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Block 13 - The Development of Cardiorespiratory Disease > ALS Lecture 1 - Respiratory Symptoms and Signs DONE > Flashcards

ALS Lecture 1 - Respiratory Symptoms and Signs DONE Flashcards

1
Q

symptom

A

what pt complains of

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2
Q

sign

A

abnormality O/E

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3
Q

history

A

time course, relationship of symptoms

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4
Q

diagnostic process (3 steps)

A
  1. history
  2. physical examination
  3. investigations
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5
Q

6 common respiratory symptoms

A

breathlessness, cough, sputum, haemoptysis, wheeze, chest pain

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6
Q

other symptoms relevant to respiratory disease (8)

A

peripheral oedema, nighttime wakening, swelling of face or arms, nasal obstruction/discharge/sneezing, voice alteration, night sweats, fevers, weight loss

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7
Q

peripheral oedema may be due to…

A

right heart failure, CHF, lung disease

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8
Q

nighttime wakening/paroxysmal nocturnal dyspnoea may be due to…

A

heart failure, asthma

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9
Q

swelling of the face/arms may be due to…

A

blocked SVC due to tumour on right lung apex (cancer)

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10
Q

voice alteration may be due to…

A

larynx problems

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11
Q

weight loss/anorexia may be due to…

A

malignancy

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12
Q

breathlessness

A

unpleasant sensation of increased demand for breathing

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13
Q

is breathlessness a symptom or sign?

A

symptom

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14
Q

tachypnoea, hypoxaemia or hypercapnia have a poor correlation with

A

breathlessness

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15
Q

breathlessness is related to work of breathing (3 points)

A
  • increased ventilation
  • respiratory muscle weakness
  • often multiple factors
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16
Q

with breathlessness we must

A

quantify exercise capacity (walking distance, flights of stairs, ADLs, work, etc.)

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17
Q

sudden (minutes) causes of breathlessness (5)

A

pulmonary oedema, pneumothorax, PE, anaphylaxis, foreign body inhalation

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18
Q

rapid (hours) causes of breathlessness (4)

A

acute asthma, pneumonia, pulmonary oedema, acute hypersensitivity pneumonitis

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19
Q

subacute (weeks) causes of breathlessness (4)

A

heart failure, anaemia, pleural effusion, lung cancer

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20
Q

slow (months/years) causes of breathlessness (4)

A

chronic bronchitis and emphysema (COPD), interstitial lung disease (e.g. idiopathic pulmonary fibrosis), pneumoconiosis, pulmonary arterial hypertension

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21
Q

cough acts as a

A

defence system, prevent inhalation of foreign objects

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22
Q

upper and lower respiratory tract are innervated by

A

sensory nerve endings to detect irritation

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23
Q

irritation leads to

A

cough reflex to clear airway

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24
Q

if cough reflex is heightened then…

A

airway nerves are hypersensitive

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25
Q

causes of cough hypersensitivity (10)

A

infection, left heart failure, lung cancer, foreign body inhalation, interstitial lung disease, tracheal compression (by lymph nodes, tumour, AA), ACE inhibitors, asthma, COPD, acid reflux

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26
Q

which 2 diseases come under COPD?

A

chronic bronchitis, emphysema

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27
Q

why do ACE inhibitors cause cough? (2 steps)

A
  1. metabolise bradykinin (as well as angiotensin), 2. accumulation increases sensitivity of airway nerve
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28
Q

label the diagram of the airway nerves

A

done

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29
Q

types of sputum colour (3)

A

mucoid, purulent, bloodstained

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30
Q

mucoid sputum

A

clear/creamy

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31
Q

purulent sputum

A

yellow/green

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32
Q

why is purulent sputum yellow/green?

A

myeloperoxidase from granulocytes (eosinophils/neutrophils)

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33
Q

in bacterial infection, sputum is green because of the

A

neutrophilic reaction

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34
Q

in asthma (allergic) cough, sputum is green because of the

A

eosinophilic reaction

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35
Q

bloodstained sputum

A

haemoptysis

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36
Q

when investigating cough we must ask what 4 things about sputum?

A

colour, volume (how much, how often), taste, odour

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37
Q

when taking a respiratory history, we must always ask

A

have you ever coughed up blood?

38
Q

causes of haemoptysis (6)

A

lung cancer, TB, bronchiectasis, pulmonary oedema, PE, pneumonia

39
Q

sputum in pulmonary oedema

A

pink, frothy

40
Q

sputum in pneumonia

A

rusty, blood mixed through purulent

41
Q

wheeze

A

musical noise due to narrowed airways

42
Q

wheeze happens upon

A

expiration

43
Q

why does wheeze happen upon expiration?

