Presentations Flashcards
List the categories of acute dyspnoea causes
- Upper airway obstruction
- Lower airway disease
- Parenchymal lung disease
- Non specific resp causes
- Cardio causes
- Metabolic acidosis
- Anxiety
List parenchymal lung diseases that can cause acute breathlessness
- Pneumonia
- Lobar collapse
- ARDS: acute resp distress syndrome
What are the symptoms of pneumonia? (8)
- Cough
- Wheeze
- Green productive sputum
- Pleuritic chest pain (towards bottom of lung)
- Sepsis: sweats, fevers
- SOB
- Worse lying down
Pneumonia signs (7)
- Tachypnoea
- Intercostal muscle movement
- Wheeze
- Dull percussion
- Bronchial breathing
- Coarse crackles
- Raised CRP
What are the complications of pneumonia? (3)
- Pleural effusion
- Empyema: pus in cavity
- Pulmonary cavity
- Recurrence if patient immunocompromised/partially treated first infection
What are the symptoms of a progression to an empyema/pulmonary cavity?
H
How is a diagnosis of puenmonia made?
On chest x ray NOT just signs and symptoms
What is the duration of pneumonia symptoms without further complications?
Short hours to a few days
Lobar collapse (3)
Not obvious
- Difficulty breathing/rapid and shallow
- Wheeze
- Cough
List non specific resp conditions that can cause acute dyspnoea (4)
- Pneumothorax (simple/tension)
- Pleural effusion
- PE
- Acute chest wall injury
What are the most common conditions that can progress to a pleural effusion? (3)
- Heart failure
- Pneumonia (paraneumonic effusion/pleural infection)
- Malignancy
What are the signs of a progression to a pleural effusion on the affected side?
- Reduced chest expansion
- Mediastinal displacement
- Stony dull percussion
- Reduced/absent breath sounds
- Reduced/absent vocal resonance
When are the signs of a pleural effusion present?
When greater than 500 ml
What are the symptoms of a simple puenmothorax? (4)
- At rest and sudden onset
- Pleuritic chest pain on 1 side
- SOB
- Proportionate to size and stable
How are the symptoms and signs of a tension puenmothorax different to simple? (5)
- Worsening signs and symptoms
- Unstable haemodynamically: hypotensive/tachycardic/high resp rate
- Tracheal deviation from side of PTX
- More obvious lung collapse
What can a tension puemonothorax progress to?
Cardiac arrest
What are the signs of a simple puenmothorax? (7)
- No tracheal deviation
- Subtle lung collapse = decreased peripheral lung markings CXray
- Sats normal
- Unilateral hyperresonant
- Unilateral stony dull percussion
- Unilateral
reduced/no breath sounds - Unilateral reduced vocal resonace
List the resp causes of chronic dyspnoea
- Asthma
- COPD
- Lung cancer
- ILD (interstitial lung diseases) e.g sarcoidosis, idiopathic pulmonary fibrosis, extrinsic allergic alveolitis/pneumocitosis
- Pleural effusion
- Chronic pulmonary thromboembolism
- Bronchiectasis
- Cystic fibrosis
- Pulmonary hypertension (primary/secondary)
- Pulmonary vasculitis
- TB
- Laryngeal/tracheal stenosis - extrinsic compression/malignancy
What are the symptoms of asthma? (11)
- Wheezing
- Cough
- Periodic dyspnoea
- Tachypnoea
- Chest tightness
- Recurrent
- Episodic
- Diurnal (worse at night/in early morning)
- Triggered by: cold, exercise, viruses, allergens, medications
- Atrophy family history
- Recorded episode
What are the triggers for asthma? (5)
- Cold
- Exercise
- Viruses
- Allergens
- Medications (betablockers/ NSAIDs)
Give examples of medications that trigger asthma (2)
- Betablockers
- NSAIDs
What are the signs of asthma?
