Resp. Misc. 2/ 3/ 4 - Resp. disease signs, symptoms and exams Flashcards
What signs/ symptoms do you check for in the resp. system review/ red flags?
Chest pain Breathlessness (orthopnoea/ PND) Cough (sputum/ haemoptysis) Wheeze/ stridor Horseness Weight loss Night sweats
What are some causes of acute breathlessness? (3)
PE
Pneumothorax
Pulmonary Oedema
What are some causes of subacute breathlessness? (4)
Pneumonia
Pulmonary oedema
Pleural effusion
Asthma/ COPD
What are some causes of chronic breathlessness? (3)
COPD
Pulmonary fibrosis
Chronic PE
How do you test the “cough threshold”?
Lowest concentration of inhaled capsaicin (active component of chilli peppers - irritant) required to produce 5 coughs
What is an acute illness? (3)
It refers to an illness that is of a sudden onset or of a short duration (present for less than 1 month).
Acute can also be used as an adjective to describe a severe state of a condition.
What is the time frame of a subacute illness?
1-3 months
What is the rime frame of a chronic illness?
Greater than 3 months
What is the most common cause of an acute, dry cough?
Viral aetiology
What does sputum contain? (4)
Neutrophils
Eosinophils
Bacteria/ fungus/ virus
Airway secretions
What is classified as a massive haemoptysis?
> 500ml in 24 hours
What are the main 4 causes of haemoptysis?
What are 3 other causes?
Infection Carcinoma PE Bronchiectasis Cardiac AVM (arteriovenous malformation) Anticoagulation
What are some causes of acute breathlessness? (3)
PE
Pneumothorax
Pulmonary Oedema
What 2 drugs can cause mediastinal disease?
Bleomycin (cancer treatment)
Phenytoin (anti-convulsant)
What are some causes of chronic breathlessness? (3)
COPD
Pulmonary fibrosis
Chronic PE
How do you test the “cough threshold”?
Lowest concentration of inhaled capsaicin (active component of chilli peppers - irritant) required to produce 5 coughs
What causes lupus pernio?
Sarcoidosis (not related to lupus!)
What is classified as a non-massive haemoptysis?
less than 500ml in 24 hours
What drugs can cause Interstitial Lung Disease? (6)
Amiodarone (anti-arrhythmic)ACEIBeta blockerBleomycin (cancer treatment)Methotrexate (drug used to treat specific cancers, arthritis and severe psoriasis)Nitrofurantoin (antibiotic for bladder infections)
4 drugs that can cause airway problems?
ACEIBeta blockersContrast mediaPenicillamine (rheumatoid arthritis and wilsons disease)
What 2 drugs can cause mediastinal disease?
Bleomycin (cancer treatment)Phenytoin (anti-convulsant)
What occupations/ hobbies should you particularly ask about in social history? (8)
Asbestos exposureCoal miningFarming Pigeons/ birdsPetsAbroad travelCannabisSmoking
What is oxygen the treatment for?
Hypoxamia (not breathlessness)
What is dull to percuss (not stony dull)?
ConsolidationPleural thickeningRaised semi-diaphragm
What is asterixis?
A tremor of the hands when the wrists are extended e.g. CO2 and liver flap - CO2 flap is less rhythmical than a liver flap (use context)
What causes a CO2 flap?
Hypercapnic encephalopathy (the excess CO2 acts as a poison and the brain can’t function properly)
What is encephalopathy?
Abnormal brains structure or function
What are 2 respiratory causes pf erythema nodosum?
SarcoidosisTB
What causes lupus pernio?
Sarcoidosis (not related to lupus!)
Causes of finger clubbing?
Cyanotic heart diseaseLung disease:AbscessBronchiectasisCFDon’t say COPD!!EmpyemaFibrosisUlcerative colitis + crown’s disease (IBD)Biliary cirrhosisBirth defectInfective endocarditisNeoplasm (lung Ca, mesothelioma)GI malabsorption (coeliac disease)
Signs of cor pulmonale? (4)
CyanosisRaised JVPPitting oedemaParasternal heave
3 types of spinal curvature disorders?
Lordosis (significant inward curve at lower back)Kyphosis (abnormally rounded upper back)Scoliosis (abnormal sideways curvature of the spine)
What is pectus excavatum?
also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall.
What is a thoracoplasty?
a surgical procedure that was originally designed to permanently collapse the cavities of pulmonary tuberculosis by removing the ribs from the chest wall
What causes hyper-resonance on percussion? (2)
EmphysemaPneumothorax
What is stony dull to percuss?
Pleural effusion
What is whispering pectoriloguy?
an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields usually due to consolidation without bronchial obstruction
What is the word used to describe normal breath sounds?
Vesicular
What are the 4 main categories of things that can cause a wheeze?
Intrinsic obstruction in conducting airwaysProblems with the bronchioles e.g. asthma, bronchiolitis, foreign body, CaIntrinsic obstruction in tracheaExtrinsic mediastinal compression of trachea e.g. thyroid goitre, lymphoma, thyoma, cysts
What causes bronchial breath sounds?
