21 - Signs and Symptoms of Respiratory Disease Flashcards
What are some signs and symptoms of respiratory disease?
- Raised resp rate
- Using accessory muscles
- Some of this signs and symptoms can be linked with heart failure, anaemia and obesity too
If a patient states that they are breathless what further questions do you need to ask them?
- Onset, timing and duration
- Constant or intermittent
- Progression
- Any aggravating factors, e.g pets, weather, position
- Severity so what does it stop them from doing
What are some causes of chest pain and how would you know if it was pleuritic chest pain?
- May refer to shoulder tip by phrenic nerve
- Localised as intercostal nerve
- Sharp
- Worse with coughing and breathing in
- MSK pain can present the same
What is the cough reflex?
- Mechano and chemo receoptors
- Contraction of internal ICM and abdominal wall muscles to increase intrathoracic pressure, adduction of VC and then abductip n
If somebody has a cough what are some further questions you need to ask them in the history?
What is a bovine cough due to?
Recurrent laryngeal nerve palsy which makes weak vocal cords that cannot properly adduct so weak cough
What should you suspect if a patient has the following sputum?
- Large volumes
- Yellow/green
- Clear
- Bloody
- Bronchiectasis
- Infection
- No infection
- Red flag
What are some non-respiratory differentials you could think of with a cough?
What is a wheeze and what is it due to?
- High pitched noise heard on expiration
- Due to narrowing within the intrathoracic airways, e.g bronchial smooth muscle contraction, mucus, oedema, causing turbulent flow
- May only be audible with stethoscope
What is stridor and what is it due to?
- High pitch constant noise but mostly on inspiration
- Due to narrowing extrathoracic, e.g supraglottis, trachea
- May be audible without stethoscope and more concerning than a wheeze
What is the gold standard to diagnose a pulmonary embolism?
CTPA
What is resting pursed lip breathing a sign of and why does the patient do this?
- Chronic respiratory disease, e.g COPD
- Pursing increases resistance to outflow allowing small airways to stay open for longer to allow more air to empty and more gas exchange
What are some conditions that can cause tracheal deviation?
- Pneumothorax pulls towards that side unless tension then it goes the opposite way
- Pleural effusion pushes away
- Pulmonary fibrosis pulls towards
If you hear the following on percussion what does this indicate:
- Resonant
- Hyperresonant
- Dull
- Stony Dull
- Normal
- Increased air
- Consolidation
- Pleural effusion
What is the difference between vesicular and bronchial breathing on auscultation?
- Vesicular: no gap between inspiration and expiration and should only hear inspiration and first part of expiration
- Bronchial: gap between inspiration and expiration, can hear both and blowing harsh sound. Can hear in consolidation as solid transmits noise better
What are some added sounds you may hear on ausculation of the lungs
If you did a clinical examination of someone with a pneumothorax what would the abnormalities be?
- Reduced chest expansion on side of pneumothorax
- Hyperresonant on side
- Reduced/absent breath sounds on side
- Breathlessness at rest
Fill in the following table.
Where is the cardiophrenic angle on this CXR?
- Blunting suggests possible effusion
- One of right is obscured by cardiohepatic angle
Why are breath sounds reduced when you have a pleural effusion?
Less air can move into the lungs
How can you tell this CXR is AP and what is the diagnosis?
- Can see scapulas drawn more medially
- Should be thinking PE or pneumothorax and can tell it is pneumothorax from xray
What are the abnormalities on this CXR and what are the differential diagnoses?
- Air bronchograms
- Cavitating lesion
- TB do NAAT to confirm
What abnormality is shown on this x-ray and what is the possible diagnosis?
Cannonball metastases from colorectal cancer
What abnormality is being shown on this x-ray?
- Bat wing sign as bilateral perihilar consolidation
- Could be due to all the reasons on the image but this is likely due to pulmonary oedema from heart failure/pulmonary hypertension
