Session 11 Flashcards
- 6 cardinal signs of respiratory disease?
- Other relevant history
- • Breathlesness (dyspnoea)
- Cough
- Chest pain
- Wheeze/stridor
- Sputum
- Haemoptysis
WASH your BCC
- • Childhood illnesses (whooping cough, wheeze, asthma) • Occupation
• Pets
• Travel
• Smoking
• Medication
• Allergic disorders
• Nasal symptoms
• Psychosocial history
Breathlesness
- Ask about?
- State the type of phrases you might hear associated with breathlessness and which pathology
- Causes
- Breathlessness and speed of onset
Instantaneous: e.g.
Acute (minutes to hours): e.g.
Gradual (days) e.g.
Chronic (months to years) e.g.
- – Precipitating factors
– Timing
– Effectofposition
– Speedofonset
– Duration
– exercise tolerance (severity)
2. bronchoconstriction - “chest tightness”, “increased effort of breathing and “’air hunger”
COPD “”I cannot take a full breath”, “increased effort”, “unsatisfying breathing”
Heart failure “air hunger” or “suffocation”
- • Asthma
- COPD (reduced gas exchange same ventilation)
- Idiopathic pulmonary fibrosis
- Myocardial dysfunction
- Anemia
- Obesity (diaphragm moves up, cant contract as much as intra ab higher)
- Deconditioning
- Chronic (months to years):
– COPD
– Idiopathic pulmonary fibrosis
– Bronchiectasis
- Cough (commonest out-patient symptom)
A reflex arc initated by mechano- and/or chemoreceptors receptors in the:
- Common cause of cough
- – Respiratory epithelium
– Oesophagus
– Diaphragm
Inspire glottis closes
abdominal, intercostal contract when glottis closed
intra thoracic pressure high
glottis suddenly opens (abducts)
2.
Causes of chest pain
- Cardiac
- Pericarditis (relieved by sitting forward)
- Oesophageal pain
• Chest wall
– Costochondritis
– Ribfracture
– Spinalosteoarthritis – HerpesZoster
• Pleuritic chest pain
– Viral/bacterialpleurisy
– Pulmonaryembolism/infarction – Pneumothorax
– Pericarditis
- Why do you get wheeze?
- When do you get wheeze?
- what causes wheeze?
- Common complaint?
- Pathophysiology?
- If you have a nocturnal wheeze think of?
- You should get wheeze in asthma what is the meaning if you don’t?
- turbulent flow through narrow small airways
- mostly expiratory
- – Asthma
– COPD
– Bronchiolitis
– Sometimes in LVF
The positive intrapulmonary pressure during expiration will exacerbate any narrowing of intrathoracic airways
- chest tightness
- bronchial smooth muscle contraction, oedema and mucus production
- asthma or LVF (so-called ‘cardiac asthma’) (parasympathetic -> further constriction,
- Paradoxically, absent wheeze during a severe asthma attack (‘silent chest’) is a medical emergency
- When do you hear for stridor?
- Caused by?
- Pathophysiology of stridor
- Coarse inspiratory wheeze
- Extrathoracic upper airways obstruction
– Epiglottitis
– Croup
– Diptheria
– Aspirated foreign bodies
– Extrinsic compression e.g. large goitre
3.
Sputum
- Normal sputum production is ? Most of this is swallowed
- Increased volume is due to allergy, infection or bronchial irritants. How do you differentiate?
- Causes of increased sputum include:
- 100ml/day
- Infected sputum may be green or yellow.
- – Smoking/smoke pollution
– COPD
– Acute viral or bacterial bronchitis
– Pneumonia
– Bronchiectasis(maybefoulsmellingsputum) – Lungabscess
– Acuteasthma
– Lungcancer
– LVF(pink-tingedfrothysputum)
Haemoptysis
- Most cases are due to infection:
- Other causes:
- – Pneumonia
– TB
– Bronchiectasis
– Bronchitis
- • Lung cancer
- Pulmonary embolism
- Anticoagulation
- LVF
- Cyanosis
- Visible when there is more than 50 g/l of reduced (deoxygenated haemoglobin)
- Can be central (cardiac or respiratory cause) or peripheral
- Patients with central cyanosis will have peripheral cyanosis!
- Central cyanosis is seen in the lips and tongue
- Causes of central cyanosis
- Congenital cardiac disease with right to left shunt and severe heart failure
- Severe respiratory diseases including COPD, severe pneumonia, severe bronchospasm (including acute asthma)
- Peripheral cyanosis can affect feet, hands, tips of ears and nose
Main causes are cold exposure and Raynaud’s disease
Don’t forget that all causes of central cyanosis cause peripheral cyanosis
Respiratory causes of clubbing
• Lung cancer, mesothelioma
• Bronchiectasis, including cystic fibrosis • Empyema
• Idiopathic pulmonary fibrosis
State the muscles used in inspiration, forced inspiration and the accessory muscles of forced expiration.
Which pathology uses accessory muscles of respiration?
Explain why.
Accessory inspiratory muscle used if adequate pulmonary ventilation cannot be achieved by normal inspiratory efforts when there is gross overdistention of the lungs:
- Advanced emphysema
- Attack of severe asthma
- Stridor due to laryngeal or tracheal obstruction
Accessory expiratory muscles used when 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
How else would these patients present?
Some patients with expiratory obstruction will stand and grasp a table so that they fix the shoulder girdle and use latissimus dorsi to augment the expiratory effort
Purse lip breathing
Chest x-ray in COPD
Because lost of elastin in the lung allows the chest wall to expand (something it naturally wants to do anyway!)
Because lost of elastin in the lung allows the chest wall to expand (something it naturally wants to do anyway!)
