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SA respiratory > S11) Signs and Symptoms of Respiratory Disease > Flashcards

S11) Signs and Symptoms of Respiratory Disease Flashcards

1
Q

What are the six cardinal symptoms of respiratory disease?

A
  • Breathlesness (dyspnoea)
  • Cough
  • Chest pain
  • Wheeze/stridor
  • Sputum
  • Haemoptysis
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2
Q

Identify 8 other features in a patient’s history which are relevant to respiratory disease

A
  • Childhood illnesses (whooping cough, wheeze, asthma)
  • Occupation
  • Pets
  • Travel
  • Smoking
  • Medication
  • Allergic disorders
  • Psychosocial history e.g. anxiety
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3
Q

List four occupations which are particularly associated with lung disease

A
  • Construction worker
  • Farmer
  • Coalworker
  • Silicon and asbestos work
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4
Q

Which six questions can one ask a patient presenting with breathlessness?

A
  • Precipitating factors?
  • Timing?
  • Effect of position?
  • Speed of onset?
  • Duration?
  • Exercise tolerance? (assess severity)
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5
Q

Distinguish between the presentations of breathlessness in patients with COPD, heart failure and bronchoconstriction

A
  • Patients with bronchoconstriction: “chest tightness”, “increased effort of breathing”, “air hunger”
  • Patients with COPD: “”I cannot take a full breath”, “increased effort”, “unsatisfying breathing”
  • Patients with heart failure: “air hunger” or “suffocation”
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6
Q

Identify 7 common causes of dyspnoea (symptoms more than a sign)

A
  • Asthma
  • COPD
  • Idiopathic pulmonary fibrosis
  • Myocardial dysfunction
  • Anaemia
  • Obesity
  • Deconditioning
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7
Q

What are the different types on breathlessness in terms of speed of onset?

A
  • Instantaneous
  • Acute (minutes to hours)
  • Gradual (days)
  • Chronic (months to years)
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8
Q

What are the causes of instantaneous breathlessness?

A
  • Pulmonary embolism
  • Pneumothorax
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9
Q

What are the causes of acute breathlessness?

A
  • Asthma
  • Pulmonary embolism
  • Pneumonia
  • LVF/MI
  • Hyperventliation syndrome
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10
Q

What are the causes of gradual breathlessness?

A
  • Lobar collapse e.g. lung cancer
  • Pleural effusion
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11
Q

What are the causes of chronic breathlessness?

A
  • COPD
  • Idiopathic pulmonary fibrosis
  • Bronchiectasis
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12
Q

What is the commonest out-patient symptom?

A

A cough

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13
Q

Which muscles are important for an effective cough?

A
  • Diaphragm
  • Major inspiratory muscles
  • Major expiratory muscles
  • External intercostals
  • Glottis
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14
Q

Describe the physiological mechanism leading to a cough

A

A reflex arc is initated by mechano- and/or chemoreceptors receptors in the:

  • Respiratory epithelium
  • Oesophagus
  • Diaphragm
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15
Q

Why does vocal cord paralysis cause ‘Bovine’ cough?

A
  • A bovine cough is used to describe the non-explosive cough of someone unable to close their glottis
  • This occurs in vagus nerve lesions, associated with dysphonia
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16
Q

Identify 6 respiratory causes of a cough and provide and example for each

A
  • Acute infection e.g. bronchopneumonia
  • Chronic infection e.g. bronchiectasis
  • Nasal/sinus disease e.g. sinusitis
  • Airways disease e.g. asthma
  • Parenchymal disease e.g. lung cancer
  • Pleural disease e.g. pleural effusion
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17
Q

What are the cardiovascular, gastrointestinal and pharmacological causes of a cough?

A
  • CVS: Left ventricular failure
  • GI: Gastro-oesophageal reflux
  • Drugs: ACE inhibitors, inhaled drugs
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18
Q

Identify 5 causes of chest pain

A
  • Cardiac
  • Pericarditis (relieved by leaning forward)
  • Oesophageal pain
  • Chest wall e.g. costochondritis, rib fracture
  • Pleuritic chest pain e.g. pneumothorax, pericarditis
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19
Q

What is a wheeze?

A
  • A wheeze refers to a noisy musical sound produced by turbulent flow through narrow small airways
  • narrowing of intrathoracic airways
  • It is mostly expiratory
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20
Q

Identify two clinical conditions which often present with a wheeze

A
  • Asthma
  • COPD
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21
Q

Describe the common clinical presentation of a wheeze

A
  • Patients often complain of chest tightness
  • Nocturnal wheeze
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22
Q

What is the underlying pathophysiology for a wheeze?

