Clinical signs and symptoms of respiratory disease Flashcards
1
Q
What diseases affect the airways?
A
- Asthma
- COPD
- Bronchiectasis
- Cystic fibrosis
2
Q
What diseases affect the lung parenchyma?
A
- Pulmonary fibrosis
- Pneumonia
-TB
3
Q
What diseases affect pulmonary circulation?
A
- Pulmonary embolism
4
Q
What diseases affect the pleura?
A
- Pneumothorax
- Pleural effusion
5
Q
What diseases affect chest wall shape and the neuromuscular system?
A
- Kyphoscoliosis
- Myasthenia gravis
6
Q
What are the key signs and symptoms of respiratory disease?
A
- Severely breathlessness/feeling of suffocation
- Chest pain
- Cough
- Sputum (if green = presence of neutrophils)
- Haemoptysis
- Breath sounds
7
Q
What is dyspnoea?
A
- Symptom rather than a sign
- Subjective awareness of increased effort of breathing
- Very common
- Common to respiratory conditions
- But not specific e.g. anaemia, heart failure, obesity
8
Q
How should you further explore dyspnoea?
A
- Onset, timing and duration
- Exacerbating factors
- Progression
- Severity
9
Q
What are the mediastinal causes of chest pain?
A
- Acute coronary syndrome
- Pericarditis
- Oesophagitis/GORD
- Aortic dissection
10
Q
What are the pleural causes of chest pain?
A
- Infection (causing pleurisy)
- Pneumothorax
- Pulmonary embolism (causing infarct)
11
Q
What are the causes of chest wall pain (including skin)?
A
- Rib fracture
- Costochondritis
- Shingles (varicella zoster virus)
12
Q
What is important about the location of chest pain?
A
- Central vs non-central
- Cardiac vs pleuritic
13
Q
What is pleuritic chest pain like?
A
- Due to irritation of parietal pleura
- Thoracic wall or shoulder tip pain (referred via intercostal nerve/phrenic nerve)
- Sharp, well localised
- Worse with coughing and breathing in
14
Q
What is a cough?
A
- A short, explosive expulsion of air
- Important protective mechanism
15
Q
What stimulates a cough?
A
- Triggered by stimulation of mechano- and/or chemo-receptors within airway
- By any source of irritation e.g. inflammation, foreign body
16
Q
Outline the cough reflex
A
- Cough stimulus
- Larynx, trachea, bronchi
- Afferent limb = vagal nerves
- Central control cough centre
- Efferent limb = motor nerves
- Laryngeal and respiratory muscles
- Cough
17
Q
What is cardiac chest pain like?
A
- Visceral pain
- Dull, central, tight or crushing in nature
- Radiate to neck, jaw, shoulders and/or arm
18
Q
After an initial inhalation, which mechanisms are included in a cough?
A
- Adduction of vocal cords
- With contraction of internal intercostals and abdominal muscles
- Increases intrathoracic pressure
- Followed by abduction of vocal cords
19
Q
What questions should you ask a patient who has come to see you with a cough?
A
- Productive cough = sputum (ask about colour, consistency, volume and blood)
- Character e.g. bovine or seal-like
- Timing - nocturnal/time of year?
- Commonest cause of acute cough is URTI
20
Q
What does a bovine cough indicate?
A
- Describes non- explosivecoughof someone unable to close their glottis - Pt cannot build up the same degree of intrapulmonary pressure
- Cough less effective
21
Q
What does a seal-like cough indicate?
A
- Croup
22
Q
What kind of sputum is produced by a patient with chronic bronchitis and COPD?
A
- Clear sputum
23
Q
What kind of sputum indicates infection?
A
- Yellow-green (live/dead neutrophils)
- Large volumes could suggest bronchiectasis
24
Q
What are the respiratory causes of cough?
A
- Any irritation of:
- Airways (upper and lower respiratory tract)
- Lung parenchyma
- Or pleura
25
What are non-respiratory causes of cough?
