Respiratory Signs And Symptom Flashcards
What is a symptom?
What the patient experiences.
What is a sign?
Features of disease that can be observed.
What are the six common respiratory symptoms?
Breathlessness
Cough
Wheeze
Chest pain
Sputum
Haemoptysis
What are important diagnostic questions to refine respiratory history taking?
Peripheral oedema
Voice alteration
Orthopnea
Night sweats
Sneeze
Nasal obstruction
What is orthopnoea?
Shortness of breath when lying down.
What should be explored in breathlessness in patients?
There is a sensation of increased demand for breathing. It is important to establish:
Time period
Their new exercise capacity before SOB
What are sudden causes of shortness of breath within minutes.
Pulmonary oedema where fluid accumulation occurs in the lungs, associated with orthopnoea.
Pneumothorax where gas is present between the lungs and chest wall, associated with pleuritic chest pain.
Anaphylaxis which is associated with urticaria.
Foreign body inhalation with onset occurring during eating.
Why would shortness of breath occur for minutes?
Pulmonary oedema
Pneumonia due to lung infection
Acute asthma attack which is the progressive worsening of asthma symptoms.
Acute hypersensitivity pneumonitis which is inflammation in the lung tissues due to allergic reaction to the inhalation of a substance.
Why would shortness of breath occur for weeks?
Pleural effusion: buildup of fluid between the lungs and chest cavity
Heart failure
Anaemia
Lung cancer
Why would shortness of breath occur over months?
Pulmonary arterial hypertension, typically due to heart failure
Pneumoconiocosis: occupational lung disease from breathing in irritants
Chronic bronchitis
COPD: obstructed airflow due to narrowed airways
Emphysema: damage to alveoli
Interstitial lung disease: scarring of the lung tissue
What are the receptors in the airways?
Rapidly adapting stretch receptors
Slow adapting stretch receptors
Capillary C fibres
What is the pathophysiology of a cough?
Irritation of Mechanoreceptors stimulates the RAS, SAS and C fibres to transmit information down the vagus nerve to the nucleus tractus solitaris in the medulla oblaganta. The NTS also receives input from inflammatory cytokines from mast cells. The NTS sends signals down efferent fibres to induces the action of the contraction of the respiratory muscles to expel air.
What are the phases of a cough?
Inspiratory phase
Compressive phase
Expulsive phase
What are potential causes of a cough?
Lung cancer
Tuberculosis
Bronchitis
Heart failure
ACE inhibitors
Gastrocnemius-oesophageal reflux
Why do ACE inhibitors cause coughing?
ACE inhibitor drugs allow increased levels of the pro-inflammatory mediators bradykinin and substance P which stimulate the nucleus tractus solitaris to induce cough.
Which features of sputum should be assessed?
Colour
Volume
Taste
What is purulent sputum?
Darker sputum which may be off-white, green or yellow due to the presence of WBC.
What is the cause of haemoptysis?
Bronchitis
Nosebleed which entered the respiratory tract
Lung cancer
COPD
Tuberculosis
Pulmonary oedema
Blood clot from pulmonary emoblism
What does a large volume of sputum indicate?
Bronchieactasis, where the bronchi widen and thicken due to chronic inflammation from infection. Results in foul-smelling and large volumes of sputum.
Bronchorrhoea associated with lung cancer.
What does foul taste of sputum indicate?
Lung absecess
Bronchiectasis
What is the cause of pink frothy sputum?
Pulmonary oedema
What is the cause of rusty-like sputum?
Pneumonia
What should be assessed in haemoptysis?
Volume of blood
Frequency of coughing up blood
What is wheeze?
High pitched noise generated during expiration due to obstruction of airways. This is common in conditions such as asthma and COPD.
What is stridor?
High pitched noise generated during inspiration due to obstruction of airways.
This occurs in whooping cough, epiglottitis, laryngeal tumour and laryngeal oedema.
How should chest pain be assessed?
Site of pain.
What does pleural pain indicate?
Pleuritic pain is sharp chest pain when breathing in due to inflammation of pleura.
