4-Signs and Symptoms of respiratory medicine Flashcards
list the core respiratory symptoms
- -SOB
- -cough
- -hemoptysis
- -sputum production
- -pleuritic chest pain
- -wheezing
- -chest tightness
- -fever/chills
- -night sweats/rigors
- -weight loss
what is the differential diagnosis of SOB?
- -COPD
- -CHF
- -asthma
- -PE
- -ILD
what are the URT causes of cough?
- URTI
- Sinusitis
- Rhinitis
- Post nasal drip
what is the post-nasal drip syndrome (Upper airway cough syndrome)?
Abnormally increased nasal mucus secretion that drips down the back of the throat and can lead to coughing, a feeling of obstruction in the throat, and throat clearing. Causes include allergies, cold temperatures, viral or bacterial infections, dry air, and certain medications. First-line treatment includes first-generation antihistamines (e.g., diphenhydramine). UACS was previously referred to as post-nasal drip syndrome.
example of GI cause of cough?
GERD (especially nighttime cough)
what are the LRT causes of cough?
- LRTI / Pneumonia
- TB
- Asthma
- COPD
which medications are commonly associated with cough?
ACE inhibs, b-blockers, aspirin
what are the causes of increased sputum production?
Upper respiratory tract • Post nasal drip Lower respiratory tract • LRTI / Pneumonia • TB • Bronchiectasis • COPD
what are the causes of hemoptysis?
- Bronchogenic neoplasm
- Pneumonia
- TB
- Bronchiectasis
- PE
what conditions should be ruled out before diagnosis of hemoptysis?
epistaxis, haematemesis
**CHF – pink frothy sputum
what are the causes of pleuritic chest pain?
- Pulmonary Embolus
- Pneumonia
- Pneumothorax
does pleural effusion cause pleuritic chest pain?
- chest discomfort, not classically pleuritic
what is the night sweating?
Drenching sweats unrelated to room temperature, where the patient has to change clothes and bed clothes. Not just sweating at night!
** Prolonged symptom – weeks to months
what are the causes of night sweating?
• TB
• Empyema
• Lung abscess
Non pulmonary DDx – Lymphoma, Renal cell carcinoma
what are the causes of wheezing?
Hallmark of obstructive airways disease o Asthma o COPD o Bronchiectasis o Type 1 hypersensitivity allergic reaction
what are the respiratory causes of rigors?
• Septicaemia (pneumonia) • TB • Empyema • Lung abscess Non pulmonary DDx - pyelonephritis
what are the respiratory causes of weight loss?
• Is a very non-specific symptom, present in many non-pulmonary conditions. GI causes need to be out-ruled. • Bronchogenic neoplasm • TB • Empyema End stage COPD
what are the features and characteristics of COPD?
- Smoker > 20 pack years
- Age > 50 years
- Duration of symptoms – years
- SOB on exertion ® SOB at rest
- ± Productive cough
- Acute exacerbations - SOB, wheeze, chest tightness
- Associated LRTI – dirty sputum
- Onset- days to weeks
- Relief with bronchodilators, steroids, antibiotics
- Frequent hospital & GP visits
what is the acute exacerbation of COPD?
An acute worsening of the manifestations of chronic obstructive pulmonary disease (typically characterized by increased frequency or severity of cough, increased sputum volume or change in sputum consistency, and/or increased dyspnea). Caused by an underlying infection (e.g., viral or bacterial pneumonia) in ~ 80% of cases.
what are the signs and symptoms of COPD?
- -Chronic cough with expectoration (expectoration typically occurs in the morning)
- -Dyspnea and tachypnea
1) Initial stages: only on exertion
2) Advanced stages: continuously - -Pursed-lip breathing
- -End-expiratory wheezing, crackles, muffled breath sounds, and/or coarse rhonchi on auscultation
- -Tachycardia
- -Cyanosis
- -Often weight loss and cachexia
what are the clinical features of bronchiectasis?
- Productive Cough, Viscid mucus
- Recurrent LRTIs
- Wheeze
- Haemoptysis
- Chronic/ long history
what are the causes of bronchiectasis?
1) LOCALISED
- -Measles, pertussis
- -TB
- -Pneumonia
- -ABPA
2) GENERALISED
- -Cystic Fibrosis
- -Kartagener’s
- -Young’s Syndrome
- -Immunoglobulin deficiency
what are the features of asthma?
- Younger age group, non-smokers
- New-onset vs. established Dx (years)
- Intermittent symptoms**
- SOB, wheeze, dry cough, chest tightness
- Nocturnal symptoms
- Relieved by b2 agonists
- Acute exacerbation: Onset: hours ® days
- Precipitating factors: URTI, dust, perfumes, food substances, animal dander, seasonal variation, stress, exercise-induced.
- Personal Hx: Eczema, hay fever, atopy
- Family history
what are the precipitating factors of asthma?
Precipitating factors: URTI, dust, perfumes, food substances, animal dander, seasonal variation, stress, exercise-induced.
Does asthma occur in young or elderly?
Allergic asthma: typically in childhood
Nonallergic asthma: typically > 40 years
what are the features of pulmonary embolus?
- Main symptoms: SOB++, Pleuritic chest pain+
- ± Cough, ±haemoptysis
- Unilateral calf swelling + tenderness
- Absence of obstructive airways disease or infective symptoms
what are the signs and symptoms of PE?
- -Acute onset of symptoms, often triggered by a specific event (e.g., on rising in the morning, sudden physical strain/exercise)
- -Dyspnea and tachypnea (> 50% of cases)
- -Sudden chest pain (∼ 50% of cases), worse with inspiration
- -Cough and hemoptysis
- -Possibly decreased breath sounds, dullness on percussion, split-second heart sound audible in some cases
- -Tachycardia (∼ 25% of cases), hypotension
- -Jugular venous distension
- -Low-grade fever
- -Syncope and shock with circulatory collapse in massive PE (e.g., due to a saddle thrombus)
- -Symptoms of DVT: unilaterally painful leg swelling
what is the idiopathic pulmonary fibrosis?
