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Respiratory > Lecture 22- Symptoms and signs of respiratory disease > Flashcards

Lecture 22- Symptoms and signs of respiratory disease Flashcards

1
Q

many diseases involvinf different parts of the respiratory system

A

airways

lung parenchma

pulmonary circulation

pleura

chrst wall and neuromusculat

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2
Q

Airways (intrathoracic)

A
  • Asthma
  • COPD
  • Bronchiectasis
  • Cystic Fibrosis
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3
Q

Lung parenchyma

A
  • Pulmonary fibrosis
  • Pneumonia
  • TB
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4
Q

Pulmonary circulation

A

• Pulmonary embolism

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5
Q

Pleura (between)

A
  • Pneumothorax
  • Pleural effusion
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6
Q

Chest wall shape and neuromuscular

A

• e.g. kyphoscoliosis, myasthenia gravis

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7
Q

when trying to diagnose a resp condition

A
  • history
  • clinical exam
  • +- furthrr investigations
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8
Q

Cardinal* Signs and Symptoms of Respiratory Disease

A
  • SoB
  • chest pain
  • cough
  • sputum
  • Wheeze/ stridor
  • Haemoptysis
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9
Q

dyspnoea is a

A

subjective awareness of icnrease effort breathing

  • Symptom rather than a sign…
  • But may be objective evidence i.e. raised RR, accessory muscle use
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10
Q

SoB is very common and variably described

A

Common to all respiratory conditions

But not specific..e.g. anaemia, heart failure, obesity

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11
Q

further questions to ask if someone is breathless

A
  • onset, duration, timing
  • progression
  • precipitating factors
  • severity
    • e.g. when speaking or when walking
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12
Q

chest pain…..

A

many potential causes

  • pleura
  • chest wall
  • mediastinal structures
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13
Q

chest pain associated with the pleura

A
  • Infection (causing pleurisy)
  • Pneumothorax
  • Pulmonary embolism (causing infarct)
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14
Q

chest pain associated with the chest wall

A
  • Rib fracture
  • Costochondritis
  • Shingles (varicella zoster)
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15
Q

chest pain associated with mediastinal structures

A
  • ACS (acute coronary syndrome)
  • Pericarditis
  • Oesophagitis/GORD

• Aortic dissection

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16
Q

Pleuritic chest pain

A

irriation of the parietal pleura

  • thoracic or shoulder tip - referred- intercosta nerve/phrenic nerve
  • Pleuritic pain
  • Sharp
  • Often well localised
  • Worsens with inspiration, coughing, positional movement
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17
Q

cardiac pain

A
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18
Q

outline coughing

A

a short explosive expulsion of air- importantn protective mechanism

–> tirggered by stimulation of mechano and or chemoreceptors within airway e.g. by irriation e.g. inflammation or foregin body

  1. adduction of VCs
  2. contraction of itnernal intercostals and abdominal muscles= increased intrthoracic pressure
  3. abduction of VCs
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19
Q

cough characteristics to think about

A

Productive cough = sputum

Character e.g.

Timing

Commonest cause is URTI

But…can be a sign of more serious and/or chronic disease

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20
Q

producitve cough can mean

A

sputum and haemoptysis

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21
Q

chronic bronhcitis and COPD sputum

A

clear sputum- no active infection

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22
Q

Yellow/green sputum (live/dead neutrophils)

A

infection

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23
Q

Large volumes (yellow/green)could suggest

A

bronchiectasis

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24
Q

Haemoptysis (blood in sputum)…

A

potential red flag

25
Q

cough can be caused by

A

respiratory causes

non-resp cause

26
Q

respiratory cause of cough

A

Any irritation of airways (upper and lower respiratory tract!), lung parenchyma or pleura (acute or chronic)

27
Q

non-respiratory causes of cough

A

• LV heart failure (“pink frothy sputum”)

  • GORD
  • Drugs e.g. ACE-inhibitors
28
Q

Wheeze and Stridor

A

Abnormal breath sounds indicating narrowing within the airway causing turbulent air flow

