location
Character
Exacerbating
Relieving

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11
Q

What is orthopnoea

A

Shortness of breath that occurs when lying flat

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12
Q

What is pleurisy?

A

Inflammation of the pleura

Also called pleuritis, pleurisy causes sharp chest pain (pleuritic pain) that worsens during breathing

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13
Q

How is cardiac pain described?

A

Central, dull, poorly localised, tight, crushing, heavy, may radiate to neck/jaw/shoulders

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14
Q

How is pleuritic pain described?

A

Thoracic wall or shoulder tip (referred - intercostal n/phrenic nerve)
Sharp, well localised. Worse with coughing and breathing in.
Doesn’t necessarily mean the pleura is definitely involved.

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15
Q

How is a cough triggered?

A

Triggered by stimulation of mechano- and/or chemo-receptors within airway. Any source of inflammation (foreign body/acute or chronic inflammation/cancer)

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16
Q

Describe the mechanism of a cough

A

Deep breath in
Adduction of VC, closing off the glottis
Contraction of internal ICs and abdominal muscles increasing the intrathoracic pressure.
Followed by abduction of the vocal cords

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17
Q

What do we need to know about a cough?

A

Productive cough? Type of sputum?
Character? E.g. bovine cough/croup cough
Timing e.g worse at night? In the winter?

18
Q

What is a bovine cough?

A

A cough that isnt explosive. Less effective cough as cant close glottis.

19
Q

What is the commonest cause of a cough?

A

URTI

20
Q

What might cause clear sputum with a cough?

A

Chronic bronchitis

COPD

21
Q

What might cause yellow/green sputum?

A

Infection

Pneumonia

22
Q

What might large volumes of yellow/green sputum suggest?

A

Bronchiectasis

23
Q

Why might haemoptysis be concerning?

A

Red flag sign for lung cancer

24
Q

What are the non-respiratory causes of a cough?

A
  • LV heart failure (“pink frothy sputum”)
  • GORD
  • Drugs e.g. ACE-inhibitors (dry irritating cough)
25
Q

What causes additional breath sounds?

A

Abnormal breath sounds indicating narrowing within the airway causing turbulent air flow

26
Q

What is a wheeze?

A

A high pitched ‘musical’ breath sound. Mostly on expiration. May only be audible with stethoscope

27
Q

What causes a wheeze?

A

Narrowing in intrathoracic airways E.g. from bronchial smooth muscle contraction, oedema, mucous
Narrowing exacerbated during expiration

28
Q

What is stridor?

A

High pitch, constant, loud, audible without stethoscope. Mostly heard on inspiration.

29
Q

What causes stridor?

A

Indicates narrowing in extrathoracic airway (Upper respiratory tract)
• Supraglottis, glottis, infraglottis or trachea
• Narrowing exacerbated during inspiration

30
Q

During clinical examination, what do we inspect?

A

Respiratory rate
Look at hands (clubbing/ peripheral cyanosis)
Look at face (central cyanosis/pursed lip breathing)
Chest (accessory muscle use/abnormal shape of chest)

31
Q

What is peripheral cyanosis?

A

Peripheral (skin of feet, hands, nose and tips of ears)
• Cold exposure and decreased cardiac output
• Slowing of blood to peripheries (due to vasoconstriction)
• Increased oxygen extraction
• More deoxygenated blood present in that area

32
Q

What is central cyanosis?

A

Central cyanosis: lips and tongue (mucous membranes)
• Significant cardiac or respiratory cause
• Caused by increase in amount of deoxygenated Hb in
blood arriving at tissues [deoxygenated blood is leaving the heart]

33
Q

What are signs that may be seen on inspection in respiratory examination?

A

Clubbing
Accessory muscle use
Barrel chest

34
Q

Why is pursed lip breathing an important clinical sign?

A
  • Commonly seen in COPD
  • Pursing lips increases resistance to outflow on expiration
  • Maintains intrathoracic airway pressures allowing for small airways to remain open for longer
  • prolonging period for gas exchange to occur • and to allowing more air to empty (rather than trap)
35
Q

What is barrel chest?

A

Increased A-P diameter of chest / hyper expansion
• Associated with lung hyperinflation
• Seen in severe COPD (especially emphysema)
• AP diameter > lateral diameter
• Chronic over-inflation of lungs (due to air trapping)
• Hyperexpands the chest wall over time

36
Q

What are we assessing of clinical examination?

A 
Trachea position
Chest expansion (symmetrical/asymmetrical/reduced)
37
Q

What are we assessing on percussion?

A
  • Resonant?
  • Normal • Hyper-resonant
  • Increased air • Dull
  • Consolidation
  • Stony-dull (pneuomthorax)
38
Q

What is normal lung sounds on auscultation?

A 
Normal (vesicular)
• ‘Rustling leaves’
• Inspiration and first part of expiration
• No gap between inspiratory and
expiratory components
39
Q

What is bronchial breath sound?

A
  • ‘Blowing’ harsh sound
  • Inspiration and expiration
  • Gap between
40
Q

Where do we hear bronchial breath sounds?

A

Over an area of pneumonia
Consolidated alveoli act like a solid
Conduct the breath sounds from the larger airways more readily

41
Q

What breath sounds might be auscultated?

A 
Vesicular
Bronchial
Reduced/absent
Wheeze
Stridor 
Crackles
Pleural rub

Respiratory Unit (12 decks)

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