Clinical features of respiratory disease

Question 1

What could rhinorrhoea (runny nose), nasal blockage and attacks of sneezing indicate?

Answer 1

• Allergic rhinitis - nasal secretion is usually thin and runny
• Common colds - nasal secretion is thick and discoloured

Question 2

Are nose bleeds and blood-stained nasal discharge reasons for concern?

Answer 2

These presentations are common and rarely indicate serious pathology. However, a blood-stained nasal discharge associated with nasal obstruction and pain may be the presenting feature of a nasal tumour.

Question 3

What are the presentations of nasal polyps?

Answer 3

• Nasal blockage
• Loss of smell

Question 4

What is the most common syptom of lower respiratory tract disease?

Answer 4

Cough

Question 5

What triggers a cough?

Answer 5

• Mechanical or chemical stimulation of cough receptors in the epithelium of the pharyn, larynx, trachea, bronchi and diaphragm.
• Afferent receptors travel to the cough centre in the medulla, where efferent signals are sent to the expiratory musculature

Question 6

Explain the 2 types of coughs.

Answer 6

• Productive - sputum - chronic bronchitis
• Dry - no sputum - asthma / acid reflux (late at night)
• A dry cough may also occur in asthmatics after mild exertion or following forced expiration

Question 7

What is the most common presenting symptom of lung cancer?

Answer 7

A worsening cough - explosive character of cough is lost when vocal cord is paralysed which usually as a result of lung cancer infiltrating the left recurrent laryngeal nerve (bovine cough)

Question 8

A cough can be accompanied by stridor (harsh sound) in what conditions?

Answer 8

• whooping cough
• laryngeal or tracheal obstruction

Question 9

How much mucus is produced daily?

Answer 9

100mL

Question 10

What is the most common cause of excess mucus?

Answer 10

Smoking

Question 11

Is yellow sputum always due to infection?

Answer 11

• Not always. Eosinophils in the sputum, as seen in asthma, can give the same appearance.

Question 12

What is the reason for yellow or green sputum?

Answer 12

The presence of cellular material - roncial epithelial cells / neutrophil / eosinophil granulocytes

Question 13

What disease characteristically presents large qualities of yellow/green sputum?

Answer 13

• Broncheictasis - permanent enlargement of parts of the airways - pneumonia / TB

Question 14

What is the most common cause of haemoptysis? Other causes?

Answer 14

• Acute infection - particularly in exacerbation of COPD (should not be attributed to this without investigaton)
• Pulmonary infarction (obstruction of blood supply causing lung tissue to die. Usually a result of pulmonary embolism)
• Bronchial carcinoma
• TB

Question 15

What is the appearance in lobar pneumonia?

Answer 15

The sputum is usually rusty

Question 16

What is the appearance of the sputum in pulmonary oedma (build up of excess of fluid - main cause is heart failure due to left ventricular failure)

Answer 16

Pink and frothy

Question 17

In bronchiectasis haemoptysis is often mixed with what?

Answer 17

Purulent (discharging pus) sputum

Question 18

Large quanties of haemoptysis (>200mL/day of blood) indicates what?

Answer 18

• Bronchiectasis
• TB

Question 19

What are uncommon causes of haemoptysis?

Answer 19

• idiopathic pulmonary haemosiderosis
• Goodpasture syndrome
• Microscopic polyangiitis
• Trauma
• Blood disorders
• Benign tumours

Question 20

How should haemoptysis be investigated?

Answer 20

• CXR
• A normal CXR does not rule out diseasE
• Further investigation required - CT / bronchoscopy

Question 21

What may cause firm plugs of sputum?

Answer 21

Exacerbation of allergic bronchopulmonary aspergillosis

Question 22

What uncomfortable sensation do patients with dyspnoea often complain of?

Answer 22

Tightness in the chest - this must be differentiated from angina

Question 23

What is orthopnea and what it is classically linked to?

Answer 23

• Breathlessness on lying down
• It is linked to heart failure
• Can be partly due to the weight of the abdominal contents pushing the diaphragm up into the thorax

Question 24

What is tachypnoea and hyperpnoea?

Answer 24

An increased rate of breathing and an increased level of ventilation respectively. These are normal responses, e.g. during exercise

Question 25

What is hyperventilation?

Answer 25

An inappropiate overbreathing. This may occur at rest or on excertion, and results in a lowering of the alveolar and arterial PCO2

Question 26

What is paroxysmal nocturnal dyspnoea?

Answer 26

It is acute episodes of breathlessness at night - heart failure.

Question 27

What is wheezing? And is it diagnostic of asthma?

Answer 27

• It is a common complaint and results from airflow limitation due to any cause.
• No. Other causes include vocal chord dysfunction / bronchiolitis / COPD

Question 28

What is the most common type of chest pain reported in respiratory disease?

Answer 28

• Pleuritic - a localised sharp pain - it is made worse by deep breathing or coughing and the patient can usually localise it

Question 29

What is localized anterior chest pain with tenderness of costochonfral junction is caused by?

Answer 29

Costochondritis.

Question 30

What does shoulder tip pain suggest?

Answer 30

Irritation of the diagphramtic pleura (referal pain??)

Question 31

What does central chest pain radiating to the neck and arms indicate?

Answer 31

Trick question - not respiratory! This is likely to be cardiac.

Question 33

What is retrosternal soreness associated with?

Answer 33

Tracheitis

Question 34

What does ?retrosternal? constant, severe, dull pain indicate?

Answer 34

Malignant invasion of the chest wall.