- Obstructive lung disease PFTs on spirometer
- NO levels raised
- 15% improvement in FEV1 or PEF following the inhalation of a bronchodilator
- Expiratory wheeze
- Silent chest=serious
What is the presentation of acute asthma? (2)
- Worsening of normal symptoms (e.g wheeze/dyspnoea)
- Recorded episode: wheeze/variable PEFR/FEV1
How does atopic asthma present? (2)
- Triggered by environmental agent
- Skin test: wheal and flare reaction
How does occupational asthma present? (2)
Adult onset asthma with worse at work
What are the symptoms of COPD? (5)
- Progressive dyspnoea, persistent
- Worsens with exercise
- Chronic cough
- Dry/regular sputum production
- Recurrent winter bronchitus
What are the patient risk factors associated with COPD?
- Smoking
- Over 35 year olds
What are the red flags for breathlessness? (5)
- Acutely breathless
- Haemoptysis
- Hoarse voice
- Chest pain
- Rapid weight loss
What are the signs of COPD? And which indiate a progression to cor pulmonale? (12)
- Tachypnoea
- Hyperinflated chest
- Wheeze
- Use of accessory muscles
- Poor chest expansion
- Hyperresonant chest
- Pursing of lips on expiration
- Cyanosis *
- Peripheral oedema *
- Raised JVP *
- Cachexia
- Prolonged expiration
- = cor pulmonale
How does an exacerbation of COPD present? (5)
- Acute onset
- Worsening of COPD patient symptoms from usual stable state
- Fever/systemic infection symptoms
- Cyanosis symptoms: confusion, blue, severe SOB
- Triggers: viral/bacterial resp tract infection
What confirms a diagnosis of COPD?
History with post bronchodilator FEV1/FVC =<0.70
What are the symptoms of acute bronchitus? (4)
- Dry then later productive (any colour inc. red) cough
- Systemically unwell: fever
- Dyspnoea
- Wheezing
Presentation of ARDS? (Acute resp distress syndrome)
- Acute onset
- Wide pulmonary pressure (so not HF)
- Dyspnoea
- Tachycardia
- Tachypnoea
- Bilateral basal crackles
- Chest pain
What are the causes of ARDS?
Acute lung inflammation
- Sepsis
- Pneumonia
- Trauma
- Aspiration
- Shock : ischaemiac damage/liver failure/pancreatitus/drug overdose
What are the symptoms of pulmonary oedema? (11)
- Sig breathing probs (SOB)
- Cough w/pink frothy sputum (haemoptysis)
- SOB
- Resp distress
- Tachypnoea
- Excessive sweating
- Suffocation feeling
- Pale skin
- Wheezing
- Palpitations
- Chest pain
Pleural effusion (7)
- Chest pain
- Dry cough
- Dyspnoea/orthopnea
- Reduced chest expansion
- Tracheal deviation from affected side
- Stony dull percussion
- Reduced/absent breath sounds/vocal resonance
Signs of pulmonary oedema (3)
- Decreased O2 sats
- Raised JVP + peripheral oedema (fluid overload)
- Basal creps
What is pulmonary oedema secondary to? And what conditions is this state associated with? (5)
FLUID OVERLOAD
- Kidney failure
- IV therapy
- Heart failure
- Hypoalbuminaemia (liver failure)
- Pericarditus
What are the differences between asthma and COPD clinically? (4)
- A=better quality of life
- A=dinural, C=daytime externtional
- A=reversible, C=irreversibe
- A=allergy history, C=no allergy, more smoking
What are the symptoms of acute extrinsic allergic alveolitis? (5)
- Acute dyspnoea
- Cough
- Fever
- Rash/swelling
- Onset: a few hours after antigen exposure and resolving on cessation
What are the symptoms of bronchal carcinoma? (9)
- Chest pain : fullness to severe persistent pain. Maybe pleuritic
- Cough: dry/ (purelent if infection) - change in smoker’s cough
- Several episodes of small haemoptysis without infection
- Recurrent pneumonia – same site/slow to treatment response
- SOB: if large tumour
- Voice hoarseness
- Resp symptoms not responding to treatment
- Weight loss
- Anorexia
What is a sign that a COPD patient has progressed to a bronchial carcinoma?