What does the site of retrosternal pain indicate?
Pain located generally behind the sternum.
-> If it is constant and gets worse, even without exertion, indicates mediastinal tumour.
-> Upper retrosternal pain indicates inflammation of the trachea/tracheitis
-> GI reflux when accompanied with burning sensation
What does bony pain indicate in the chest?
Rib metastasis
Costachondritis
What does spinal root pain indicate?
Radiculopathy, where there is injury to the spinal nerve root as it leaves the spine, causing pain anywhere in the body, like the chest.
How can we assess a patient with respiratory symptoms?
Inspection
Percussion
Palpation
Auscultation
What do we assess in inspection?
Peripheral cyanosis
Finger clubbing
Oedema
Use of accessory muscles, indicating respiratory distress
Muscle wasting
Respiratory rate
Dilated veins
What does clubbing indicate?
Hypoxaemia
Malabsorption from digestive issue
What is pectus carinatum?
Chest wall protrudes out and anteriorly AKA pigeon chest.
What is pectus excavatum?
Ribs and sternum grow inwards and create a dent in the chest AKA funnel chest.
What signs do you look for in palpation?
Reduced expansion
Position of the trachea
Mediastinal shift which occurs due to:
->pleural effusion
->Pulled towards region of lung collapse or fibrosis
What do you assess in palpation?
Cricosternal distance between the cricoid cartilage and the suprasternal notch. This should be 3-4cm and is reduced in hyperinflation.
What condition is caused by hyperinflation?
COPD
Chronic asthma
What are the signs of hyperinflation?
Barrel chest
Loss of liver and cardiac dullness
What are the signs of percussion that should be assessed?
Compare the two sides which should both be resonant.
F
What is the cause of stony dullness?
Pleural effusion due to greater fluid in pleural space reducing air resonance for percussion.
What is the cause of hyper-resonance?
Pneumothorax
-> Collapse of the lung which causes air to fill between the lungs and chest wall that limits expansion, increasing air causing louder percussion.
What signs should be assessed in auscultation?
Vesicular breath sounds that are soft and low-pitched.
Vocal fremitus
Whispering
What causes diminished vesicular sounds?
Pneumothorax
Pleural effusion
What can result in absent breathing sounds?
Pneumothorax
Lung collapse
Effusion
What causes low-pitched and ‘sticky’ bronchial breathing on auscultation?
Consolidation of the lungs, where the air-filled spaces are filled with inflammatory exudate in the alveoli. This occurs due to atelactasis, infection, lung cancer and pulmonary haemorrhage.
What is amphoric breathing?
Breath sounds over a cavity
What causes crackles when breathing?
Typically occurs on inspiration
-> if they clear when coughing,it is due to larger airway secretions
What causes coarse crackles?
Pneumonia
Bronchieactasis
What are the features found in consolidation?
Air filled spaces of the lungs become filled with material like fluid or pus.
There is dull percussion due to loss of air, increased vocal resonance and air sounds are bronchial breathing which is loud and harsh.
What features are found in pleural effusion?
On an X-Ray:
There is blunting of the costophrenic angle of the diaphragm
Mediastinal shift to contralateral side
Grey colour of lungs due to fluid
Fluid collection around the diaphragm due to action of gravity.
Examination will show dull, stony percussion and reduced chest expansion, vocal resonance and breath sounds.
What features are found in airway obstruction?
Chest expansion is symmetrical with wheezing. Otherwise, there is normal breath sounds and percussion.
What features are found in pneumothorax?
Pneumothorax is when air enters the pleural space and causes lung collapse. Features on X ray shows:
Mediastinal shift to contralateral side
Completely black lung with no sight of vascularisation and dullness of heart border
Examination will show hyper-resonance, reduced breath sounds and reduced chest expansion.
What features are found in lung collapse?
Atelactasis is collapse of the lung due to compression or airway obstruction. X ray will show:
Mediastinal shift TOWARDS the side of the opacity, where the lung will be grey in colour and not its normal black
Phrenic angle will be higher
Silhouette of the heart will be hazy
