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Block 3 - Resp > Lecture 9 - Respiratory Symptoms And Signs > Flashcards

Lecture 9 - Respiratory Symptoms And Signs Flashcards

1
Q

Respiratory symptoms

A
  • dyspnoea
  • cough
  • haemoptysis
  • Chest pain
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2
Q

Respiratory signs

A
  • Clubbing
  • Percussion
  • Auscultation
  • Vocal resonance and Fremitus
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3
Q

Symptom definition

A
  • any sensation or change in bodily function experienced by a patient that is associated with a particular disease
  • subjective sensation
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4
Q

Sign Definition

A
  • evidence of disease pereceptible to the examining physician
  • objective observations
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5
Q

Differentiatl diagnosis

A
  • a list of two or more conditions which may share clinical symptoms or signs
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6
Q

The diagnostic method:

A
  • 1) list a set of all possibilities of diagnosis
    2) Reorder these based on probability, incorporating your history and exam findings
    3) Test these differential diagnoses with further enquiry or investigations
    4) Re-evaluate your list of differentials
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7
Q

Creating a differential diagnosis list - by types of pathology : I VINDICATE AIDS

A
  • Idiopathic
  • Vascular: Pulmonaru Embolus
  • infectious: Pneumonia
  • neoplastic: Lung Cancer
  • degenerative: COPD
  • inflammatory: Pleurisy
  • Congenital: Cyanotic heart disease
  • Autoimmune: Vasculitis
  • Traumatic: Pneumothorax
  • Endocrine and metabolic: Acidosis
  • Allergic: Asthma
  • Iatrogenic
  • Drugs: Methotrexate
  • Social: Anxiety
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8
Q

Creating a differential diagnosis list - by systems review

A
  • Neurological: Neuromuscular disease
  • Endocrine/ Metabolic: Acidosis
  • Cardiovascular: AMI, APO, Valvular
  • Respiratory: a lot
  • Hematological: Anemia, Coagulopathy
  • Gastrointestinal: Reflux
  • Genitourinary: None
  • Reproductive: None
  • Musculoskeletal: Deconditioning
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9
Q

Creating and prioritising a differential diagnosis list - by time course

A
  • suddon onset: Pulmonary embolism
  • Rapid onset - Asthma
  • Acute onset - Pneumonia
  • Sub-acute onset: TB
  • Chronic : neuromuscular disease
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10
Q

Creating and prioritising a differential diagnosis list - as per John Murtagh

A

1) The probability diagnosis
2) The serious disorders not to be missed
3) The conditions which are often missed
4) The seven masquerade: Depression, diabetes, drugs, anemia, thyroid, spinal, UTI
5) Is the patient trying to tell me something: interpersonal conflicts, financial, drugs, fears, family

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11
Q

Dyspnoea

A
  • subjective awareness of discomfort related to breathing
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12
Q

Dyspnoea - DDx: Sudden

A
  • Pneumothorax
  • pulmonary embolism
  • Myocardial infarct
  • Arrythmias
  • Aspiration
  • Anaphylaxis
  • Anxiety/psychogenic
  • Trauma
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13
Q

Dyspnoea - DDx - Acute

A
  • Asthma
  • pneumonia
  • pulmonary oedema
  • respiratory tract infection
  • lung tumour
  • Pleural effusion
  • Metabolic acidosis
  • Renal failure
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14
Q

Dyspnoae - DDx - Chronic

A
  • COPD
  • heart failure
  • arrhythmia
  • anemia
  • bronchiectasis
  • cystic fibrosis
  • Pulmonary hypertension
  • Pulmonary fibrosis
  • Neuromuscular
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15
Q

Variations of dyspnoea

A
  • Tachypnoea - rapid breathing
  • Hyperpnoea - increased volume breathing
  • Orthopneoa - Dyspnoea when lying supine
  • Paroxysmal noctunarl dyspnoae - waking with dyspnoae in the middle of the night (often associated with heart failure)
  • Platypnoea - Dyspnoea when sitting erect
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16
Q

Mechanism of dyspnoea can be divided into

A
  • increased central respiratory drive
  • increase respiratory load
  • lung irritation
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17
Q

Dyspnoea - mechanisms

A
  • afferent signal: Mechanoreceptors/chemoreceptors/ lung receptors
  • Efferent smuscle fibres
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18
Q

Assessing/Measuring dyspnoea

A
  • MMRC

- Modified Borg scale

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19
Q

Cough receptors

A

1) lung receptors: Type 1 receptors
- rapidly adapting (myelinated)
- found in airway epithelium
- stimulated by exogenous and endogenous substances
- cough
2) Larynx and Carina - Very sensitive to foreign bodies/vapors
3) Terminal bronchiole and alveoli - sensitive to chemical stimuli

