Lecture 20: Symptoms and signs of respiratory disease Flashcards
What are some examples of diseases involving the respiratory system?
Airways
- asthma
- COPD
- bronchiectasis
- cystic fibrosis
Lung parenchyma
- TB
- pneumonia
- pulmonary fibrosis
Pulmonary circulation
-pulmonary embolism
Pleura
- pneumothorax
- pleural effusion
Chest wall shape & neuromuscular
- kyphoscoliosis
- myasthenia gravis
What are the key (cardinal) signs and symptoms of respiratory disease?
- breathlessness
- chest pain
- cough
- sputum production
- haemoptysis
- sounds (wheeze/stridor)
What is breathlessness?
Dyspnoea: subjective awareness of increased effort of breathing
(symptom rather than a sign, but there may be objective evidence e.g. raised RR, accessory muscles used)
-it is a very common presenting complaint to all respiratory conditions but it is not specific (e.g. anaemia, heart failure, obesity)
What futher questions will we ask a patient who is suffering from dyspnoea?
- onset, timing, duration
- constant/intermittent
- exacerbating/relieving factors
- progression
- severity (what has it stopped them being able to do)
What are some causes for chest pain?
Pleura: infection (causing pleurisy), pneumothorax, pulmonary embolism
Chest wall: rib fractures, costochondritis (inflammation of costal cartilages), shingles (varicella zoster)- pain sensation over skin
Mediastinal structures: ACS (acute coronary syndromes), pericarditis, oesophagitis/GORD, aortic dissection
What is pleurisy?
Inflammation of the pleura which causes sharp chest pain (pleuritic pain) when breathing
What are the types of chest pain?
Cardiac: dull, central, poorly localised, crushing/heavy
Pleuritic: irritation of parietal pleura has somatic innervation- sharp, well localised, made worse with breathing in and coughing (could be MSK)
(central-mediastinal structures, non-central-resp/MSK)
What is the cough reflex?
Short, explosive expulsion of air, which is an important protective mechanism and is triggered by a stimulation of mechano/chemoreceptors within the airway
-cough stimulus within the airway
-triggers vagus nerve (afferent limb)
-to central area for control of cough reflex
-efferent limb via motor nerves
-contraction of laryngeal and respiratory muscles
=cough
What is the mechanism of a cough?
- adduction of vocal cords
- contraction of internal intercostal muscles and abdominal muscles increasing intrathoracic pressure
- followed by abduction of the vocal cords
What features of a cough do we look for?
- productive cough= sputum (colour/volume/blood?)
- sounds (bovine: not explosive/barking: croup)
- timing (worse at night/time of year)
What is the commonest cause for a cough?
URTI
What do the different kinds of sputum indicate?
Clear sputum (no active infection): chronic bronchitis and COPD
Yellow/green sputum (live/dead neutrophils): infection
Large volumes (yellow/green): could suggest bronchiectasis
Haemoptysis: red flag
What are some non-respiratory causes of a cough?
- LV heart failure (pink frothy sputum)
- GORD
- drugs (ACEI)
What is wheeze and stridor?
Abnormal breath sounds indicating narrowing within the airway causing turbulent air flow
Wheeze:
-high pitched
-on expiration
-narrowing in intrathoracic airways (from bronchial smooth muscle contraction/oedema/mucous), and narrowing is exacerbated during expiration as pressure increases in thoracic cavity
(may only be audible with stephoscope)
Stridor:
-high pitched, constant, loud
-on inspiration
-indicates narrowing in extrathoracic airways (supraglottis, glottis, infraglottis, trachea)
-narrowing exacerbated during inspiration
(often audible without stephoscope)
When you do a clinical examination what do you look for which indicate signs of respiratory disease?
- raised RR
- peripheral cyanosis/clubbing
- central cyanosis
- pursed lip breathing
- accessory muscle use
- abnormalities in chest shape
