Resp22 - Signs & Symptoms of Respiratory Disease

Question 1

6 cardinal signs and symptoms of respiratory disease

Answer 1

1. ) Dyspnoea (SOB) - symptom rather than sign because SOB is subjective
   - history: onset, duration, progression, precipitating factors, severity
   - differential causes: anaemia, HF, obesity, DKA
2. ) Pleuritic Chest Pain - non-central, sharp, well localised, worse w/ inspiration or coughing
   - may involve shoulder tip (phrenic nerve dermatome)
   - differential causes of chest pain: see CVS notes
3. ) Cough - triggered by any source of irritation
   - non-respiratory causes: LV HF, GORD, drugs (ACEi)

4.) Haemoptysis - red flag for cancer but may also be TB

5. ) Sputum in Cough - character tells you cause
   - clear sputum: no active infection (bronchitis/COPD)
   - yellow/green: active infection (dead neutrophils)
   - large volumes of Y/G sputum suggests bronchiectasis
   - pink, frothy: LV heart failure
6. ) Abnormal Breath Sounds - indicates narrowing within the airway causing turbulent air flow
   - wheeze: high-pitched, musical noise on expiration suggests intrathoracic airways (oedema, mucous etc.)
   - stridor: high-pitched, loud, constant noise on inspiration suggests extrathoracic (larynx or trachea)

Question 2

Signs in a clinical examination

Inspection x6
Palpation x2
Percussion x3
Ausculation x3
Added Sounds on Auscultation x4

Answer 2

1. ) Inspection
   - breathing: raised RR, pursed lip, accessory muscles
   - other: cyanosis, nail clubbing, barrel-shaped chest

2.) Palpation - tracheal position (mediastinal shift), chest expansion (symmetrical?)

3. ) Percussion - normal is resonant
   - hyper-resonant = increased air: pneumothorax
   - dull = fluid: consolidation
   - stony dull = fluid: pleural effusion
4. ) Auscultation - normal is vesicular (like rustling leaves), heard in inspiration and first part of expiration, no gap between inspiration and expiration
   - bronchial: blowing harsh sound, and a gap between inspiration and expiration, breath sounds come from the large airways more readily
   - reduced or absent: breath sounds not transmitted to chest wall
5. ) Added Sounds on Auscultation - wheeze or stridor
   - crackles: snapping open of small airways, fine crackles = pulmonary fibrosis, course = COPD or bronchiectasis
   - pleural rub: scratching, coarse sound suggesting inflammation of pleura (pleurisy)

Question 3

5 main signs in a clinical examination

Tracheal Deviation
Chest Wall Movement
Percussion Note
Breath Sounds/Auscultation
Added Breath Sounds

Answer 3

1. ) Tracheal Deviation - only occurs in a tension pneumothorax or a very large pleural effusion
2. ) Chest Wall Movement - always reduced on affected side apart from asthma where it’s reduced symmetrically
3. ) Percussion Note - normal is resonant
   - hyper-resonant = pneumothorax, dull = consolidation
   - stony dull = pleural effusion
4. ) Breath Sounds/Auscultation - normal is vesicular
   - asthma: can be normal or reduced
   - consolidation: bronchial
   - pleural effusion: absent over the fluid
   - pneumothorax: absent
5. ) Added Breath Sounds
   - pleural effusion: pleural rub (not always)
   - consolidation: crackles
   - asthma or COPD: wheeze