Clinical features of respiratory disease Flashcards
What could rhinorrhoea (runny nose), nasal blockage and attacks of sneezing indicate?
- Allergic rhinitis - nasal secretion is usually thin and runny
- Common colds - nasal secretion is thick and discoloured
Are nose bleeds and blood-stained nasal discharge reasons for concern?
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.
What are the presentations of nasal polyps?
- Nasal blockage
- Loss of smell
What is the most common syptom of lower respiratory tract disease?
Cough
What triggers a cough?
- 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
Explain the 2 types of coughs.
- 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
What is the most common presenting symptom of lung cancer?
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)
A cough can be accompanied by stridor (harsh sound) in what conditions?
- whooping cough
- laryngeal or tracheal obstruction
How much mucus is produced daily?
100mL
What is the most common cause of excess mucus?
Smoking
Is yellow sputum always due to infection?
- Not always. Eosinophils in the sputum, as seen in asthma, can give the same appearance.
What is the reason for yellow or green sputum?
The presence of cellular material - roncial epithelial cells / neutrophil / eosinophil granulocytes
What disease characteristically presents large qualities of yellow/green sputum?
- Broncheictasis - permanent enlargement of parts of the airways - pneumonia / TB
What is the most common cause of haemoptysis? Other causes?
- 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
What is the appearance in lobar pneumonia?
The sputum is usually rusty
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)
Pink and frothy
In bronchiectasis haemoptysis is often mixed with what?
Purulent (discharging pus) sputum
Large quanties of haemoptysis (>200mL/day of blood) indicates what?
- Bronchiectasis
- TB
What are uncommon causes of haemoptysis?
- idiopathic pulmonary haemosiderosis
- Goodpasture syndrome
- Microscopic polyangiitis
- Trauma
- Blood disorders
- Benign tumours
How should haemoptysis be investigated?
- CXR
- A normal CXR does not rule out diseasE
- Further investigation required - CT / bronchoscopy
What may cause firm plugs of sputum?
Exacerbation of allergic bronchopulmonary aspergillosis
What uncomfortable sensation do patients with dyspnoea often complain of?
Tightness in the chest - this must be differentiated from angina
What is orthopnea and what it is classically linked to?
- 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
What is tachypnoea and hyperpnoea?
An increased rate of breathing and an increased level of ventilation respectively. These are normal responses, e.g. during exercise
