Respiratory Systems 9 - Sensory Aspects of Respiratory Symptoms

Question 1

Define symptoms

Answer 1

An abnormal or worrying sensation that leads the person to seek medical attnetion

Question 2

Define physical sign

Answer 2

An observable feature on physical examination

Question 3

Describe the pathway of conscious sensation

Answer 3

• Sensory stimulus causes excitation of a sensory nerve, which results in a sensory impression
• Perception and evoked sensation follow

Question 4

List the causes of coughs

Answer 4

• Acute infections and airway diseases (eg. COPD/Asthma)
• Cronic infections (TB)
• Parenchymal diseases (fibrosis)
• Tumours
• Cardiovascular diseases
• Gastroesophageal reflux disease

Question 5

Describe the location of cough receptors

Answer 5

• Most numerous on the posterior wall of the trachea
• At the main carina, and branching points of large airways
• Absent beyond the respiratory bronchioles
• In the pharynx

Question 6

Describe the function of cough receptors

Answer 6

• Rapidly adapting irritant receptors located within the airway epithelium
• Respond to chemical and mechanical stimuli

Question 7

List the sensory receptors in the lung and airways

Answer 7

• C-fibre receptors
• Rapidly adapting stretch receptors
• Slowly adapting stretch receptors

Question 8

List the functions of C-fibre receptors in the airways

Answer 8

• Free nerve endings
• Larynx, trachea, bronchi and lungs
• Respond to chemical irritant stimuli, inflammatory mediators
• Release neuropeptide inflammatory mediators

Question 9

What are rapidly adapting stretch receptors in the lung? Location, structure and stimuli.

Answer 9

• Naso-pharynx, larynx, trachea, bronchi
• Small, myelinated nerve fibres
• Respond to mechanical and chemical irritant stimuli

Question 10

What are slowly adapting stretch receptors in the lung and airways? Location, structure, and stimuli

Answer 10

• Located in the smooth muscle, predominantly in the trachea and main bronchi
• Myelinated nerve fibres
• Mechanoreceptors, so respond to lung inflation

Question 11

List the afferent nerve pathways for cough

Answer 11

• Mainly the vagus nerve
• Also superior laryngeal nerve
• Goes to the cough centre in the medulla which sends signals to the cerebral cortex

Question 12

Describe the causes and duration of an acute cough

Answer 12

• Lasts less than 3 weeks

- Caused by a common cold

Question 13

Describe the causes and duration of a chronic persistent cough

Answer 13

> 3 weeks

• Asthma/eosinophilic associated
• Gastro-oesophageal reflux
• Chronic brochitis
• ACE inhibitors
• Post viral/idiopathic

Question 14

Describe cough hypersensitivity syndrome

Answer 14

• Irritation in the throatm or upper chest
• Difficult to control
• Triggered by deep breaths, laughing, talking, vigorous exercise, smells, cigarette smoke, cold air

Question 15

How does plasticity of neural mechanisms relate to cough?

Answer 15

• Excitability of nerves increases
• Increase in receptor numbers
• Neurotransmitter increase

Question 16

List the muscles involved in the cough reflex

Answer 16

• Diaphragm
• Intercostal muscles
• Laryngeal muscles
• Abdominal muscles

Question 17

List the treatments for cough

Answer 17

• Opiates such as codiene/morphine suppress symptoms
• Disease-specific therapies include inhaled corticosteroids if eosinophil associated, and propton pump inhibitors for gastro-oesophageal reflux disease

Question 18

List treatments for cough hypersensitivity syndrome

Answer 18

• Amitryptiline
• Gabapentin
• Opiates

Question 19

List the locations of sensory input from the lungs for chest pain.

Answer 19

• Trigeminal nerve in the nose
• Glossopharyngeal nerve and vagus nerve supply the pharynx
• Larynx and lung supplied by the vagus nerve
• Chest wall supplied by spinal nerves

Question 20

Describe the pathway taken in chest pain

Answer 20

• A delta/C-fibres via dorsal horn

- Passesthrough the spino-thalamic tract to the thalamus and then to primary somatosensory cortex

Question 21

List the different types of pain

Answer 21

• Visceral pain from organs, it is hard to localise

- Somatic pain is from skin

Question 22

List causes of chest pain relating to the respiratory system

Answer 22

• Pleuropulmonary disorders (infection, pneumothorax, embolism)
• Trachobronchitis
• Inflammation/trauma to the chest wall
• Reffered pain - shoulder pain due to diaphragmatic irritation

Question 23

List the non-respiratory causes of chest pain

Answer 23

• Cardiovascular disorders (MI, pericarditis, aneurysm)
• Gastrointestinal disorders (gastroesophageal reflux)
• Psychiatric disorders (panic disorder/self-inflicted)

Question 24

What is nociception?

Answer 24

The response of the sensory nervous system to pain, including chemical, mechanical or thermal stimulation

Question 25

How is dyspnea assessed clinically?

Answer 25

• From 0 to 4, 4 being very severe, too breathless to leave the house (clinical dyspnea scale)
• 1-10 (intensity of sensation, Borg scale)
• Descriptor clusters (air hunger cluster, tightness cluster, work/effort cluster)
• Exercise testing
• Quality of life related

Question 26

List the disorders presenting with dyspnea

Answer 26

• Impaired pulmonary function (COPD, asthma, stenosis, fibrosis, neuromuscular weakness)
• Impaired cardiovascular function (heart failure, valvular disease, pericardial disease)
• Altered central ventilatory drive (systemic or metabolic disease, anaemia, acidosis)

Question 27

List the treatments for dyspnea

Answer 27

• Treat the cause
• Bronchodilators
• Morphine/diazepam
• Lung resection
• Pulmonary rehabilitation (improvement of fitness)