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20
Q

Cough DDx - Acute

A
  • inhaled foreign body
  • aspiration
  • Respiratory infection
  • inhaled irritiants
  • Left ventricular failure
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21
Q
  • Cough DDx- Chronic
A
  • COPD
  • Bronchiectasis/CF
  • Pulmonary Oedema
  • Tuberculosis
  • Smoking
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22
Q

Cough - DDx - Chronic, non productive

A
  • Asthma
  • Post nasal drip
  • Gastro-oesophagal reflux
  • Drugs
  • Lung Cancer
  • Pulmonary Fibrosis
  • TB
  • whooping cough (pertussis)
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23
Q

Cough types

A
  • Barking
  • Honking
  • Paroxysmal
  • Stacatto
  • Wet cough
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24
Q

Sputum

A
  • Fairly non-specific sign
  • Sputum is mucous secretion from glands in the tracheobronchial tree: any irrititant increases sputum production
  • green colour more likely to be bacterial infection
  • change in colour or volume usually indicates infection, particularly in COPD
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25
Q

Sputum investigations

A
  • Examine appearance and odour
  • Microscopy, Gram stain and culture
  • Cytology: Makignancy, cell count
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26
Q

Hemoptysis

A
  • coughing up blood or blood stained sputum

1) Volume and type
- blood flecks in sputum
- blood stained/streaked sputum
- old clots vs Fresh
- Frank Hemoptysis

27
Q

Chest pain

A
  • relatively non-specific and carries a long differential diagnosis list
  • pleuritic chet pain: pain on inspiration/breathing. More specific for respiratory problems
28
Q

4 steps to a resp exam

A
  • inspect
  • palpate
  • percuss
  • auscultate
29
Q

Clubbing

A
  • characteristic bulging of the distal finger and nail bed

Develops in 5 stages

30
Q

Dyspnoea - DDx: Sudden

A
  • Pneumothorax
  • pulmonary embolism
  • Myocardial infarct
  • Arrythmias
  • Aspiration
  • Anaphylaxis
  • Anxiety/psychogenic
  • Trauma
31
Q

Dyspnoea - DDx - Acute

A
  • Asthma
  • pneumonia
  • pulmonary oedema
  • respiratory tract infection
  • lung tumour
  • Pleural effusion
  • Metabolic acidosis
  • Renal failure
32
Q

Dyspnoae - DDx - Chronic

A
  • COPD
  • heart failure
  • arrhythmia
  • anemia
  • bronchiectasis
  • cystic fibrosis
  • Pulmonary hypertension
  • Pulmonary fibrosis
  • Neuromuscular
33
Q

Variations of dyspnoea

A
  • Tachypnoea - rapid breathing
  • Hyperpnoea - increased volume breathing
  • Orthopneoa - Dyspnoea when lying supine
  • Paroxysmal noctunarl dyspnoae - waking with dyspnoae in the middle of the night (often associated with heart failure)
  • Platypnoea - Dyspnoea when sitting erect
34
Q

Mechanism of dyspnoea can be divided into

A
  • increased central respiratory drive
  • increase respiratory load
  • lung irritation
35
Q

Dyspnoea - mechanisms

A
  • afferent signal: Mechanoreceptors/chemoreceptors/ lung receptors
  • Efferent smuscle fibres
36
Q

Assessing/Measuring dyspnoea

A
  • MMRC

- Modified Borg scale

37
Q

Cough receptors

A

1) lung receptors: Type 1 receptors
- rapidly adapting (myelinated)
- found in airway epithelium
- stimulated by exogenous and endogenous substances
- cough
2) Larynx and Carina - Very sensitive to foreign bodies/vapors
3) Terminal bronchiole and alveoli - sensitive to chemical stimuli

38
Q

Cough DDx - Acute

A
  • inhaled foreign body
  • aspiration
  • Respiratory infection
  • inhaled irritiants
  • Left ventricular failure
39
Q
  • Cough DDx- Chronic
A
  • COPD
  • Bronchiectasis/CF
  • Pulmonary Oedema
  • Tuberculosis
  • Smoking
40
Q

Cough - DDx - Chronic, non productive

A
  • Asthma
  • Post nasal drip
  • Gastro-oesophagal reflux
  • Drugs
  • Lung Cancer
  • Pulmonary Fibrosis
  • TB
  • whooping cough (pertussis)
41
Q

Cough types

A
  • Barking
  • Honking
  • Paroxysmal
  • Stacatto
  • Wet cough
42
Q

Sputum

A
  • Fairly non-specific sign
  • Sputum is mucous secretion from glands in the tracheobronchial tree: any irrititant increases sputum production
  • green colour more likely to be bacterial infection
  • change in colour or volume usually indicates infection, particularly in COPD
43
Q

Sputum investigations

A
  • Examine appearance and odour
  • Microscopy, Gram stain and culture
  • Cytology: Makignancy, cell count
44
Q