A
  • Bronchial smooth muscle contraction
  • Oedema
  • Mucus production
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23
Q

Why do wheezes occur during expiration?

A

The positive intrapulmonary pressure during expiration will exacerbate any narrowing of intrathoracic airways

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24
Q

What is stridor?

A

Stridor describes a coarse inspiratory wheeze caused by extrathoracic upper airways obstruction e.g. epiglottitis, croup aspirated foreign bodies, extrinsic compression

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25
Q

Describe the underlying pathophysiology of stridor

A
  • The negative pressure in the pleural space during inspiration helps to keep the airways open
  • The negative pressure in the upper airways caused by inspiratory air flow leads to stridor
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26
Q

When is sputum production increased?

A

Increased sputum volume is due to allergy, infection or bronchial irritants

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27
Q

How does infected sputum present?

A

Infected sputum may be green or yellow

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28
Q

Identify some causes of increased sputum production

A
  • Smoking / smoke pollution
  • COPD
  • Acute bronchitis
  • Pneumonia
  • Bronchiectasis
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29
Q

Identify 5 causes of haemoptysis

A
  • Infection (most common) e.g. pneumonia, TB
  • Lung cancer
  • Pulmonary embolism
  • Anti coagulation
  • LVF
30
Q

What does cyanosis indicate?

A

Cyanosis indicates the presence of deoxygenated haemoglobin due to hypoxia

31
Q

What are some causes of central cyanosis (around lips and tongue)?

A
  • Congenital cardiac disease (right to left shunt)
  • Severe heart failure
  • Severe respiratory diseases e.g. COPD, severe pneumonia, acute asthma
32
Q

What are some causes of peripheral cyanosis (feet, hands, ears, nose)?

A
  • All causes of central cyanosis
  • Cold exposure
  • Raynaud’s disease
33
Q

What are the main respiratory causes of clubbing?

A
  • Lung cancer (mesothelioma)
  • Bronchiectasis
  • Cystic fibrosis
  • Empyema
  • Idiopathic pulmonary fibrosis
34
Q

When are the accessory inspiratory muscles used?

A

Accessory inspiratory muscle used if adequate pulmonary ventilation cannot be achieved by normal inspiratory efforts when there is gross overdistension of the lungs:

  • Advanced emphysema
  • Attack of severe asthma
  • Stridor due to laryngeal/ tracheal obstruction
35
Q

When are the accessory expiratory muscles used?

A

Accessory expiratory muscles used the elastic recoil of the lungs is insufficient to empty the alveoli or if there is expiratory airway obstruction:

  • Some patients with emphysema
  • Some cases of chronic bronchitis
  • Asthma
36
Q

How do patients with expiratory obstruction present?

A

Some patients will stand and grasp a table so that they fix the shoulder girdle and use latissimus dorsi to augment the expiratory effort

37
Q

Why does pursed lip breathing present in emphysema?

A
  • Pursed lip breathing is a a breathing technique used to control shortness of breath
  • It allows pressure to be maintained in the alveoli, preventing their collapse and limiting trapped air to improve ventilation
38
Q

Why is there barrel chest in emphysema?

A

Barrel chest occurs due to loss of elastin in the lung allows the chest wall to expand

39
Q

What is the significance of tracheal position in emphysema?

A

Tracheal position is used to detect mediastinal displacement

40
Q

Which conditions cause tracheal deviation away from affected side?

A
  • Tension pneumothorax
  • Large pleural effusion
41
Q

Which conditions cause tracheal deviation towards the affected side?

A
  • Lung/ lobar collapse
  • Pulmonary fibrosis (particularly upper lobe)
42
Q

Describe the underlying pathophysiology of lung/lobar collapse

A
  • Occurs following obstruction of a bronchus
  • Gas is resorbed from the lung parenchyma distal to the obstruction
  • Lung collapses (volume reduction and negative mass effect)
43
Q

Which areas on the chest are expected to be dull on percussion in a normal individual?

A

Due to density of structures:

  • Liver
  • Heart
  • Clavicle
  • Sternum
44
Q

In COPD, why are normal areas of dullness absent?

A

On percussion, there is decreased hepatic and cardiac dullness due to hyperinflation of the lungs as it pushes the liver down and increases air in the cavity (hyperresonance)

45
Q

Which lobes of the lungs are best auscultated over the anterior chest?