Change in character of smoker’s cough
What suggests pneumonia is associated with malignancy? (3)
- Slow to heal
- Same site
- Slow response to treatment
What signs are found in bronchial carcinoma? (2)
- Phrenic involvement - diaphragm raising = absent breath sounds and dull percussion
- Pleural rub/pleural effusion signs if pleura involvement
List the interstitial lung diseases causing breathlessness (7)
- Chronic extrinsic allergic alveolitis
- Idiopathic pulmonary fibrosis
- Sarcoidosis
- Simple coal workers pneumoconiosis
- Complicated coal workers’ pneumoconiosis/progressive massive fibrosis
- Asbestosis
- Silicosis
What are the symptoms of simple coal workers pneumoconiosis? (2)
- Asymptomatic
- Or some bronchitis
What are the symptoms of complicated coal workers’ pneumoconiosis/progressive massive fibrosis? (3)
- Cough
- Dyspnoea
- Black sputum
- Progressing despite dust exposure cessation
What can progressive massive fibrosis eventually lead to? (2)
- Pulmonary hypotension
- Cor pulmonale
What are the symptoms and signs of chronic extrinsic allergic alveolitus? (7)
- Insidous onset
- Cough
- Progressive dyspnea
- Fatigue
- Weight loss
- Clubbing
- Acute episodes: fever and SOB after antigen exposure
What are the signs of chronic extrinsic allergic alveolitus? (5)
- Type 1 resp failure
- Hypoxemia at rest, desat with exercise
- Resp distress
- Tachypnoea
- Inspiratory crackles on lower lung fields
Symptoms of idiopathic pulmonary fibrosis (8)
- 45-65 years
- Progressive breathlessness
- Weight loss
- Malaise
- Type 1 resp failure/cor pulmonale
- Clubbing
- End insp crackles
- Reduced chest expansion
Bronchiectasis presentation (5)
Decreased FEV1 Decreased FEV1/VC ratio (less than 0.7) Cough Fever Foul smelling purulent sputum
What lung cancer is associated with kidney stones? And why? (2)
- Squamous cell = hypercalcaemia
- Ectopic PTH secretion
Acute asthma signs 3
- Expiration wheeze
- Silent chest=emergency!
- Hypokalaemia
What can progress to lobar collapse? (4)
- Blockage of bronchiole/bronchus=within airway e.g foregin body/mucus plug in asthma
- From wall blockage= tumour
- Compressing from outside .g tumour
- Pneumothorax/pleural effusion
Effusion vs consolidation clinical signs
- Effusion: stony dull vs consolidation dull
- Effusion: vocal resonance is decreased/absent + consolidation: increased VR
Acute LVF heart failure signs (4)
- Tachypnoea
- Cold hands
- Tachycardia
- Crackles/wheeze
Lung cancer (8)
- Hoarse voice
- Blood in sputum
- Progressive SOB
- Anaemia (palpitations/tiredness)
- Night sweats
- Cough
- Chest pain
- Horner’s syndrome: ptosis/myosis/adenlyclosis
Acute COPD exercabation (2)
- Acutely SOB
- Sputum colour change
TB (8)
- Young and travel
- Cough (+/haemptosis)
- Night sweats
- Fever/chills
- SOB
- Fatigue
- Weight loss
- Systemic infections e.g menignitus/pericarditus)
TB vs lung cancer (5)
- Age: young vs old
- Smoking: non vs yes
- Weight loss: slow vs sudden
- Chest pain: not present vs present
- Hoarseness: not present vs present
Drugs with clottiing risks? (2)
- HRT
- Contraceptive pill
Puemonthorax risk factors (9)
- Cystic fibrosis
- Marfan’s syndrome
- Male
- Tall
- Young (20s)
- Smoking
- COPD
- Asthma
- Cystic fibrosis
What sign can be found particularly in patients with lower lobe pneumonia?
Upper abdo tenderness
Heart failure (9)
- Pink frothy sputum
- PND
- Orthopnoea
- Tachycardia
- Lung crackles
- Raised JVP
- S3 gallop
- Displaced apex beat
- Wheeze
- Fluid overload: acites
Asbestosis (5)
- Persistent dry cough
- Wheezing
- Fatigue
- Joint pain (hand and foot)
- Clubbing
How does lesions in the lung predispose to infections?
Obstruction decreases lung clearance of secretions