A

airways narrow as lungs get smaller

44
Q

what is stridor?

A

wheeze sound on inspiration

45
Q

stridor tends to indicate

A

upper airway issues, e.g. epiglottis, larynx, trachea

46
Q

give 4 causes of wheeze

A

acute bronchitis, asthma, COPD, large airway obstruction (tracheal/laryngeal tumour)

47
Q

in asthma airway obstruction we see (5)

A
  • eosinophils
  • basement membrane thickening
  • smooth muscle hypertrophy
  • goblet cell hyperplasia
  • mucus plugging
48
Q

chest pain important question

A

show me where it is

49
Q

pleurisy

A

pleuritic pain

50
Q

what causes pleuritic pain?

A

injured/inflamed pleura

51
Q

what kind of pain is pleuritic pain?

A

sharp, stabbing, worse on inspiration

52
Q

causes of pleuritic pain (3)

A

pneumonia, PE, pneumothorax

53
Q

we need to distinguish pleuritic pain from (6)

A

upper retrosternal pain, musculoskeletal pain, retrosternal pain, bony pain, spinal root pain, shingles (before rash)

54
Q

retrosternal pain could be due to

A

mediastinal tumour, constant/progressive, unrelated to exertion

55
Q

bony pain could be due to

A

rib metastases

56
Q

4 parts of respiratory exam

A

inspection, palpation, percussion, auscultation

57
Q

2 main features to look for upon inspection

A

central cyanosis, finger clubbing

58
Q

central cyanosis

A

lips, tongue, 20-30% of Hb deoxygenated

59
Q

peripheral cyanosis

A

fingers, toes

60
Q

give 4 features of finger clubbing

A

loss of angle between nail and nail bed, more spongy nail bed, curved nails, swollen end of fingers

61
Q

asterexis

A

flapping tremor, type 2 respiratory failure with CO2 retention

62
Q

respiratory distress can be indicated by

A

use of accessory muscles

63
Q

patients with apical lung tumour can develop

A

muscle wasting (hands, brachial plexus), Horner’s syndrome

64
Q

give 3 types of chest deformities

A

kyphoscoliosis, pectus carinatum (pigeon), pectus excavatum (funnel)

65
Q

label the chest wall deformities

A

done

66
Q

expansion (2 points)

A
  • compare sides

- reduced expansion always on side with pathology

67
Q

position of trachea to

A

assess mediastinal shift

68
Q

the trachea is pushed way by (2)

A

pleural effusion, pneumothorax

69
Q

the trachea is pulled towards (2)

A

collapse, fibrosis

70
Q

cricosternal distance

A

how many fingers can we get between cricoid cartilage and suprasternal notch

71
Q

normal cricosternal distance

A

3-4 fingers

72
Q

types of sound on percussion

A

resonant, dull, stony dull, hyperresonant

73
Q

normal percussion should be

A

resonant

74
Q

dull percussion can mean

A

consolidation (pneumonia) collapse, dense fibrosis

75
Q

stony dull percussion can mean

A

pleural effusion

76
Q

hyperresonant percussion can mean

A

pneumothorax, bulla

77
Q

normal breath sounds should be

A

vesicular

78
Q

types of breath sounds

A

vesicular, diminished vesicular, absent, bronchial

79
Q

breath sounds may be diminished vesicular in (2)

A

pneumothorax, collapse, effusion

80
Q

breath sounds may be absent in (2)

A

big effusion, big pneumothorax

81
Q

breath sounds may be bronchial in (1)

A

consolidation

82
Q

added sounds on auscultation may be (2)

A

wheeze, crackles

83
Q

crackles/crepitations are

A

explosive opening of multiple occluded small airways

84
Q

coarse crackles may be seen in (2)

A

pneumonia, bronchiecstasis

85
Q

pleural rub

A

creaking sound (like walking in fresh snow)

86
Q

vocal resonance/tactile vocal fremitus (1)

A

ask pt to say 99

87
Q

increased vocal resonance

A

bronchophony, sign of consolidation

88
Q

reduced vocal resonance

A

collapse, pneumothorax, effusion

89
Q

whispering pectoriloquy

A

whisper heard clearly through stethoscope, consolidation

90
Q

fill in the blanked out table

A

done

Block 13 - The Development of Cardiorespiratory Disease (14 decks)

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