Consolidation with patent bronchial system e.g. pneumonia, pulmonary fibrosis
What causes generalised wheezing?
Smaller airway obstruction e.g. asthma
What causes a localised wheeze?
Large airway disease
What causes squeaks and crackles on auscultation?
Bronchiolitis
Are crackles (crepitations) usually on inspiration or expiration?
Inspiration - due to expolosive re-opening of small airways blocked by exudate, inflammation or fibrosis
What cause fine late inspiratory crackles?
Pulmonary fibrosis
What causes moderate/ coarse crackles? (3)
Pulmonary oedemaConsolidationBronchiectasis
What causes a pleural rub? (3)
PneumoniaPulmonary embolusViral or auto-immune pleurisy
What reduces vocal resonance? (5)
EffusionCollapseBronchial occlusionPneumothoraxEmphysema
What increases vocal resonance?
Consoidaiton e.g. pneumonia
What is whispering pectoriloguy?
an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields usually due to consolidation without bronchial obstruction
What are some other causes of dyspnoea apart from respiratory aetiology? (5)
Haematological (anaemia)Abdominal (e.g. obesity, ascites, pregnancy)AltitudeCardiac (e.g. muscle disease, valve disease, electrical diseases, congenital disease)Psychological (functional dyspnoea)
What are the 4 main categories of things that can cause a wheeze?
Intrinsic obstruction in conducting airwaysProblems with the bronchioles e.g. asthma, bronchiolitis, foreign body, CaIntrinsic obstruction in tracheaExtrinsic mediastinal compression of trachea e.g. thyroid goitre, lymphoma, thyoma, cysts
What is the word used to describe non-infective sputum?
Mucoid (clear/ yellow) e.g. COPD
What is the word used to describe infective sputum?
Purulent (green) e.g. pneumonia, bronchiectasis
What does tactile vocal fremitus involve?
Using finger to feel vibration over the chest wall when someone speaks (decreased over areas where there is no lung e.g. pneumothorax and increased over areas of consolidation) - different from vocal resonance but test the same thing
Is pleuritic chest pain worse on inspiration or expiration?
Inspiration
What respiratory problems can cause chest wall pain?
Malignant invasion of soft tissue or ribs
What causes a burning retrosternal pain?
Oesophageal reflux
What is the usual cause of a deep chest pain?
Malignant invasion/ compression
What usually causes a pleuritic pain?
Acute inflammation due to an infection, PE or pneumothorax
What is the cause of respiratory synths with non-specific constitutional symptoms (e.g. weight loss, night sweats, lethargy) until proven otherwise? (3)
CaTbLymphoma
What is the cause of “a daily productive cough with lots of green sputum in a non-smoker with a past history of pneumonia?
Bronchiectesis
What is the cause of “an acute productive cough, pleuritic pain, dyspnoea and fever in any age”?
Community acquired pneumonia
What is the cause of “acute onset of pleuritic pain with dyspnoea in a young adult male”?
Pneumothorax
What is the cause of “haemoptysis, weight loss and night sweats in a young asian adult who has just moved to the UK from India”?
TB
What is the cause of “progressive dyspnoea without cough or wheeze in non smoker with rheumatoid disease”?
Interstitial lung disease e.g. fibrosing alveolitis
What is the cause of:-reduced wall movement unilaterally-no mediastinal shift-increased vocal fremitus-dull percussion note-bronchial breath sounds-presence of crackles
Consolidation
What does tactile vocal fremitus involve?
Using finger to feel vibration over the chest wall when someone speaks (decreased over areas where there is no lung e.g. pneumothorax and increased over areas of consolidation) - different from vocal resonance but test the same thing
What is the cause of:-reduced wall movement unilaterally-mediastinal shift towards lesion-decreased vocal fremitus-dull percussion note-presence of breath sounds-no added sounds
Collapse with proximal obstruction e.g. malignancy
What is the cause of:-reduced wall movement unilaterally-mediastinal shift towards opposite site from lesion-absent vocal fremitus-stony dull percussion note-absent breath sounds with upper bronchial breath sounds-no added sounds
Large pleural effusion
What is the cause of:-reduced wall movement symmetrically-no mediastinal shift-normal vocal fremitus-normal percussion note-normal breath sounds-presence of crackles symmetrically
Diffuse fibrosing alveolitis
What is the cause of:-normal wall movement-no mediastinal shift-normal vocal fremitus-normal percussion note-normal breath sounds (reduced if severe)-wheeze symmetrically
Asthma
What is the cause of:-reduced wall movement unilaterally-mediastinal shift towards opposite side-decreased vocal fremitus-hyper-resonant percussion note-breath sounds reduced unilaterally breath sounds-no added sounds
Large pneumothorax
What is the cause of:-reduced wall movement symmetrically-no mediastinal shift-normal vocal fremitus-hyper-resonant percussion notes symetrically-breath sounds reduced symmetrically-presence of wheeze symmetrically
Emphysema
