Clinical Signs and Symptoms of Respiraory Diseases Flashcards
What is haemoptysis and what causes it?
Is it the same as haematemesis?
Coughing up of blood
Bronchitis, bronchial carcinoma, pneumonia, pulmonary infarction or TB
Haematemesis – vomiting up blood.
What is pleuritic chest pain and what is its most common cause?
Pleuritic Chest Pain – anywhere in the chest, usually related to respiration, typically sharp and made worse by deep inspiration and coughing, may have secondary symptoms. Can be caused by lobar pneumonia, pulmonary embolism, infarction and pneumothorax. Other causes of chest pain – cardiac causes are too important to ignore.
What is Dyspnoea?
Breathlessness (SOB) – Dyspnoea – taking an abnormal amount of effort to breath. Dyspnoea scale 1-5
If a cough lasts less than 3 weeks what is it most likely to be?
Cough – less than 3 weeks – upper respiratory chest infection or lower respiratory chest infection. Greater than 3 weeks – COPD, Asthma, Carcinoma of the lung, reflux or medication e.g. ACE inhibitors.
What is wheezing and why does it occur?
Wheeze – whistling noise that comes from the chest (not upper airway) usually maximum wheeze on expiration. Caused by – asthma, COPD and foreign body.
What causes hoarseness of breath?
Hoarseness – transient inflammation of the vocal cords, vocal cord tumour, recurrent laryngeal nerve palsy – left side particularly vulnerable to e.g. bronchial carcinoma.
What drugs can cause respiratory symptoms?
Drug History – coughs – ACE inhibitors. Wheeze – beta blockers. Pulmonary embolism – oestrogens and Fibrotic lung changes – Amiodarone.
What can be the cause of reduced chest movements - less air moving in and out of lungs
Pneumonia
Pneumothorax
Pleural effusion
Lobar collapse – obstruction of large airway no air entering affected lobe/lung
What can be the cause of Tracheal shift
Pushed to opposite side – massive effusion, large or tension pneumothorax.
Pulled to same side – central collapse, unilateral fibrosis (e.g. previous TB infection)
Not shifted – pneumonia, COPD, Asthma, diffuse fibrosis
How does percussion sound different depending on the condition of the lungs you are percussing?
Percussion – Normal lung – resonant note, Hollow structure (pneumothorax) – hyperressonant, Over solid structures (organs/collapsed lung) – dull note and Fluid filled areas – Stoney dull
How can breath sounds change and be described?
Breath sounds – normally vesicular. Bronchial breath sounds – consolidation (lobar pneumonia), reduced intensity/absent breath sounds – air (pneumothorax) or fluid (effusion) between chest wall and lung.
How can vocal resonance change?
Vocal resonance – increased when bronchial breathing present such as lobar pneumonia, decreased (same caused as reduced breath sounds) and pneumothorax and pleural effusion.
What does lobar pneumonia present with on examination?
Consolidation, trachea and mediastinum not shifted, reduced chest movement on affected side, dull percussion sounds, breath sounds – bronchial breath sounds conducted through consolidated lung to chest wall, vocal resonance increased and crackles and increased pleural rub.
What does pleural effusion present with on examination
Trachea and mediastinum pushed away from effusion if large, reduced chest movement on affected side, stony dull percussion sounds over effusion, breath sounds – vesicular – reduced intensity or absent on affected side and vocal resonance decreased.
What does Pneumothorax present with on examination
Trachea and mediastinum pushed away if large or tension, reduced chest movement on affected side, hyper resonant percussion sounds on affected side, breath sounds – vesicular – reduced intensity or absent on affected side and vocal resonance decreased.
What does Lobar Collapse present with on examination
Trachea and mediastinum pulled towards affected side, reduced chest movement on affected side, normal or dull percussion sounds on affected side, breath sounds reduced intensity or absent on affected side and vocal resonance decreased.
What does Localised Lung fibrosis present with on examination
Trachea and mediastinum pulled towards affected side, reduced chest movement on affected side, normal percussion sounds on affected side, breath sounds vesicular with crackles on affected side and vocal resonance normal or increased.
Localised lung fibrosis can occur due to healed or old TB.
What does Diffuse Lung Fibrosis present with on examination
Trachea and mediastinum central, symmetrically reduced chest movement on both side, normal percussion sounds, breath sounds vesicular with crackles and vocal resonance normal or increased.
Diffused lung fibrosis can occur due to interstitial lung disease
What does COPD present with on examination
Barrel chest in COPD central trachea and mediastinum, symmetrically reduced chest movement on both side, resonant percussion sounds, breath sounds vesicular with prolonged expiration and wheezes and vocal resonance normal.
What is tactile vocal fremitus?
Note tactile vocal fremitus is palpable vocal resonance, detected by placing the hand on chest whilst patient says 99 etc. hence findings will be similar to VR findings.
What is a hydrothorax?
Note Hydrothorax is where the lung is compressed by fluid in the pleural space.
Compare COPD with Fibrosis?
COPD
Loss of elastic tissue, airway obstruction and reduced elastic recoil - hyperinflation of the chest, FEV1/FVC < 70%, FVC not really reduced and low diffusion capacity.
Fibrosis
Increased fibrous tissue, less compliant - (hard to stretch, smaller lungs), no airway obstruction, FEV1/FVC > 70%, FVC markedly reduced, low diffusion capacity.
