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Signs and Symptoms in Respiratory Medicine Flashcards

1
Q

Symptoms vs sign

A

Symptoms is what the patient feels and tells you, signs is what you pick up on examination.

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2
Q

Secondary polycythaemia can cause

A

It is an abnormal increase in concentration of haemoglobin in the blood, through reduction of plasma volume or increase in red blood cells. Cause cyanosis

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3
Q

What can cause CO2 flap

A

Hypercapnic enchephalopathy

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4
Q

What is erythema nodosum

A

Swollen fat under skin causing red bumps and patches. Can be due to sarcoidosis or TB

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5
Q

What is lupus pernio

A

Chronic raised hardened lesion of skin, often purplish in colour. Often due to sarcoidosis

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6
Q

What can finger clubbing indicate

A

Bronchial carcinoma, fibrosing alveolitis, lung suppuration (bronchiectasis, lung abscess or empyema), cyanotic congenital heart disease, infective endocarditis, malabsorption states (ulcerative colitis, crohns disease, liver cirrhosis), congenital, idiopathic

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7
Q

What is horners syndrom

A

Nerve pathway from brain to eye is disrupted causing small pupil, ptosis (drooping or falling of upper eyelid), enophthalmos (posterior displacement of eye).

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8
Q

Cause of horner’s syndrome in respiratory medicine

A

Pancoast’s tumour - Tumour of pulmonary apex or cervical lymphadenopathy

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9
Q

Uveitis can be caused by?

A

Uveitis is inflammation of uvea, caused by sarcoidosis or tuberculosis

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10
Q

What can increased intracranial pressure due to chronically raised CO2 cause

A

Papilloedema, optic disc swelling

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11
Q

What is kyphoscoliosis

A

Abnormal curvature of the spine in coronal (kyphosis) and sagittal (scoliosis) plane

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12
Q

What is pectus excavatum

A

Congenital deformity of anterior thoracic wall in which the sternum and rib cage grow abnormally, producing a caved in or sunken appearance

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13
Q

What is thoracoplasty

A

Surgical procedure originally designed to permanently collapse cavities of pulmonary tuberculosis by removing the ribs from chest wall

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14
Q

Changes associated with pectus excavatum

A

Pulmonary artery murmur, right lower lobe changes on chest x-ray mimics pulmonary infiltrate, diminished lung volumes lead to reduced lung sounds

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15
Q

Cause of hyper-resonance on percussion

A

Emphysema, pneumothorax

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16
Q

Cause of impaired resonance

A

Pulmonary consolidation, pleural thickening, raised hemi-diaphragm

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17
Q

Stony dull percussion causes

A

Pleural effusion

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18
Q

Why is there impaired resonance over heart in obesity and commonly at right base

A

Due to fatty deposits over the heart in obesity. Over right base as the liver pushes diaphragm up

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19
Q

What condition has a normal chest cxr but may show signs on auscultation

A

Asthma, pulmonary embolus

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20
Q

What disease is auscultation generally normal

A

Tuberculosis

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21
Q

What part of stethoscope for low and high pitch sounds

A

Low pitch = Bell

High pitch = Diaphragm

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22
Q

What is aegophony

A

Increased resonance of voice sounds when auscultating the lungs. Low frequency noises are filtered out with high-frequency sounds transmitted across the fluid

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23
Q

Common causes of aegophony

A

Lung consolidation and fibrosis

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24
Q

What is whispered pectoriloquy

A

Increase loudness of whispering noted during auscultation. Usually, spoken words would not be heard by the clinician on auscultation.