Hemoptysis

A
  • coughing up blood or blood stained sputum

1) Volume and type
- blood flecks in sputum
- blood stained/streaked sputum
- old clots vs Fresh
- Frank Hemoptysis

45
Q

Chest pain

A
  • relatively non-specific and carries a long differential diagnosis list
  • pleuritic chet pain: pain on inspiration/breathing. More specific for respiratory problems
46
Q

4 steps to a resp exam

A
  • inspect
  • palpate
  • percuss
  • auscultate
47
Q

Clubbing

A
  • characteristic bulging of the nail bed

May develop in 5 stages

1) Softening of the nail bed
2) Loss of the normal

48
Q

Clubbing mechanism

A
  • not very understood
  • Normal pulmonary circulation disruption -> megakaryocyte not broken into fragments -> deposition in circulation of extremities -> platelet growth factors released -> proliferation of muscle cells and fibroblasts -> clubbing
49
Q

Clubbing DDx

A
  • Respiratory: suppuratie lung disease, idiopathic pulmonary fibrosis
  • Malignancy: Lung cancer, lymphoma
  • CardiacL congenital cyanotic heart disease, infective endocarditis
  • Gastrointestinal: Liver cirrhosis, inflammatory bowel disease

COPD alone is not a cause of clubbing - think lung cancewr

50
Q

Percussion notes

A
  • air : hyperresonant
  • Infiltrate: Dull, Percussion, note
  • normal lung: resonant (normal)
  • effusion: stony dull
51
Q

How sound travels

A
  • Air: 343 m/s
  • Water: 1484m/s
  • Normal lung parenchyma: 70m/s
  • sound generally does not like interfaces
52
Q

Adventitious sounds

A
  • Wheeze
  • Crackles
  • Stridor
  • Rubs
53
Q

Crackles

A
  • inspiratory
  • non-continuous, popping sounds
  • caused by opening of obstructed airways
  • course crackles: wet - low pitched: sound made by fluid secretion in airway (Pneumonia, COPD, Pulmonary oedema, IPF)
  • Fine crackles: dry, velcro-like sounds. Sounds made by stiff alveoli popping open (DDx: pulmonary fibrosis, radiation pneumonitis)
54
Q

Auscultation sounds

A
  • air: absent breath sounds
  • Infiltrate: reduced breath sounds/coarse crackles
  • normal lung: normal vesicular breath sounds
  • effusion: absent breath sounds
55
Q

Wheeze

A
  • expiratory
  • continuous, high-pitched
  • polyphonic, musical sounds
  • occurs in multiple airways simultaneously

DDx:

  • asthma
  • pulmonary oedema - cardiac wheeze
  • small airway trauma
56
Q

Stridor

A
  • inspiratory: above the glottis
  • expiratory: below the thoracic inlet
  • Biphasic: fixed obstruction in either constant location
  • Loud, monophonic with constant pitch
  • cause: any large airway obstruciton
  • DDx: tumours, croup, foreign bodies, aspiration, vocal cord dysfunction, sub-glottic stenosis, laryngomalacia
57
Q

Pleural rubs

A
  • rubbing.scratiching sound heard over inflammed pleura
  • can be heard in both inspiration and expiration
  • not to be confused with pericardial rib, which is independent of respiration
  • Mechanism: inflammation of the pleura and loss of the normal pleural lubrication
  • DDx: pleurisy, PE, Pneumonia, TB, Serositis
58
Q

Bronchial breath sounds

A
  • increased clarity and loudness of breath sounds
  • soft/non-musical
  • same sound as that heard when listening over the trachea with your stethoscope
  • indicates that patient airway is surrounded by consolidated lung tissue
  • DDx: Consolidation
59
Q

Cocal resonance

A
  • normal lung tissue only transmits higher pitched sounds
  • consolidated lung tissue transmits both high and low pitched sounds
  • more difficult to hear in woman
  • normal vocal resonance: muffled sounds
  • consolidated lung: sounds more clear
  • Pleural effusion: decreased/absent vocal resonance
60
Q

Signs of consolidation

A
  • bronchophony: voice is louder than normal and higher vocal resonance
  • whispering pectoriloquy: whispered words are clearly heard
  • Aegophony: nasal, bleating quality to the sound
61
Q

Vocal fremitus

A
  • the vibration felt when placing the hands on the back of a patient and asing them to speak
  • similar findings to that found in vocal resonance
62
Q

Vocal resonance sounds

A
  • air: absent
  • infiltate: increased vocal resonance/fremitus
  • normal lung: normal vocal resonance
  • Effusion: absent/reduced vocal resonance
63
Q

Signs of pulmonary consolidation

A
  • decreased chest expansion on affected side
  • dull to percussion
  • decreased breath sounds, with inspiratory crackles
  • bronchial breath sounds
  • increased vocal resonance with: bronchophony, whispering pectoriloquy, aegophony

Block 3 - Resp (44 decks)

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