Signs and Symptoms in Respiratory Medicine Flashcards
Symptoms vs sign
Symptoms is what the patient feels and tells you, signs is what you pick up on examination.
Secondary polycythaemia can cause
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
What can cause CO2 flap
Hypercapnic enchephalopathy
What is erythema nodosum
Swollen fat under skin causing red bumps and patches. Can be due to sarcoidosis or TB
What is lupus pernio
Chronic raised hardened lesion of skin, often purplish in colour. Often due to sarcoidosis
What can finger clubbing indicate
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
What is horners syndrom
Nerve pathway from brain to eye is disrupted causing small pupil, ptosis (drooping or falling of upper eyelid), enophthalmos (posterior displacement of eye).
Cause of horner’s syndrome in respiratory medicine
Pancoast’s tumour - Tumour of pulmonary apex or cervical lymphadenopathy
Uveitis can be caused by?
Uveitis is inflammation of uvea, caused by sarcoidosis or tuberculosis
What can increased intracranial pressure due to chronically raised CO2 cause
Papilloedema, optic disc swelling
What is kyphoscoliosis
Abnormal curvature of the spine in coronal (kyphosis) and sagittal (scoliosis) plane
What is pectus excavatum
Congenital deformity of anterior thoracic wall in which the sternum and rib cage grow abnormally, producing a caved in or sunken appearance
What is thoracoplasty
Surgical procedure originally designed to permanently collapse cavities of pulmonary tuberculosis by removing the ribs from chest wall
Changes associated with pectus excavatum
Pulmonary artery murmur, right lower lobe changes on chest x-ray mimics pulmonary infiltrate, diminished lung volumes lead to reduced lung sounds
Cause of hyper-resonance on percussion
Emphysema, pneumothorax
Cause of impaired resonance
Pulmonary consolidation, pleural thickening, raised hemi-diaphragm
Stony dull percussion causes
Pleural effusion
Why is there impaired resonance over heart in obesity and commonly at right base
Due to fatty deposits over the heart in obesity. Over right base as the liver pushes diaphragm up
What condition has a normal chest cxr but may show signs on auscultation
Asthma, pulmonary embolus
What disease is auscultation generally normal
Tuberculosis
What part of stethoscope for low and high pitch sounds
Low pitch = Bell
High pitch = Diaphragm
What is aegophony
Increased resonance of voice sounds when auscultating the lungs. Low frequency noises are filtered out with high-frequency sounds transmitted across the fluid
Common causes of aegophony
Lung consolidation and fibrosis
What is whispered pectoriloquy
Increase loudness of whispering noted during auscultation. Usually, spoken words would not be heard by the clinician on auscultation.
What can the patient be asked to say to identify aegophony or whispered pectoriloquy
99, 1-1-1, toy boat, scooby doo
What is ronchi
Low pitched wheeze; musical sound as air passes through narrowed airways
What can localised wheeze be sign of
Large airway tumour
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
What can squeaks and crackles be a sign of
Bronchiolitis
What can cause crackles or crepitations
Explosive re-opening of small airways blocked by exudate, inflammation or fibrosis upon inspiration
What can cause fine crackles
Pulmonary fibrosis, late inspiratory
What can cause moderate/coarse crackles
Pulmonary oedema, consolidation, bronchiectasis
What is pleural rub
Leathery, creaking sound made by inflammed pleural surfaces rubbing together
What can cause pleural rub
Pneumonia, pulmonary embolus, viral or auto-immune pleurisy
When can you hear a pleural click
Pneumothorax
What can cause reduced vocal resonance of voice sounds
Pleural effusion, atelectasis, bronchial occlusion, pneumothorax, emphysema
What can increase vocal resonance of voice sounds
Consolidation such as in pnemonia
What transmits whispering pectoriloquy
Consolidation without bronchial obstruction
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
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
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
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
Calgary cambridge guide to consultation
Initiating the session, gathering information, physical examination, explanation & planning, closing session
SOCRATES
Site, Onset, Character, Radiation, Associated symptoms, Time, Exacerbating/relieving symptoms, Severity
What is referred pain
Pain felt in the body other than its actual source
How does pleuritic pain refer
Sharp stabbing pain worse on inspiration (especially deep breaths). non specific but easy to locate (using finger)
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
Chest pain history can be classified under?