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25
What can the patient be asked to say to identify aegophony or whispered pectoriloquy
99, 1-1-1, toy boat, scooby doo
26
What is ronchi
Low pitched wheeze; musical sound as air passes through narrowed airways
27
What can localised wheeze be sign of
Large airway tumour
28
What can general wheeze be a sign of
General wheeze is usually polyphonic (multiple sounds) due to small airway obstruction such as asthma and bronchitis
29
What can squeaks and crackles be a sign of
Bronchiolitis
30
What can cause crackles or crepitations
Explosive re-opening of small airways blocked by exudate, inflammation or fibrosis upon inspiration
31
What can cause fine crackles
Pulmonary fibrosis, late inspiratory
32
What can cause moderate/coarse crackles
Pulmonary oedema, consolidation, bronchiectasis
33
What is pleural rub
Leathery, creaking sound made by inflammed pleural surfaces rubbing together
34
What can cause pleural rub
Pneumonia, pulmonary embolus, viral or auto-immune pleurisy
35
When can you hear a pleural click
Pneumothorax
36
What can cause reduced vocal resonance of voice sounds
Pleural effusion, atelectasis, bronchial occlusion, pneumothorax, emphysema
37
What can increase vocal resonance of voice sounds
Consolidation such as in pnemonia
38
What transmits whispering pectoriloquy
Consolidation without bronchial obstruction
39
``` 75 year old man Cough for 8 weeks Streaky haemoptysis Increasingly breathless Stopped smoking 6 weeks ago Takes aspirin and simvastatin Back pain for about a month Tar stained fingers Clubbing Cachexia Stony dull PN left lower zone Decreased breath sounds left lower zone Tender L5 ```
Cancer
40
``` 21 year old girl Increasing breathlessness over 6/52 Worse in the mornings Nocturnal cough Just bought a cat Sister has eczema Never smoked Drinks socially Slightly overweight Widespread wheeze Excoriations over flexor surfaces of arms ```
Asthma
41
``` 66 year old man 3 month history of increasing breathlessness Dry cough No chest pain Stopped smoking 5 months ago Retired bin man Drinks 2 pints of beer a night Keeps 15 racing pigeons 55 Mild clubbing Crackles through the chest, more in the apices Reduced chest expansion PN normal ```
Hypersensitivity pneumonitis - Bird fancier's lungs
42
``` 35 year old man Itchy, painful red eye for 6/52 Gradual increase in breathlessness for 3 weeks Raised red lesions on both shins Non smoker Red eyes bilaterally Normal breath sounds Normal chest expansion Raised red lesions on both shins ```
Sarcoidosis
43
Calgary cambridge guide to consultation
Initiating the session, gathering information, physical examination, explanation & planning, closing session
44
SOCRATES
Site, Onset, Character, Radiation, Associated symptoms, Time, Exacerbating/relieving symptoms, Severity
45
What is referred pain
Pain felt in the body other than its actual source
46
How does pleuritic pain refer
Sharp stabbing pain worse on inspiration (especially deep breaths). non specific but easy to locate (using finger)
47
What are juxtacapillary (J) receptors
Sensory nerve endings located within alveolar walls in juxtaposition to pulmonary capillaries of the lungs and innervated by vagus nerve. Involved in sensation of dyspnea
48
Chest pain history can be classified under?
Cardaic, resp, GI and MSK
49
Differences in chest pain presentation in different system
Cardiac - Tight GI - Burning Resp - Hurts when breathing in Muscular - Hurts during movement
50
Cause of acute breathlessness
Pulmonary embolism, pneumothorax, pulmonary oedema
51
Cause of chronic breathlessness
COPD, pulmonary fibrosis, pulmonary embolism, Asthma
52
What is pneumonitis also known as
Extrinsic allergic pneumonitis or hypersensitivity pneumonitis
53
What does sputum usually contain
Neutrophils, eosinophils, bacterial, fungi, virus, airway secretion
54
Massive vs non-massive haemoptysis
Non-massive < 500 ml in 24 hours | Massive > 500 ml in 24 hours
55
4 common causes of haemoptysis
