Session 11 - Symptoms And Signs Of Respiratory Disease

Question 1

What are the six cardinal symptoms of respiratory disease?

Answer 1

Breathlessness (dyspnoea)
Cough
Chest pain
Wheeze/stridor
Sputum 
Haemoptysis

Question 2

How might patients suffering from bronchoconstriction describe their breathlessness?

Answer 2

‘Chest tightness’
‘Increased effort of breathing’
‘Air hunger’

Question 3

How might patients suffering from COPD describe their breathlessness?

Answer 3

‘Cannot take a full breath’

‘Unsatisfying breathing’

Question 4

How might patients suffering from Herat failure describe their breathlessness?

Answer 4

‘Air hunger’

‘Suffocation’

Question 5

Give some common causes of dyspnoea.

Answer 5

Asthma
COPD
Idiopathic pulmonary fibrosis 
Myocardial dysfunction
Anaemia 
Obesity 
Deconditioning

Question 6

What are some causes of instantaneous breathlessness?

Answer 6

Pulmonary embolism

Pneumothorax

Question 7

What are some causes of acute breathlessness (onset in minutes to hours)?

Answer 7

Asthma
Pulmonary embolism
Pneumonia 
Left ventricular failure/myocardial infarction
Hyperventilation syndrome

Question 8

What are some causes of gradual onset (days) breathlessness?

Answer 8

Lobar collapse (e.g. lung cancer)
Pleural effusion

Question 9

What are some causes of chronic onset (months to years) breathlessness?

Answer 9

COPD
Idiopathic pulmonary fibrosis
Bronchiectasis

Question 10

What are the common causes of cough?

Answer 10

Respiratory 
- acute infection
- chronic infection
- nasal/sinus disease
- airways disease
- parenchyma disease
- irritant 
- pleural disease
Cardiovascular 
- left ventricular failure
Gastrointestinal 
- gastro-oesophageal reflux
Drugs
- ACE inhibitors, inhaled drugs

Question 11

Give some causes of pleuritic chest pain.

Answer 11

Viral/bacterial pleurisy
Pulmonary embolism/infarction
Pneumothorax
Pericarditis

Question 12

Give some causes of chest wall pain.

Answer 12

Costochondritis
Rib fracture
Spinal osteoarthritis
Herpes Zoster (shingles)

Question 13

What is wheeze?

Answer 13

A noisy musical sound produced by turbulent flow through narrow small airways. It is mostly expiratory.

Question 14

Wheeze is seen commonly in what conditions?

Answer 14

Asthma
COPD
Bronchiolitis
Sometimes seen in LVF

Question 15

What is stridor?

Answer 15

A course inspiratory wheeze.

Question 16

What are the common causes of stridor?

Answer 16

Extrathoracic upper airways obstruction:

• epiglottis
• croup
• diptheria
• aspirated foreign bodies
• extrinsic compression (e.g. large goitre)

Question 17

What are some possible causes of increased sputum?

Answer 17

Smoking/smoke pollution
COPD
Acute viral or bacterial bronchitis
Pneumonia
Bronchiectasis 
Lung abscess
Acute asthma
Lung cancer 
LVF

Question 18

What is the most common cause of haemoptysis?

Answer 18

Infection:

• pneumonia
• TB
• bronchiectasis
• bronchitis

Question 19

Other than infection, what possible causes are there for haemoptysis?

Answer 19

Lung cancer
Pulmonary embolism
Anticoagulation
LVF

Question 20

What are the causes of central cyanosis?

Answer 20

Congenital heart disease - right to left shunt

Severe respiratory disease - COPD, severe pneumonia, severe bronchospasm (including acute asthma)

Question 21

What are the respiratory causes of clubbing?

Answer 21

Lung cancer
Bronchiectasis, including CF
Empyema
Idiopathic pulmonary fibrosis

Question 22

What are the accessory inspiratory muscles?

Answer 22

Sternocleidomastoid 
Latissimus dorsi
Scalene muscles
Pectoralis minor 
Serratus anterior

Question 23

What are the primary inspiratory muscles?

Answer 23

External intercostal muscles

Diaphragm

Question 24

What are the accessory expiratory muscles?

Answer 24

Internal intercostal muscles
Transversus thoracis 
External oblique
Rectus abdominis
Internal oblique

Question 25

Barrel chest is seen in what condition?

Answer 25

Emphysema

Question 26

Why does barrel chest occur in emphysema?

Answer 26

Loss of elastin in the lungs allows the chest wall to expand

Question 27

Why do COPD patients do pursed lip breathing?

Answer 27

Stops them exhaling too much air meaning the alveoli don’t get too small, making it easier to take the next breath.

Question 28

The position of the trachea is used to detect what?

Answer 28

Mediastinal displacement

Question 29

What conditions would causes tracheal deviation away from the affected side?

Answer 29

Tension pneumothorax

Large plural effusion

Question 30

What conditions would cause tracheal deviation towards the affected side?

Answer 30

Lung or lobar collapse

Pulmonary fibrosis, particularly of the upper lobe

Question 31

Why is lung/lobar collapse relatively common after complete obstruction of a bronchus?

Answer 31

Gas is resorbed from the lung parenchyma distal to the obstruction resulting in the collapse of the lung, with volume reduction and negative mass effect.

Question 32

What is lung consolidation?

Answer 32

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 the alveoli.

Question 33

What is the commonest cause of lung consolidation?

Answer 33

Pneumonia

Question 34

What change in breath sounds would indicate consolidation?

Answer 34

Hearing bronchial breath sounds over lung fields where it is normal to hear vesicular breath sounds is a classic finding of lung consolidation.

Question 35

Give examples of conditions in which you may find fine crackles.

Answer 35

Pulmonary fibrosis
Consolidation
LVF

Question 36

Give examples of conditions in which you might find coarse crackles.

Answer 36

COPD

Bronchiectasis

Question 37

In what conditions would you hear a pleural friction rub?

Answer 37

Pleurisy

Pulmonary infarction due to PE