- LV heart failure (pink frothy sputum)
- GORD
- Drugs e.g. ACE-inhibitors
26
What are wheeze and stridor?
- Abnormal breath sounds indicating narrowing within airways causing turbulent airflow
27
What does wheeze sound like?
- High-pitched, musical
- Mostly on expiration
28
What causes wheezing?
- Narrowing in intrathoracic airways e.g. from bronchial smooth muscle contraction, oedema, mucus
- Narrowing exacerbated during expiration
- May only be audible with stethoscope
29
What does stridor sound like?
- High pitch, constant, loud
- Mostly on inspiration
30
What causes stridor?
- Indicates narrowing of extra-thoracic airway (supraglottis, glottis, infraglottis or trachea)
- Narrowing exacerbated during inspiration
- Often audible without stethoscope
31
What are we looking for on clinical examination of someone with a potential respiratory difficulty?
- Is patient comfortable
- Breathless at rest and/or with speaking
- Elevated resp rate
- Closer inspection of hands, face and chest
32
What is peripheral cyanosis?
- Affects skin of feet, hands, nose and tip of ears
- Due to cold exposure or decreased cardiac output
- Slowing of blood to peripheries (due to vasoconstriction)
- Increased oxygen extraction
- More deoxygenated blood present in that area
33
What is central cyanosis?
- Affects lips and tongue
- Significant cardiac or respiratory cause
- Caused by increase in amount of deoxygenated Hb in blood arriving at tissues
34
What are some causes of haemoptysis?
- Bronchiectasis
- TB
- Lung cancer
- PE
35
What is pursed lip breathing?
- Commonly seen in COPD
- Pursing lips increases resistance to outflow on expiration
- Maintains intrathoracic airway pressures allowing for small airways to remain open for longer
- Prolongs period for gas exchange to occur and and to allow more air to empty
36
What might you see on examination of a patient who is really struggling to breathe?
- Accessory muscle use – increased work of breathing
- Adequate ventilation not achieved by normal inspiratory efforts
- More effort required to move air through airways e.g. narrowed
- Accessory muscles help create greater negative intrathoracic pressure on inspiration
- Pulling more air in
- May cause tracheal tug
37
How does barrel chest present?
- Increased A-P diameter
- Associated with lung hyperinflation (seen in severe COPD)
- AP diameter > lateral diameter
- Chronic over-inflation of lungs due to air trapping
- Hyperexpands the chest wall over time
38
What do we need to palpate in a resp examination?
- Tracheal position
- Chest expansion
39
What can the symmetry of chest expansion tell us about a patient's condition?
- Symmetrically reduced
- Common in severe COPD
- Diffuse pulmonary fibrosis
- Asymmetrically reduced
- Indicates unilateral abnormality e.g. collapse, pneumothorax, effusion
40
What do the different sounds of percussion suggest in resp examination?
- Resonant (normal), hyper-resonant, dull
- Certain areas over chest dull to percussion
- Normal (e.g. area of liver, heart)
- Rest of lung should be resonant
- Dull to percussion
- Suggests consolidation
- Solidification due to filling of lungs with ~solid material
- Percussion over area of pleural effusion- stony dull
- Hyper-resonant
- Area of increased air e.g. lung hyperinflation, pneumothorax
41
What does normal (vesicular) auscultation sound like?
- Rustling leaves
- Inspiration and first part of expiration
- No gap between inspiratory and expiratory components
42
What does bronchial breathing sound like?
- 'Blowing' harsh sound
- Inspiration and expiration
- Gap between
- Due to consolidated alveoli acting like a solid
- Conduct breath sounds from larger airways more readily
43
What added sounds can be heard on auscultation of the lungs?
- Wheeze or stridor
- Crackles - snapping open of alveoli/small bronchi
- Pleural rub - scratching, coarse sound due to inflammation of pleura
44
Which conditions are associated with fine crackles?
- Pulmonary fibrosis
45
Which conditions are associated with coarse crackles?
- COPD
- Bronchiectasis (due to air bubbling through mucous secretions)