Infection, carcinoma, pulmonary embolism and bronchiectasis
56
What is pulmonary arteriovenous malformations (PAVM)
They are rare vascular anomalies of the lung in which abnormal dilated vessels provide a right to left shunt between pulmonary artery and vein
57
What is atopy
It is the genetic tendency to develop allergic disease such as allergic rhinitis, asthma and atopic dermatitis
58
How should be included in history taking
Occupation/history (asbestos/coal mining/farming/pigeon birds), tobacco, cannabis, foreign travel, pets, smoker, alcohol
59
Non infective mucous is generally what colour
Clear or yellow, COPD
60
Purulent mucous is
Green, pneumonia or bronchiectesis
61
What can cause pleuritic chest pain
Worse on inspiration, due to pneumonia, infarction, pneumothorax
62
Cause of chest wall pain
Chronic due to malignant invasion of soft tissue and ribs
63
What is tight chest pain associated with
Radiating to arms and jaw, angina
64
What is burning chest pain associated with
Oesophageal reflux
65
Common pattern of asthma symptoms
Episodic non-productive cough and wheeze with diurnal variation in young non-smoker with history of atopy such as hay fever or eczema
66
Common pattern of COPD
Chronic productive cough, wheeze and dyspnoea in elderly smoker
67
Common pattern of bronchiecstasis
Daily productive cough with lots of green sputum in non-smoker with past history of pneumonia
68
Common pattern of community acquired pneumoniae
Acute productive cough, pleuritic pain, dyspnoea and fever in any age
69
Common pattern of pulmonary embolus
Acute pleuritic pain with dyspnoea and swollen leg (DVT) following recent hip replacement surgery
70
Common pattern of pneumothorax
Acute onset pleuritic pain with dyspnoea in young adult male
71
Common pattern of bronchial cancer
Cough, haemoptysis, weight loss, hoarseness in middle aged or elderly smoker
72
Common pattern of mesothelioma
Intractable chronic chest pain with weight loss in ship yard worker with asbestos exposure
73
Common pattern of tuberculosis
Haemoptysis, weight loss, night sweats in young asian adult who has just moved to the UK from India
74
Common pattern of interstitial lung disease
Also called fibrosis alveolitis. Progressive dyspnoea without cough or wheeze in non-smoker with rheumatoid disease
75
Large pleural effusion is heard as what on auscultation
Stony dull
76
Emphysema vs large pneumothorax on examination
Emphysema is hyper-resonant symetrically where pneumothorax is hyperresonant with unilateral reduced breath sounds
77
Mediastinal shift in pleural effusion and pneumothorax
Opposite side
78
Acute cough can be a sign of?
Lower respiratory tract infection | Pneumonia
79
Chronic cough can be
Chronic bronchitis | Bronchiestasis
80
What is known as the 100 day cough
Pertusis
81
How can sputum be quantified
Volume - Thimble, egg cup, tea cup, bowl, bucket Colour - White, yellow, clear
82
Signs of tonsilitis
Swollen tonsils, erythematous, dysphagia, dysphonia, recurrent tonsillitis
83
What is quinsy
Peritonsillar abscess, a complication of tonsilitis
84
Upper tract infections
Coryza, pharyngitis, quinsy, epiglottitis, sinusitis
85
Lower respiratory tract infections
Acute bronchitis, COPD acute exacerbatons, pneumonia, influenza, fungal infection
86
Treatment of sinusitis
Self-limiting resolves in 10 days. Might need nasal decongestant such as Oxymetazoline
87
Acute bronchitis chest examination and x-ray
Normal, may have transient wheeze
88
Wheeze vs stridor
Wheeze is high-pitched, continuous lung sounds produced by a narrow lumen in airways. Stridor is a special kind of musical wheeze at a constant pitch in patients with laryngeal and tracheal obstruction
89
IV antibiotics in the old
When the oral route isn't available Drug-resistant organism Deep-seated infection - Abscess, bone, endocarditis, meningitis First dose - Rapid increase in plasma concentration

Respiratory (26 decks)

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