Session 11: Signs and Symptoms of Respiratory Disease

Question 1

Diseases involving airways.

Answer 1

Asthma

COPD

Bronchiectasis

CF

Question 2

Diseases involving lung parenchyma

Answer 2

Pulmonary fibrosis

Pneumonia

TB

Question 3

Diseases involving pulmonary circulation.

Answer 3

Pulmonary embolism

Question 4

Diseases involving the pleura

Answer 4

Pneumothorax

Pleural effusion

Question 5

Diseases involving the chest wall shape and neuromuscular.

Answer 5

Kyphoscoliosis

Myasthenia gravis

Question 6

State the cardinal signs and symptoms of resp disease.

Answer 6

Breathlessness

Chest pain

Coughing

Haemoptysis

SPutum

Wheeze

Pulmonary crackles etc…

Question 7

What is breathlessness called more clinically?

Answer 7

Dyspnoea

Question 8

Give examples of other diseases not involving resp that might cause dyspnoea.

Answer 8

Anaemia

Heart failure

Obesity

Diabetic ketoacidosis

Question 9

What is dyspnoea?

Answer 9

Subjective awareness of increased effort of breathing

Question 10

How might a patient tell you that they have dyspnoea?

Answer 10

Difficulty getting enough air

Short of breath

Can’t catch my breath

Chest feels tight

Question 11

What further questions might you ask about their dyspnoea?

Answer 11

Onset (acute vs gradual), timing and duration (constant vs. transient)

Precipitating factors

Progression (is it getting worse?, if transient is it getting more frequent?)

Severity

Question 12

Give examples of precipitating factors of dyspnoea.

Answer 12

Position of body

Cold (asthma and COPD)

Allergy and asthma

Dogs (allergy and asthma)

Question 13

How might you assess severity of dyspnoea?

Answer 13

Can they speak normally?

Difficulty walking?

Difficulty ascending stairs?

Question 14

Give types of chest pain.

Answer 14

Pleuritic

Cardiac

Question 15

Give causes of pleura leading to chest pain.

Answer 15

Infection causing pleurisy

Pneumothorax

Pulmonary embolism causing infarct where dead lung tissue can irritate the parietal pleura

Question 16

Give example of chest wall conditions that can lead to chest pain.

Answer 16

Rib fracture

Costochondritis

Shingles

Question 17

Give example of mediastinal structures leading to chest pain.

Answer 17

ACS

Pericarditis

Oesophagitis/GORD

Aortic dissection

Question 18

Explain pleuritic pain.

Answer 18

Irritation of parietal pleura

Thoracic wall pain or should tip referred via the intercostal and phrenic nerve.

Sharp and well localised

Worse with coughing and breathing in

The pain will be over the affected area and the patient will often be able to point exactly where it hurts.

Question 19

Explain cardiac pain.

Answer 19

Central

Dull/heavy

Crushing

Poorly localised

Radiating to shoulder and jaw

Coughing will not usually make it worse unless it is pericarditis.

Question 20

What is a cough triggered by?

Answer 20

Stimulation of mechano and/or chemo-receptors within airway.

By any source of irriation, inflammation, foreign body etc..

Question 21

What questions might you ask about a cough?

Answer 21

Productive?

Character?

Timing?

Question 22

What might you ask about their sputum?

Answer 22

Color

How much?

Blood in it?

Question 23

What type of characteristic might a cough have?

Answer 23

Whtether it is a bovine cough (Weakness of vocal cords)

Or

Seel cough (Croup)

Question 24

What might you ask about the timing of their cough?

Answer 24

Is it worse during night, or day?

During which season of the year?

Question 25

Most common cause of a cough?

Answer 25

URTI

Question 26

Give some causes of cough that are non-respiratory.

Answer 26

LV heart failure (pink frothy sputum) GORD (usually at night) Drugs like ACE-inhibitors

Question 27

What is a wheeze or stridor caused by?

Answer 27

Abnormal breath sounds indicating narrowing within the airway causing turbulent flow

Question 28

What does a wheeze sound like?

Answer 28

High pitched musical sound

Question 29

Explain a wheeze.

Answer 29

High pitched and musical Mostly heard on **expiratio**n due to **narrowing airways**. The **narrowing is exacerbated on expiration**. E.g. bronchial smooth muscle contraction, oedema and mucous.

Question 30

Explain a stridor.

Answer 30

Hight pitch, constant and loud. Harsher than a wheeze. Mostly heard on **inspiration** and indicates **narrowing in the extrathoracic airway**. E.g. supraglottis, glottis, infraglottis or trachea. Narrowing exacerbated during inspiration.

Question 31

When is pursed lip breathing seen?

Answer 31

In COPD

Question 32

Why is pursed lip breathing done in COPD?

Answer 32

Increases resistance to outflow on expiration. It maintains the intrathoracic airway pressure allowing for small airways to remain open for longer. This **prolongs period for gas exchange to occur** **Allows more air to empty** rather than **trap**.

Question 33

Explain barrel shaped chest

Answer 33

Associated with lung hyperinflation Seen in severe COPD AP diameter \> lateral diameter Chronic over-inflation of lungs Hyperexpands the chest wall over time

Question 34

What to do on palpation in resp.

Answer 34

Tracheal position Chest expansion

Question 35

What do on percussion.

Answer 35

Resonance | (Dull, hyper-resonant, stony dull)

Question 36

When might you hear fine crackles?

Answer 36

Pulmonary fibrosis

Question 37

When might you hear course crackles?

Answer 37

COPD Bronchiectasis (air bubbling through mucous secretions)

Question 38

What is pleural rub?

Answer 38

Scratching, coarse sound

Question 39

Example of when pleural rub can be heard.

Answer 39

In inflammation of pleura like pleurisy

Question 40

Answer 40