Resp. Misc. 2/ 3/ 4 - Resp. disease signs, symptoms and exams Flashcards by Sam Donnelly

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

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What are some causes of acute breathlessness? (3)

PE
Pneumothorax
Pulmonary Oedema

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What are some causes of subacute breathlessness? (4)

Pneumonia
Pulmonary oedema
Pleural effusion
Asthma/ COPD

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What are some causes of chronic breathlessness? (3)

COPD
Pulmonary fibrosis
Chronic PE

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How do you test the “cough threshold”?

Lowest concentration of inhaled capsaicin (active component of chilli peppers - irritant) required to produce 5 coughs

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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.

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What is the time frame of a subacute illness?

1-3 months

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What is the rime frame of a chronic illness?

Greater than 3 months

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What is the most common cause of an acute, dry cough?

Viral aetiology

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What does sputum contain? (4)

Neutrophils
Eosinophils
Bacteria/ fungus/ virus
Airway secretions

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What is classified as a massive haemoptysis?

> 500ml in 24 hours

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What are the main 4 causes of haemoptysis?

What are 3 other causes?

Infection
Carcinoma
PE
Bronchiectasis
Cardiac
AVM (arteriovenous malformation)
Anticoagulation

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What are some causes of acute breathlessness? (3)

PE
Pneumothorax
Pulmonary Oedema

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What 2 drugs can cause mediastinal disease?

Bleomycin (cancer treatment)

Phenytoin (anti-convulsant)

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What are some causes of chronic breathlessness? (3)

COPD
Pulmonary fibrosis
Chronic PE

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How do you test the “cough threshold”?

Lowest concentration of inhaled capsaicin (active component of chilli peppers - irritant) required to produce 5 coughs

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What causes lupus pernio?

Sarcoidosis (not related to lupus!)

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What is classified as a non-massive haemoptysis?

less than 500ml in 24 hours

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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)

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4 drugs that can cause airway problems?

ACEIBeta blockersContrast mediaPenicillamine (rheumatoid arthritis and wilsons disease)

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What 2 drugs can cause mediastinal disease?

Bleomycin (cancer treatment)Phenytoin (anti-convulsant)

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What occupations/ hobbies should you particularly ask about in social history? (8)

Asbestos exposureCoal miningFarming Pigeons/ birdsPetsAbroad travelCannabisSmoking

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What is oxygen the treatment for?

Hypoxamia (not breathlessness)

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What is dull to percuss (not stony dull)?

ConsolidationPleural thickeningRaised semi-diaphragm

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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?

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"?

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?

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