Signs And Symptoms Of Respiratory Disease Flashcards
What are the cardinal signs and symptoms of respiratory disease?
Breathlessness
Chest pain
Cough
Haemoptysis
Sputum
Wheeze / Stridor
What is breathlessness?
Subjective awareness of increased effort required for breathing
-Symptom rather than a sign
…But objective evidence of breathless may present (e.g. raised respiratory rate or use of accessory muscles)
Very common (often variably described)
-Common to all respiratory conditions
BUT not specific to resp conditions (e.g. anaemia, heart failure, obesity)
How does onset, timing and duration affect the differentials of breathlessness?
Instant-minutes: PE, acute asthma, pneumothorax, foreign body
Hours to Days: Pneumonia, acute exacerbation COPD, Pleural effusion (days)
Weeks to months: Pleural effusion (days), heart failure, lung cancer
Months to years: COPD, pulmonary fibrosis, anaemia
What things can you ask regarding breathlessness?
Triggers - allergies, cold weather..
Impact - stop you doing?
Exacerbating / relieving factors - position, cold weather, pets
Stable or getting worse
What could cause chest pain?
Pleural:
- Infection (pleurisy)
- Pneumothorax
- PE (causing infarct)
Chest wall:
- Rib fracture
- Costochondritis
- Shingles (varicella zoster)
Mediastinal structures:
- MI
- Pericarditis
- Oesophaitis / GORD
- Aortic dissection
Why are location character and exacerbating or releasing factors important when discussing chest pain?
It can help you work out the cause of the pain.
Central vs non-central
Cardiac vs “pleuritic”
What type of pain will irritation of the parietal pleural cause?
Irritation of the parietal pleural cause pain that is sharp, localised and referred to thoracic wall (intercostal nerve) or shoulder tip (phrenic nerve)
What is a cough?
A short, explosive expulsion of air triggered by mechano- or chemo-receptors within the airway.
There is forced expiratory effort against an initially closed glottis.
- Build up intrathoracic pressure, followed by sudden opening of glottis.
- Air expelled with high velocity!
Describe the cough reflex
Cough stimulus
Larynx / trachea / bronchi (receptors)
Afferent limb vagal nerves
Central cough control
Efferent limb motor nerves
Laryngeal respiratory muscles
Cough
What questions should you ask about a cough?
Productive or dry?
If productive - volume, colour blood?
Character e.g. “bovine,”(COPD) “seal like” (Croup)
Timing e.g. nocturnal, time of year
Cause: URTI (most common), could be a sign of more serious, chronic pathology.
What are some respiratory causes of a cough?
Anything that irritates the airways, lung parenchyma or pleura.
Infection (pneumonia Bronchiectasis and CF Pulmonary fibrosis Lung cancer Foreign body Irritants e.g. smoking, occupational Nasal and sinus disease (post-nasal drip)
What are some non-respiratory causes of a cough?
LV heart failure
GORD
Drugs e.g. ACE-inhibitors
What can the different colours of sputum tell you about cause?
Clear sputum - chronic bronchitis / COPD
Yellow / grey sputum (live / dead neutrophils) - infection
Large volumes (yellow / green) - Bronchiectasis
Haemoptysis - Potential red flag (TB, lung cancer)
What is a wheeze?
Abnormal breath sounds indicating narrowing within the airway causing turbulent flow.
High pitch, “musical”
Mostly on expiration - due to decrease pressure which narrows airway even more during expiration
Indicates narrowing in intrathoracic airways. e.g. bronchial smooth muscle, contraction, oedema, mucous
May only be audible with a stethoscope.
What is stridor?
Abnormal breath sounds indicating narrowing within the airway causing turbulent airflow.
High pitch, constant, loud
Mostly on inspiration
Indicates narrowing in extra thoracic airway - supra glottis, glottis, infraglottis or trachea
Narrowing exacerbated during expiration - because negative pressure.
Often audible without a stethoscope.
What do you look for upon inspection during a respiratory exam?
Raised respiratory rate
Cyanosis - central vs peripheral
Increased work of breathing - accessory muscles
Pursed lip breathing
Barrel shaped chest
Clubbing
What do accessory muscles do?
Adequate ventilation not achieved by normal inspiration efforts
More effort required to move air through airways -e.g. narrowed
Accessory muscles help create greater negative intrathoracic pressure on inspiration. This pulls more air in and may cause tracheal tug.
Seen in patients with COPD and severe acute asthma.
What is the difference in differentials between peripheral and central cyanosis?
Peripheral:
- Can affect skin of feet, hands, nose and tips of ears.
- Slow of blood to peripheries (due to vasoconstriction) increases the oxygen extraction so that more deoxygenated blood is present in that area.
Central cyanosis:
- Affects lips and tongue (mucous membranes)
- Indicates significant cardiac or respiratory cause
- Caused by an increase in amount of deoxygenated Hb in blood arising at tissues (deoxygenated blood is leaving the heart)
What is barrel shaped chest?
Associated with lung hyperinflation - seen in severe COPD
AP diameter > Lateral diameter
Chronic overinflation of lungs due to air trapping.
Hyperexpands the chest wall over time.
What is pursed liped breathing and why is is useful?
Breathing out slowly through mouth with pursed lips
Commonly seen in COPD.
Pursing lips increases resistance to outflow expiration.
Maintains intrathoracic airway pressures allowing small airways to remain open for longer:
-Prolonging period for gas exchange and allowing more air to empty rather than trap.
On palpation, what is suggestive of a respiratory disease?
Chest expansion
Symmetrically reduced:
- Severe COPD
- Diffuse pulmonary fibrosis
Asymmetrically reduced
-Indicated unilateral abnormality e.g. collapse, pneumothorax, effusion
On percussion, what is suggestive of a respiratory disease?
Most of lung should normally be resonant (not if heart, liver..)
Dull to percuss = consolidation (solidification due to filling of lungs with solid (ish) material.)
Stony dull = pleural effusion
Hyperresonant = Area of increased air e.g. lung hyperinflation, pneumothorax
On auscultation, what is suggestive of a respiratory disease?
Crackles (abrupt ‘snapping’ open of alveoli and small bronchi)
-Interrupted, non-musical
-Fine or coarse
Fine (soft, high pitch) = pulmonary fibrosis
Coarse (loud, low pitch) = COPD, bronchiectasis (air bubbling through mucous secretions, may reduce on coughing)
Pleural rub
- Scratching or coarse sound
- Inflammation of pleura e.g. pleurisy
In a respiratory exam, what could clubbing indicate?
Lung cancer, CF, Bronchiectasis
