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.