A
  • Right upper lobes
  • Right middle lobes
  • Left upper lobes
46
Q

Which lobes of the lungs are best auscultated over the posterior chest?

A
  • Right lower lobes
  • Left lower lobes
47
Q

What are the three different types of breath sounds?

A
  • Vesicular
  • Bronchial
  • Tracheal
48
Q

Describe the location, quality and pitch of tracheal breath sounds

A
  • Location: trachea
  • Quality: loud, harsh, hollow
  • Pitch: higher
49
Q

Describe the location, quality and pitch of bronchial breath sounds

A
  • Location: manubrium
  • Quality: loud, less harsh, hollow
  • Pitch: higher
50
Q

Describe the location, quality and pitch of vesicular breath sounds

A
  • Location: peripheral lung
  • Quality: softer (audible gap between inspiratory & expiratory phase sounds)
  • Pitch: low
51
Q

What is lung consolidation?

A
  • Lung consolidation is 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
52
Q

What is the commonest cause of lung consolidation?

A

Pneumonia

53
Q

What pathological processes may lead to consolidation?

A

Pneumonia – bacterial infection in alveoli produces an inflammatory process and exudate accumulates in alveoli

54
Q

In lung consolidation, what is heard over the lung fields during ausculation?

A

Bronchial breathing

55
Q

Why are bronchial breath sounds heard over an area of pneumonic consolidation?

A
  • If bronchial breath sounds are heard over the chest, it suggests consolidation/fibrosis
  • Sounds of bronchial breathing are generated by turbulent air flow in the large airways, and are usually heard over the trachea/manubrium in healthy patients
56
Q

What are the different types of abnormal breath sounds?

A
  • Discontinuous (non-musical):

I. Crackles

II. Pleural friction rub

  • Continuous (musical):

I. Wheezes

II. Stridors

57
Q

What are the causes of pleural friction rub?

A
  • Pleurisy
  • Pulmonary infarction (due to PE)
58
Q

What are respiratory crackles?

A

Respiratory crackles are abnormal breath sounds due to the snapping open of airways / fluid in airways)

59
Q

What are the two types of respiratory crackles and when are they seen?

A
  • Fine crackles – early and fine in idiopathic pulmonary fibrosis, consolidation and LVF
  • Coarse crackles – early and coarse in COPD, bronchiectasis (may reduce after coughing)
60
Q

What are the four possible sounds heard on percussion?

A
  • Resonant → normal finding
  • Dull → increased tissue density
  • Stony dull → pleural effusion
  • Hyperresonant → decreased tissue density
61
Q

Describe the signs of pleural effusion in terms of:

  • Chest radiograph
  • Mediastinal shift
  • Chest wall movements
  • Percussion
  • Breath sounds
A
62
Q

Describe the signs of pneumothorax in terms of:

  • Chest radiograph
  • Mediastinal shift
  • Chest wall movements
  • Percussion
  • Breath sounds
A
63
Q

Describe the signs of consolidation in terms of:

  • Chest radiograph
  • Mediastinal shift
  • Chest wall movements
  • Percussion
  • Breath sounds
  • Added sounds
A
64
Q

Describe the signs of lobar collapse in terms of:

  • Chest radiograph
  • Mediastinal shift
  • Chest wall movements
  • Percussion
  • Breath sounds
  • Added sounds
A
65
Q

Which structures in the thorax are well-endowed with pain fibres and which are not?

A
  • Well-endowed: parietal pleura
  • Poorly endowed: visceral pleura
66
Q

What is the significance of pain fibres with reference to how patients experience pain in respiratory conditions?

A
  • Pathology involving the parietal pleura is very sharp, well-localised pain which is worse on inspiration and coughing
  • Pathology arising in the lung itself is diffused and poorly-localised pain
67
Q

Why does the trachea shift in tension pneumothorax?

A

Increased pressure of air in the pleural space pushes the trachea away from the lesion

68
Q

In 4 steps, explain why hypotension often presents with tension pneumothorax

A

⇒ Pushed mediastinum obstructs great vessels in lung hilum

⇒ Decreased venous return from the pulmonary artery

⇒ Decreased cardiac output

⇒ Hypotension

69
Q

what are some potential causes for chest pain?

A
  • mediastinal structures: ACS, pericarditis
  • pleura: infection, pneumothorax, pulmonary embolism
  • chest wall: rib fracture, shingles
70
Q

summary table

A

SA respiratory (23 decks)

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