Respiratory Flashcards
Cardinal respiratory symptoms?
Cough Sputum Haemoptysis Breathlessness Wheeze Chest pain
Cough - explode
- Sound of the cough (harsh, barking, quiet)
- Timing (nocturnal/daytime/morning/evening/weekend sparing)
- Circumstances (after swallowing, in particular places)
Causes of cough (adult)?
Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD
Important to exclude: Tumour, LRTI, IFB/aspiration
Other causes:
Sinuses - Infection
Larynx-trachea-bronchi - Irritant dusts
Small airways - Post-viral reactivity, COPD, Bronchiectasis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts
Interstitium - ILD, sarcoidosis
Causes of cough (adult)?
Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD
Important to exclude: Tumour, LRTI, IFB/aspiration
Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli
Sinuses - Infection
Larynx-trachea-bronchi - Irritant dusts
Small airways - Post-viral reactivity, COPD, Bronchiectasis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts
Causes of cough (adult)?
Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD
Important to exclude: Tumour, infection, IFB/aspiration
Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli
Sinuses - Infection
Larynx-trachea-bronchi - GOR, Irritant dusts
Small airways - Asthma, post-viral reactivity, COPD, Bronchiectasis, Bronchiolitis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts
Describe the different types of sputum and associated conditions
Serous/mucoid/purulent/rusty/black
Serous:
- Clear/watery/frothy/pink: Acute pulmonary oedema, alveolar cell cancer
Mucoid:
- Clear/grey: COPD
- White/viscid: Asthma
Purulent:
- Yellow/green: Bronchopulmonary infection (any cause)
- Green: Disease with associated white cell infiltrates (eg. asthma)
Rusty:
- Rusty/golden: Early pneumococcal pneumonia
Black:
- Rupture of necrotic areas of pulmonary fibrosis in pneumoconiosis
Causes of cough (adult)?
Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD
Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli
Sinuses - Infection
Larynx-trachea-bronchi - Infection, tumour (benign/malignant/1ry/2ry), aspiration, GOR, FB, Irritant dusts
Small airways - Asthma, post-viral reactivity, COPD, Bronchiectasis, Bronchiolitis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Infection (pneumonia, TB), Alveolitis, LVF, Irritant dusts
Sputum - explode
- Normal/new (change?)
- Amount (teaspoons/day)
- Chronicity/Timing (how long for/regular/one-off)
- Colour (clear/green/yellow/rusty/black)
- Foul taste/smell
- Solid material (bronchial casts/necrotic tumour/IFB)
Describe the different types of sputum and associated conditions
Serous/mucoid/purulent/rusty/black
Serous:
- Clear/watery/frothy/pink: Acute pulmonary oedema, alveolar cell cancer
Mucoid:
- Clear/grey: COPD
- White/viscid: Asthma
Purulent:
- Yellow/green: Bronchopulmonary infection (any cause)
- Green: Disease with associated white cell infiltrates (eg. asthma)
Rusty:
- Rusty/golden: Early pneumococcal pneumonia
Black:
- Rupture of necrotic areas of pulmonary fibrosis in pneumoconiosis
Haemoptysis - explode
- Clarify origin (lung/UGI/nasopharyngeal)
- Amount (quantify)
- Appearance (pure blood/streaking/clots)
- Frequency/duration
Causes of haemoptysis?
Commonest cause: Infection (TB, bronchiectasis, abscess, pneumonia)
Important to exclude tumour (Ca Lung, mets, bronchial carcinoid)
Other causes:
(Rare)infection/Vascular/Vasculitis/Trauma/Cardiac/Haematological
Infection: Mycetoma, CF
Vascular: PE, AV malformation
Vasculitis: Wegener’s, Goodpasture’s
Trauma: IFB, penetrating chest trauma, iatrogenic (eg. biopsy)
Cardiac: Mitral valve disease, Acute LVF
Haematological: Blood dyscrasias, anticoagulation
Chest pain - explode
- Site (central/non-central)
- Onset (when?/sudden/gradual/activity at time)
- Time course (evolution/pattern/wake at night)
- Character (dull/sharp/gnawing)
- Severity
- Radiation (neck/jaw/shoulder/arm/back/abdomen)
- Exacerbating/relieving factors (position/respiration/movement)
- Associated Sx (resp+cardio Sx review/N&V/sweating/anxiety/fever)
Causes of chest pain?