The most common interstitial lung disease. Characterized by irreversible pulmonary fibrosis and impaired pulmonary function. The conditions takes an insidious course that initially presents with exertional dyspnea that progresses to dyspnea at rest, persistent nonproductive cough, and fatigue. Progression to respiratory failure usually occurs within 3–7 years.
what are the features of idiopathic pulmonary fibrosis?
- Age > 60 years
- M > F
- Presenting symptom: SOB on exertion
- Onset of symptoms: 6 ® 12 months
- Progressive: from SOBoE to SOB at rest
- ± Dry cough
what are the features of URTI?
- Pharyngitis, sinusitis, rhinitis, coryza
- Short, acute Hx (1-3 days)
- Very common, all age groups
- Fever, chills, myalgia
- Sore throat
- Blocked/runny nose, sneezing
- Dry or productive cough
what are the signs and symptoms of atypical pneumonia
- Prolonged Hx - 2®4 weeks
- Malaise, myalgia, headaches
- Ear pain, diarrhoea
- Dry cough, SOB
- Unresponsive to penicillins/cephalosporins
why atypical pneumonia is unresponsive to penicillins?
cause common causes like chlamydia and mycoplasma lack cell wall
what are the features of lung cancer?
- Mainly smokers
- Symptom duration: Weeks ® Months
- Haemoptysis
- SOB (pleural effusion, atelectasis)
- Weight loss
- Prolonged dry cough
- Persistent hoarseness
- Bone pain, jaundice, headaches (metastases
what are the features of CHF?
- Age > 50 years
- Background: IHD, Valvular HD
- SOB on exertion - SOB at rest
- Orthopnoea, PND, ankle edema
- Relieved by diuretics
- Chronic CCF onset: weeks - months
- Acute pulmonary edema: minutes - hours
what is the orthopnea?
A sensation of shortness of breath that occurs upon lying down and is relieved by sitting up. Left ventricular failure is a common cause.
what is the paroxysmla nocturnal dyspnea?
A symptom characterized by nocturnal bouts of coughing and acute shortness of breath resulting from the effect of lying in a supine position, which increases pulmonary venous congestion as well as reabsorption and redistribution of edema.
what is the pneumothorax?
A collapsed lung caused by the loss of negative pressure between the visceral and parietal pleural membranes that occurs when air abnormally enters the pleural space. Manifestations include pleuritic chest pain, dyspnea, tachycardia, and reduced breath sounds on the ipsilateral side.
• Acute unilateral pleuritic pain
• Acute SOB
Any age group
Marfanoid features (rare)
Definite clinical signs (± CXR) – confirm diagnosis
what is the primary spontaneous pneumothorax?
1) Ruptured subpleural apical blebs
2) Risk factors
- -Family history
- -Male gender
- -Asthenic body habitus (slim, tall stature) (e.g., in Marfan syndrome)
- -Smoking: 90% of cases; up to 20-fold increase in risk (risk increases with cumulative number of cigarettes smoked)
- -Homocystinuria
what are the features of empyema?
- Pus in the pleural space
- Duration: weeks to months
- Fever, chills, rigors, night sweats, weight loss, chest discomfort, SOB
- At risk: Elderly, intellectual disability, long term care, aspiration/swallowing difficulties, poor dentition, alcohol abuse.
who is at risk for empyema?
Elderly, intellectual disability, long term care, aspiration/swallowing difficulties, poor dentition, alcohol abuse.
what are the P/E signs of CO2 retention on hands?
warm bounding pulse, dilated veins, asterixes – almost exclusive to chronic severe COPD
what is the clubbing?
A physical finding characterized by painless swelling of the distal phalanges. Often defined by an angle ≥ 180° between the base of the nail and its surrounding skin (Lovibond angle). The nailbed often feels spongy when pressed and springs back when released. Typically associated with chronic hypoxemia (e.g., cardiac shunts, interstitial lung disease, lung cancer, cystic fibrosis), though patients with COPD alone typically do not develop this finding. Thought to be due to fibrovascular proliferation in the region of the nail bed due to accumulation of megakaryocytes in digital vessels that are normally filtered in the lung.
what are the causes of nail clubbing?
–Commonly chronic hypoxemia (including congenital heart disease, cardiac shunts, interstitial lung disease, cystic fibrosis, and lung cancer)
• Malignancy – lung carcinoma, mesothelioma
• Pulmonary fibrosis - cryptogenic fibrosing alveolitis, asbestosis
• Suppurative lung diseases – empyema, lung abscess, bronchiectasis
- -COPD does not cause nail clubbing and a COPD patient with nail clubbing is concerning for underlying malignancy.
- -Can also be seen in hypertrophic osteoarthropathy: a syndrome (either hereditary or paraneoplastic) that manifests with painful nail clubbing, synovial effusions, and periostitis
does COPD cause clubbing?
COPD does not cause nail clubbing and a COPD patient with nail clubbing is concerning for underlying malignancy.
in what conditions trachea is pulled towards the abnormal site?
atelectasis, pneumothorax, unilateral fibrosis, pneumonectomy
in what conditions trachea is pushed towards the normal site?
large pleural effusion, tension pneumothorax
what are the causes of symmetrically reduced chest expansion?
- Obstructive lung disease
* Restrictive lung disease
what are the causes of asymmetrically (unilaterally) reduced chest expansion?
- Pneumothorax
* Pleural effusion