29
Q

describe what a wheeze sounds like and when it occurs

A
  • high pitched, “musical”
  • Mostly on expiration
  • Narrowing in intrathoracic airways
    • E.g. from bronchial smooth muscle
      • contraction, oedema, mucous
  • Narrowing exacerbated during expiration
  • May only be audible with stethoscope
30
Q

describe what stridor sounds like and what will cause it

A
  • High pitch, constant, loud
  • Mostly on inspiration
  • Indicates narrowing in extrathoracic airway (upper airway)
    • Supraglottis, glottis, infraglottis or trachea
  • Narrowing exacerbated during inspiration
  • Often audible without stethoscope!
31
Q

A 38 year old woman with a history of smoking presents with acute onset of dyspnoea and chest pain…

Oxygen saturations are 90% on air, respiratory rate 28, pulse rate 90, temperature 36.6°C and BP 120/87

A. Pneumonia
B. Acute coronary syndrome

C. Pulmonary embolism
D. Pneumothorax

A

D

32
Q

clinical exam

A
  • inspection
    • face
    • chest
    • hands
  • palpation
    • tracheal position
    • chest expansion- symmetrical?
  • percussion
    • resonant
    • hyper-resonant
    • dull
    • stony-dull
  • auscultation
    • normal (vesicular)
    • bronchial
    • reduced or absent
    • added sounds
33
Q

inspection looking for

A
  • raised RR
  • central or peripheral cyanosis
  • clubbing
  • use of accessory muscles to breath
  • pursed lip breathing
  • barrel shaped chest
34
Q

peripheral cyanosis

A
  • Cold exposure and decreased cardiac output
  • Slowing of blood to peripheries (due to vasoconstriction)
    • Increased oxygen extraction
    • More deoxygenated blood present in that area
35
Q
A
36
Q

Central cyanosis

A

lips and tongue (mucous membranes)
• Significant cardiac or respiratory cause
• Caused by increase in amount of deoxygenated Hb in blood arriving at tissues [deoxygenated blood is leaving the heart]

37
Q
A
38
Q

clubbing

A

is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen.

39
Q

use of accesory muscles to breath

A

The diaphragm muscle is of the skeletal or striated type and is the major muscle of ventilation. Accessory muscles of ventilation include the scalene, the sternocleidomastoid, the pectoralis major, the trapezius, and the external intercostals.

40
Q

pursed lip breathing

A

Breathing out slowly through mouth with pursed lip

Commonly seen in COPD

41
Q

how does Pursed lip breathing help

A

Pursing lips increases resistance to outflow on expiration

Maintains intrathoracic airway pressures allowing for small airways to remain open for longer-

  • prolonging period for gas exchange to occur
  • and to allowing more air to empty (rather than trap)
42
Q

Barrel Shaped Chest Increased…..

A

increased …A-P diameter

  • Associated with lung hyperinflation
    • Seen in severe COPD (especially emphysema)
  • AP diameter > lateral diameter
  • Chronic over-inflation of lungs (due to air trapping)
  • Hyperexpands the chest wall over time
43
Q

tracheal position in pleural effsion

A

pushes the trachea to the opposite side

44
Q

tracheal position in pneumothroax

A

possible if tension

  • will push away
45
Q

how to check symmetry of chest expansion

A

using both hands on the chest

46
Q

normal percussion?

A

resonant

47
Q

hyper resonant on percussion

A

increased air e.g. pneumothorax

48
Q

dull sound on percussion

A

cosolidation e.g. pneumonia

49
Q

stony dull sound on percusion

A

pleural effusion

50
Q

normal auscultation called

A

vesicular

  • rusting leaves
  • inpriation and first part of expiration
  • no gap between inspiratory and expiratory components
51
Q

bronchial sound on auscultation

A
  • ‘Blowing’ harsh sound
  • Inspiration and expiration

• Gap between

52
Q
A
53
Q
A
54
Q

reduced or absent sound on auscultation

A

pleural effusion- absent over fluid

asthma- normal or reduced

pneumothorax- absent

55
Q

added sounds heard on auscultation

A
  • wheeze or stridor
  • crackles
  • pleural rub
56
Q

what causes crackles and how can they sound

A

Snapping open of alveoli/small bronchi

  1. Fine –> pulmonary fibrosis
  2. Course –> COPD, bronchiectasis (air bubbling through mucous secretions)
57
Q

Pleural rub

A
58
Q

summary of clinical exam of diff lung conditions

A

Respiratory (27 decks)

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