Cardaic, resp, GI and MSK
Differences in chest pain presentation in different system
Cardiac - Tight
GI - Burning
Resp - Hurts when breathing in
Muscular - Hurts during movement
Cause of acute breathlessness
Pulmonary embolism, pneumothorax, pulmonary oedema
Cause of chronic breathlessness
COPD, pulmonary fibrosis, pulmonary embolism, Asthma
What is pneumonitis also known as
Extrinsic allergic pneumonitis or hypersensitivity pneumonitis
What does sputum usually contain
Neutrophils, eosinophils, bacterial, fungi, virus, airway secretion
Massive vs non-massive haemoptysis
Non-massive < 500 ml in 24 hours
Massive > 500 ml in 24 hours
4 common causes of haemoptysis
Infection, carcinoma, pulmonary embolism and bronchiectasis
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
What is atopy
It is the genetic tendency to develop allergic disease such as allergic rhinitis, asthma and atopic dermatitis
How should be included in history taking
Occupation/history (asbestos/coal mining/farming/pigeon birds), tobacco, cannabis, foreign travel, pets, smoker, alcohol
Non infective mucous is generally what colour
Clear or yellow, COPD
Purulent mucous is
Green, pneumonia or bronchiectesis
What can cause pleuritic chest pain
Worse on inspiration, due to pneumonia, infarction, pneumothorax
Cause of chest wall pain
Chronic due to malignant invasion of soft tissue and ribs
What is tight chest pain associated with
Radiating to arms and jaw, angina
What is burning chest pain associated with
Oesophageal reflux
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
Common pattern of COPD
Chronic productive cough, wheeze and dyspnoea in elderly smoker
Common pattern of bronchiecstasis
Daily productive cough with lots of green sputum in non-smoker with past history of pneumonia
Common pattern of community acquired pneumoniae
Acute productive cough, pleuritic pain, dyspnoea and fever in any age
Common pattern of pulmonary embolus
Acute pleuritic pain with dyspnoea and swollen leg (DVT) following recent hip replacement surgery
Common pattern of pneumothorax
Acute onset pleuritic pain with dyspnoea in young adult male
Common pattern of bronchial cancer
Cough, haemoptysis, weight loss, hoarseness in middle aged or elderly smoker
Common pattern of mesothelioma
Intractable chronic chest pain with weight loss in ship yard worker with asbestos exposure
Common pattern of tuberculosis
Haemoptysis, weight loss, night sweats in young asian adult who has just moved to the UK from India
Common pattern of interstitial lung disease
Also called fibrosis alveolitis. Progressive dyspnoea without cough or wheeze in non-smoker with rheumatoid disease
Large pleural effusion is heard as what on auscultation
Stony dull
Emphysema vs large pneumothorax on examination
Emphysema is hyper-resonant symetrically where pneumothorax is hyperresonant with unilateral reduced breath sounds
Mediastinal shift in pleural effusion and pneumothorax
Opposite side
Acute cough can be a sign of?
Lower respiratory tract infection
Pneumonia
Chronic cough can be
Chronic bronchitis
Bronchiestasis
What is known as the 100 day cough
Pertusis
How can sputum be quantified
Volume -
Thimble, egg cup, tea cup, bowl, bucket
Colour -
White, yellow, clear
Signs of tonsilitis
Swollen tonsils, erythematous, dysphagia, dysphonia, recurrent tonsillitis
What is quinsy
Peritonsillar abscess, a complication of tonsilitis
Upper tract infections
Coryza, pharyngitis, quinsy, epiglottitis, sinusitis
Lower respiratory tract infections
Acute bronchitis, COPD acute exacerbatons, pneumonia, influenza, fungal infection
Treatment of sinusitis
Self-limiting resolves in 10 days. Might need nasal decongestant such as Oxymetazoline
Acute bronchitis chest examination and x-ray
Normal, may have transient wheeze
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
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
