Resp: Signs of Lung Disease Flashcards
What are the 6 cardinal signs of respiratory disease?
- Breathlessness (dyspnoea)
- Cough
- Chest pain
- Wheeze/stridor
- Sputum
- Haemoptysis
What are the causes of dyspnoea?
- Asthma
- COPD
- Idiopathic pulmonary fibrosis
- Myocardial dysfunction
- Anaemia
- Obesity
- Deconditioning
What are possible causes of instantaneous breathlessness?
- Pulmonary embolism
- Pneumothorax (tension)
What are possible causes of acute breathlessness?
- Asthma
- Pulmonary embolism
- Pneumonia
- LVF/MI
- Hyperventilation syndrome
What are causes of gradual breathlessness?
- Lobar collapse (e.g. lung cancer)
- Pleural effusion
What are causes of chronic breathlessness?
- COPD
- Idiopathic pulmonary fibrosis
- Bronchiectasis
What are causes of chest pain?
- Cardiac
- Pericarditis (relieved by sitting forward)
- Oesophageal pain – reflux which is a burning pain. Nut cracker oesophagus (oesophagus goes into spasm)
- Chest wall (costochondritis, rib fracture, spinal osteoarthritis, Herpes zoster)
- Pleuritic chest pain (viral, bacterial, pulmonary embolism, pneumothorax, pericarditis)
What is cough?
A reflex arc initiated by mechano- and/or chemoreceptors receptors in the:
- Respiratory epithelium
- Oesophagus (reflux oesophagitis leads to chronic cough. Fluid comes up to the mouth and into the trachea)
- Diaphragm
What are causes of cough?
- Respiratory (Acute infection, Chronic infection, Nasal/sinus disease, Airways disease, Parenchymal disease, Irritant, Pleural disease)
- Cardiovascular (LVF due to orthopnoea)
- Gastrointestinal (Gastro-oesophageal reflux)
- Drugs (ACE inhibitor, Inhaled drugs)
What are causes of stridor?
- Epiglottitis
- Croup
- Diptheria
- Aspirated foreign bodies
- Extrinsic compression e.g. large goitre
What is stridor?
Stridor describes a coarse inspiratory wheeze.
What are cause of increased sputum production?
- Smoking/smoke pollution
- COPD
- Acute viral or bacterial bronchitis
- Pneumonia
- Bronchiectasis (maybe foul-smelling sputum) – anaerobic infection
- Lung abscess
- Acute asthma
- Lung cancer
- LVF (pink-tinged frothy sputum)
How does asthma causes a wheeze?
Positive intrapulmonary pressure during expiration will exacerbate any narrowing of intrathoracic airways.
What is a wheeze?
Wheeze refers to a noisy musical sound produced by turbulent flow through narrow small airways. It is mostly expiratory.
Underlying pathophysiology is bronchial smooth muscle contraction, oedema and mucus production
What are the causes of wheeze?
- Asthma
- COPD
- Bronchiolitis
- Sometimes seen in LVF – fluid in the airway causes wheezing
Why is a silent chest concerning in asthma attacks?
Absent wheeze during a severe asthma attack (‘silent chest’) is a medical emergency
What are the conditions assoiciated with a nocturnal wheeze?
- Asthma (PNS is more active at rest so constriction of the airways)
- LVF (so-called ‘cardiac asthma’. Fluid in lung. Legs are up so more strain on heart)
What are causes of central cyanosis?
- Congenital cardiac disease with right to left shunt and severe heart failure.
- Severe respiratory diseases including COPD
- Severe pneumonia
- Severe bronchospasm (including acute asthma
Where can central cyanosis be seen?
- Lips
- Tongue
What are the causes of peripheral cyanosis?
- Cold exposure
- Raynaud’s disease.
Present if central is present.
What are respiratory causes of clubbing?
- Lung cancer
- Mesothelioma
- Bronchiectasis, including cystic fibrosis
- Empyema
- Idiopathic pulmonary fibrosis
When are accessory muscle of inspiration used?
- Advanced emphysema – need the accessory to take in breath with already inflated lungs
- Attack of severe asthma
- Stridor due to laryngeal or tracheal obstruction
When are accessory muscle of expiration used?
- Some patients with emphysema
- Some cases of chronic bronchitis
- Asthma
Which muscle can be used to augment expiratory effort?
Some patients with expiratory obstruction will stand and grasp a table so that they fix the shoulder girdle and use latissimus dorsi to augment the expiratory effort
What is the purpose of pursed lip breathing?
- La Places law
- Trouble breathing in with COPD
- Stop the alveoli getting too small to prevent difficulty in taking the next breath
What is barrel chest?
- Fight between the ribs and lungs. The ribs want to expand but the elastic recoil of the chest prevent it from expanding normally.
- Loss of elastin in lungs so therefore less elastic recoil
Where are the upper and lower lobes percussed?
Upper lobes are mainly percussed in the front
Lower lobes are mainly percussed in the back
When does tracheal deviation away from affected side occur?
- Tension pneumothorax – pressure in the pleural cavity shifts the mediastinum
- Large pleural effusion
When does tracheal deviation towards the affected side occur?
- Lung or lobar collapse (Common and occurs following obstruction of bronchus. Gas is resorbed from lung parenchyma distal to the obstruction resulting in collapse of the lung, with volume reduction and negative mass effect)
- Pulmonary fibrosis, particularly upper lobe (fibrosis pulls the lobe)
What is lung consolidation?
This means a solidification of lung tissue due to the filling of the lungs with liquid and solid material. These liquids replace the air normally
present in alveoli. By far the commonest cause is pneumonia
What is the effect of punctures to the lung?
- Pneumothorax (air in pleural cavity)
- Haemothorax (blood in pleural cavity)
Why is the right lung more likely to be the location of foreign bodies?
The right bronchus has a wider shaped and is more vertically aligned when compared to the left bronchus
What are the features of vesicular breath sounds?
Long inspiratory phase Short expiratory phase Softer sounds Low pitch Continuous
What are the features of bronchial breath sounds?
- Shorter inspiratory
- Longer expiratory phase
- Gap between the expiratory and inspiratory phase
- Higher pitch
- Loud, less harsh and hollow
What is the classic finding in breath sounds during consolidation?
-Bronchial breath sounds heard over lung fields where it is normal to hear vesicular breath sounds.
Why are bronchial breath heard over lung fields in consolidation?
Bronchial breath sounds heard over the lung field is due to due to more solid material so conduction is better
Does a pneumothorax always result in a mediastinal shift?
No.
Tension pneumothorax causes a mediastinal shift
When are crackles heard?
Fine crackles
- Idiopathic pulmonary fibrosis
- Consolidation
- LVF
Coarse crackles
- Early and coarse in COPD
- Bronchiectasis. Due to viscid secretions and may reduce after coughing
When is a pleural friction rub heard?
- Pleurisy
- Pulmonary infarction due to PE
What occurs in pleural effusion?
Fluid collects in costo-diaphragmatic space In the upright position
