8. Signs and Symptoms of Respiratory Disease Flashcards
What is the differential for a young person with shortness of breath?
Asthma
PE
What is the differential for an older person with shortness of breath?
COPD
Congestive heart failure
Pulmonary fibrosis
What are the upper respiratory tract causes of cough?
URTI
Sinusitis
Rhinitis
Post nasal drip
What are the lower respiratory tract causes of cough?
Pneumonia
TB
Asthma
COPD
What are the GI causes of cough?
GORD (reflux)
What drugs can cause a cough?
ACE inhibitors
B-blockers
What are the upper respiratory causes of sputum production?
Post nasal drip
What are the lower respiratory causes of sputum production?
Pneumonia
TB
COPD
Bronchiectasis
What is the differential for haemoptysis?
Bronchogenic neoplasm Pneumonia TB Bronchiectasis PE
What is the differential for pleuritic chest pain?
PE
Pneumonia
Pneumothorax
What is the differential for wheeze/rhonchi?
Obstructive diseases
Allergy
Bronchiectasis
What is the differential for fever?
Upper or lower RTI
What is the differential for rigors?
Sepsis
TB
Empyema and abscess
What is the differential for night sweats?
TB
Empyema and abscess
What is the differential for weight loss?
Bronchogenic neoplasm
TB
Empyema
End stage COPD
What is the typical patient in COPD?
> 50
Smoker
Progressive SOB and productive cough
Frequent GP and hospital visits
What are the symptoms of an acute exacerbation of COPD?
Increase in SOB, wheeze and chest tightness
in LRTI change of sputum colour
What is the typical patient in decompensated heart failure?
> 50
Background of heart disease
What are the symptoms of decompensated heart failure?
Progressive SOB Orthopnoea Noctural dyspnoea Ankle oedema Acute pulmonary oedema
What is orthopnoea?
Feeling like unable to breathe when lying flat
What drugs can give relief in decompensated heart failure?
Diuretics
What is the typical patient in asthma?
Younger, non-smoker
Intermittent symptoms, may be worse at night, at work or when exercising
Can be undiagnosed for years
Family or personal history of atopy
What drugs can give relief in asthma?
B2 antagonists
Oral steroids
What is the typical patient in PE?
Signs of DVT
Risk factors
Absence of obstructive disease or infection
What is the typical patient in IPF?
> 60, male
Progressive SOB over 6-12 months
What are the symptoms of lung cancer?
Haemoptysis, shortness of breath, weight loss, dry cough, hoarseness
Bone pain, jaundice and headaches
What signs of respiratory disease can be seen in the hands?
Signs of CO2 retention in severe COPD
Clubbing
What diseases can cause clubbing?
Malignancy
Pulmonary fibrosis
Suppurative lung diseases
What diseases/surgery cause the trachea to be pulled towards the abnormal side?
Pneumothorax
Unilateral fibrosis
Atelectasis
Pneumonectomy
What diseases cause the trachea to be pushed away from the abnormal side?
Large PE
Tension pneumothorax
What diseases cause chest expansion to be symmetrically reduced?
Obstructive and restrictive diseases
What diseases cause chest expansion to be unilaterally reduced?
Pneumothorax
Pleural effusion
What disease causes an increase in tactile fremitus?
Pneumonia
What diseases cause a decrease in tactile fremitus?
Pleural effusion
Pneumothorax
Atelectasis
Which diseases cause hyper-resonant percussion?
Pneumothorax
COPD
Which diseases cause dull percussion?
Pneumonia
Atelectasis
Tumour
Which disease causes stony dull percussion?
Pleural effusion
What features are looked for when auscultating?
Intensity of sounds and air entry
Vesicular or bronchial breathing
Symmetry
Added sounds
What is bronchial breathing caused by?
Consolidation
What are the features of rhonchi?
Always expiratory and bilateral
Are creps inspiratory or expiratory?
Inspiratory
What are the causes of bibasal creps?
Pulmonary oedema
IPF
Bronchiectasis
What causes unilateral creps?
Pneumonia
Are rubs inspiratory or expiratory?
Both
When are rubs heard?
Pleural inflammation
What are the causes of bilateral effusion?
Congestive heart failure
Liver and renal failure
What are the causes of unilateral effusion?
Post pneumonia
Neoplasm
TB
What are the specific signs of COPD?
Signs of CO2 retention
Hyperinflation
Hyper-resonant percussion
Expiratory wheeze
What are the specific signs of decompensated heart failure?
Tachypnoea Tachycardia Hypotension Bibasal creps Decreased breath sounds Increased JVP, hepatomegaly, ascites, oedema
What are the specific signs of IPF?
Tachypnoea
Clubbing
Decreased chest expansion
Fine end bibasal creps
What are the specific signs of bronchiectasis?
Clubbing
Lots of dirty sputum
Coarse creps
What are the specific signs of pleural effusion and empyema?
Trachea pushed to opposite side Reduced expansion on that side Reduced tactile fremitus over effusion Stony dull percussion Reduced or absent breath sounds
What are the specific signs of pneumothorax?
Trachea pulled towards (pushed away if tension)
Reduced expansion on that side
reduced tactile fremitus over pneumothorax
Hyper-resonant percussion
Reduced or absent breath sounds
What are the specific signs of pneumonia?
Increased tactile fremitus and dull percussion over infection
Coarse creps unilaterally
Bronchial breathing
What is Pemberton’s sign?
Patient’s face turns red when they raise their arms
Sign of SVC obstruction
What are the specific signs of fibrosis from an old TB infection?
Biapical Trachea deviated towards side of max fibrosis Mildly decreased fremitus Slightly dull on percussion Bronchial breathing
What are the specific signs of a pneumonectomy?
Thoracotomy scar
Trachea deviated towards empty side
Expansion and fremitus decreased on that side
Dull percussion
What are the specific signs of a lobectomy?
Chest findings are normal: remaining lobes re-expand to fill space