Common causes (age dependent) include: Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis), oesophageal (GORD, hiatus hernia), anxiety
Important to exclude: Pneumothorax, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis
Other causes include:
Central
Causes of chest pain?
Common causes (age dependent) include: Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety
Important to exclude: Pneumothorax, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis
Other causes include:
Central - Tumour, lymphadenopathy
Pleural - Infection, tumour, connective tissue disease
Chest wall - Tumour, Coxsackie B infection, shingles
Causes of central chest pain?
Cadiac/oesophageal/tracheal/aortic/mediastinal
Common causes (age dependent) include: ACS/angina, oesophagitis, anxiety
Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour
Other causes include:
Oesophageal
Causes of chest pain?
Common causes (age dependent) include: Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety
Important to exclude: Pneumothorax, tumour, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis
Other causes include:
Central - Lymphadenopathy
Pleural - Suppurative lung disease, TB, CTD
Chest wall - Tumour, Coxsackie B infection, shingles
Causes of central chest pain?
Cadiac/oesophageal/tracheal/aortic/mediastinal/psychological
Common causes (age dependent) include: ACS/angina, oesophagitis, anxiety
Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour
Other causes include:
Tracheal infection, irritant inhalation, lymphadenopathy
Causes of pleuritic chest pain?
Infection/malignancy/pneumothorax/PE/CTD
Common causes (age dependent) include: PE/pneumonia, malignancy
Causes of central chest pain?
Common causes (age dependent) include: ACS/angina, oesophagitis, anxiety
Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour
Other causes include:
Tracheal - infection, irritant inhalation
Mediastinal - lymphadenopathy
Causes of pleuritic chest pain?
Common causes (age dependent) include: Musculoskeletal (from chest wall), LRTI, PE, pneumothorax
Important to exclude: Pneumonia/abscess, malignancy
Other causes include:
Other infective causes - Bronchiectasis, TB
Connective tissue disease - RhA, SLE
Causes of chest wall pain?
Common causes include:
Costochondritis, rib pain, muscle sprain/tear
Causes of chest pain?
Common causes (age dependent) include: Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety
Important to exclude: Pneumothorax, tumour, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis
Other causes include:
Central - Lymphadenopathy
Pleural - Suppurative lung disease, TB, CTD
Chest wall - Coxsackie B infection, shingles
Causes of chest wall pain?
Common causes include:
Costochondritis, rib pain/#, muscle sprain/tear, fibromyalgia, RhA
Important to exclude: Malignancy
Other causes include:
Infection - Coxsackie B virus, herpes zoster
Autoimmune - Ank Spond, SLE, PsA
Intercostal nerve compression
Causes of chest wall pain?
Common causes include:
Costochondritis, rib pain/#, muscle sprain/tear, fibromyalgia, RhA
Important to exclude: Malignancy
Other causes include:
Infection - Coxsackie B virus, herpes zoster
Autoimmune - Ank Spond, SLE, PsA
Intercostal nerve compression
Breathlessness - explode
- Onset (rapid/gradual/activity at time)
- Time course (duration/progression)
- Variation (nocturnal/morning/week(end)/location)
- Exacerbating/relieving factors (position/activity/exercise/animals/perfumes/smoke/drugs)
- Severity (exercise tolerance/effect on ADLs/hobbies)
- Associated Sx (resp/cardio Sx review, dizziness, light-headedness, anxiety, tingling, syncope)
Causes of breathlessness?
Acute causes:
Respiratory - AECOPD, asthma, pneumonia, pneumothorax, PE, IFB, anaphylaxis, epiglottitis
Cardiac - Severe pulmonary oedema, MI, arrhythmia, pericarditis, pericardial effusion
Other - Pain, DKA, drugs (eg. aspirin OD), airway trauma, panic, hyperventilation, thyrotoxicosis, altitude sickness
Chronic causes:
Respiratory - Asthma, COPD, pulmonary fibrosis, pleural effusion, Ca lung, bronchiectasis, sarcoidosis
Cardiac - LVF, mitral/aortic valvulopathy, arrhythmia, pericarditis
Other - Obesity, anaemia, anxiety, neuromuscular (Guillain-Barré, MG), thyroid disease
