Clinical Features of Respiratory diseases Flashcards
What are the main defining clinical features for asthma?
Wheeze
Cough
Dyspnoea
What other causes of wheezing illness (other than asthma) are there?
COPD
Bronchiectasis
Bronchiolitis
Cystic Fibrosis
What are the essential investigations to do when diagnosing asthma?
Spirometry Full pulmonary function testing (To exclude COPD/ emphysema) Reversibility with bronchodilator/oral corticosteroid Peak flow (If spirometry is normal)
What other investigations can be useful in asthma? (Non-essential)
Chest X-ray (Will show hyper inflation)
Skin prick testing (Identifies allergens)
What 5 things do you look for to assess the severity of the asthma?
Ability to speak HR RR PEFR Oxygen sats/ABGs
What are the main symptoms for someone presenting with COPD?
Cough
Sputum
Dyspnoea
Wheeze
What are some of the signs for someone with COPD?
Tachypnoea Use of respiratory accessory muscles Hyperinflation (Barrel chest) Quiet breath sounds Flapping tremor Cyanosis
What are the essential investigations in a COPD patient?
Spirometry
Full Pulmonary function testing (Increase in RV and TLC)
Reversibility to bronchodilator? (should be none)
What are some useful investigations for a COPD patient? (Non-essential)
CXR (hyperinflation + flat hemidiaphragms)
ECG: (RA + RV hypertrophy)
ABGs (Decreased PaO2 and potentially hypercapnia)
What are the signs of an acute exacerbation of COPD?
Increased cough with sputum Increased dyspnoea Increased wheeze Increased oedema Inability to sleep Confusion
What are the general treatments for someone with COPD?
Smoking cessation
Improved nutrition
Treat obesity
What is the treatment for someone with severe COPD?
Combination of long-acting B2 agonist and corticosteroids (budesonide and formeterol)
What are the main clinical features of pneumonia?
Malaise Fever Pleuritic chest pain Cough with purulent or rusty sputum Dyspnoea
What are the main signs of pneumonia?
Pyrexia Tachypnoea Central cyanosis Dullness on percussion of the affected lobes Bronchial breath sounds Increased vocal resonance
What are the investigations that should be done if pneumonia is suspected?
Serum biochemistry and Full blood count
Chest X-ray
Blood culture and throat swab
Sputum microscopy and culture
What are the main symptoms of Bronchiectasis?
Chronic cough
Daily sputum production
Occasional wheeze, dyspnoea and tiredness
What are the main signs in bronchiectasis?
Finger clubbing
Coarse crepitations
What investigations should be done if bronchiectasis is suspected?
CT thorax
Sputum culture
CF genotyping
Serum immunoglobulins
What may an empyema resemble on a chest x-ray?
Pleural effusion
What are the general common symptoms of URTIs?
Nasal congestion Runny nose Nasal breathing Sneezing Sore throat Painful swallowing Cough Fever Malaise
What are the main symptoms of the common cold?
Tickling nose
Sneezing
Clear nasal discharge
What are the main causative organisms for tonsilitis?
Strep. Pyogenes
Adenovirus
EBV (If glandular fever)
What are the main clinical features for epiglottitis?
Sudden onset of sore throat - painful swallowing
Dry cough
Muffled voice
Fever/ drooling
What are the clinical features of glandular fever?
Sore throat Cervical lymphadenopathy Fever Hepatitis Fine red skin rash
If tonsilitis is suspected, what two main investigations would you carry out?
Throat swab
Blood film
What are the investigations recommended if pulmonary embolism is suspected?
ABGs ( May show hypoxia and hypocapnia) D-dimer (negative result excludes PE) ECG CXR FBCs, U+Es V/Q scan - V/Q mismatch can be very useful
What are the investigations recommended for Deep vein thrombosis?
D-dimer (helpful if -ve)
Ultrasound (Ifd-dimer +ve)
Venogram
What are the symptoms of Pulmonary embolism?
Breathlessness
Pleuritic Chest pain
Cough
Haemoptysis
What are the major signs of Pulmonary hypertension?
Cyanosis Tachypnoea Tachycardia Raised JVP Pleural Rub/effusion
What are the main clinical features of a DVT?
Leg swelling Redness Tenderness Oedema Tight calves Mild fever
What are the symptoms of pulmonary hypertension?
Dyspnoea Fatigue Weakness Angina Syncope Chest tightness
What are the main signs of pulmonary hypertension?
RV heave
Ejection systolic murmur
Peripheral oedema
Hepatomegaly
What are the main investigations to do when PHT is suspected?
CXR ECG Pulmonary Function test V/Q scan Echo High resolution CT
What are the signs of bronchitis?
Wheeze
Increased RR
Hyperinflation
What are the main symptoms of bronchitis?
Breathlessness
Cough
Sputum
What are the main signs of lung cancer?
Lymphadenopathy Weight Loss Hoarse voice Eyelid drop Clubbing Pleural effusion
What are the main symptoms of lung cancer?
Shoulder pain Cough Haemoptysis SOB Malaise
Which investigations would be done if lung cancer is suspected?
CXR Biopsy Sputum Cytology Bronchoscopy Fine needle aspiration CT/ MRI/ PET
What g/l would a transudate be?
What are the main signs of a pleural effusion?
Decreased Chest expansion
Bronchial breath sounds
Increased JVP
Deviated trachea (Large effusion)
What are the main symptoms of a pleural effusion?
SOB (Increasing)
Pleuritic chest pain
Dry cough
What are the main signs of a pneumothorax?
Decreased Chest expansion
Absent breath sounds
Deviated trachea
What are the main signs of sarcoidosis?
Lymphadenopathy
Spleen affected
Abnormal CXR
What are the main symptoms of Sarcoidosis?
SOB
Cough
Erythema nodosum (red lumps on skin)
What are the main signs of hypersensitive pneumonitis?
Crackles
Wheeze
Increased Resp rate
What are the main symptoms of Hypersensitive pneumonitis?
Fever Dry cough Chills Malaise SOB
What are the main signs of tuberculosis?
Erythema nodosum Night sweats Pleural effusion Cough Mucus in sputum Haemoptysis
What are the main signs of cystic fibrosis?
Cyanosis Finger clubbing Pancreatic insufficiency Failure to thrive Offensive stools Recurrent chest infections Lung abscess
What are the main symptoms of cystic fibrosis?
Male infertility (95%) Nasal polyps
What are the main signs of sleep apnoea?
Snoring
Unrefreshing sleep
Daytime solemnence
Decreased levels of concentration
