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respiratory > Clinical signs and symptoms of respiratory disease > Flashcards

Clinical signs and symptoms of respiratory disease Flashcards

1
Q

What diseases affect the airways?

A
  • Asthma
  • COPD
  • Bronchiectasis
  • Cystic fibrosis
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2
Q

What diseases affect the lung parenchyma?

A
  • Pulmonary fibrosis
  • Pneumonia
    -TB
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3
Q

What diseases affect pulmonary circulation?

A
  • Pulmonary embolism
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4
Q

What diseases affect the pleura?

A
  • Pneumothorax
  • Pleural effusion
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5
Q

What diseases affect chest wall shape and the neuromuscular system?

A
  • Kyphoscoliosis
  • Myasthenia gravis
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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
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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
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8
Q

How should you further explore dyspnoea?

A
  • Onset, timing and duration
  • Exacerbating factors
  • Progression
  • Severity
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9
Q

What are the mediastinal causes of chest pain?

A
  • Acute coronary syndrome
  • Pericarditis
  • Oesophagitis/GORD
  • Aortic dissection
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10
Q

What are the pleural causes of chest pain?

A
  • Infection (causing pleurisy)
  • Pneumothorax
  • Pulmonary embolism (causing infarct)
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11
Q

What are the causes of chest wall pain (including skin)?

A
  • Rib fracture
  • Costochondritis
  • Shingles (varicella zoster virus)
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12
Q

What is important about the location of chest pain?

A
  • Central vs non-central
  • Cardiac vs pleuritic
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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
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14
Q

What is a cough?

A
  • A short, explosive expulsion of air
  • Important protective mechanism
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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
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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
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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
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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
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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
Q

What are non-respiratory causes of cough?

A
  • LV heart failure (pink frothy sputum)
  • GORD
  • Drugs e.g. ACE-inhibitors
26
Q

What are wheeze and stridor?

A
  • Abnormal breath sounds indicating narrowing within airways causing turbulent airflow
27
Q

What does wheeze sound like?

A
  • High-pitched, musical
  • Mostly on expiration
28
Q

What causes wheezing?

A
  • Narrowing in intrathoracic airways e.g. from bronchial smooth muscle contraction, oedema, mucus
  • Narrowing exacerbated during expiration
  • May only be audible with stethoscope
29
Q

What does stridor sound like?

A
  • High pitch, constant, loud
  • Mostly on inspiration
30
Q

What causes stridor?

A
  • Indicates narrowing of extra-thoracic airway (supraglottis, glottis, infraglottis or trachea)
  • Narrowing exacerbated during inspiration
  • Often audible without stethoscope
31
Q

What are we looking for on clinical examination of someone with a potential respiratory difficulty?

A
  • Is patient comfortable
  • Breathless at rest and/or with speaking
  • Elevated resp rate
  • Closer inspection of hands, face and chest
32
Q

What is peripheral cyanosis?

A
  • 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
Q

What is central cyanosis?

A
  • Affects lips and tongue
  • Significant cardiac or respiratory cause
  • Caused by increase in amount of deoxygenated Hb in blood arriving at tissues
34
Q

What are some causes of haemoptysis?

A
  • Bronchiectasis
  • TB
  • Lung cancer
  • PE
35
Q

What is pursed lip breathing?

A
  • 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
Q

What might you see on examination of a patient who is really struggling to breathe?

A
  • 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
Q

How does barrel chest present?

A
  • 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
Q

What do we need to palpate in a resp examination?

A
  • Tracheal position
  • Chest expansion
39
Q

What can the symmetry of chest expansion tell us about a patient’s condition?

A
  • Symmetrically reduced
  • Common in severe COPD
  • Diffuse pulmonary fibrosis
  • Asymmetrically reduced
  • Indicates unilateral abnormality e.g. collapse, pneumothorax, effusion
40
Q

What do the different sounds of percussion suggest in resp examination?

A
  • 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
Q

What does normal (vesicular) auscultation sound like?

A
  • Rustling leaves
  • Inspiration and first part of expiration
  • No gap between inspiratory and expiratory components
42
Q

What does bronchial breathing sound like?

A
  • ‘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
Q

What added sounds can be heard on auscultation of the lungs?

A
  • Wheeze or stridor
  • Crackles - snapping open of alveoli/small bronchi
  • Pleural rub - scratching, coarse sound due to inflammation of pleura
44
Q

Which conditions are associated with fine crackles?

A
  • Pulmonary fibrosis
45
Q

Which conditions are associated with coarse crackles?

A
  • COPD
  • Bronchiectasis (due to air bubbling through mucous secretions)

respiratory (21 decks)

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