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Respiration > Signs and Symptoms of Respiratory Disease > Flashcards

Signs and Symptoms of Respiratory Disease Flashcards

1
Q

What Respiratory diseases affect the airway?

A
  1. Asthma.
  2. COPD.
  3. Brochiectasis.
  4. Cystic Fibrosis.
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2
Q

What respiratory diseases affect the lung parenchyma?

A
  1. Pulmonary fibrosis.
  2. Pneumonia.
  3. TB.
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3
Q

What respiratory diseases affect the pulmonary circulation?

A
  1. Pulmonary Embolism.
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4
Q

What respiratory diseases affect the pleura?

A
  1. Pneumothorax.

2. Pleural effusion.

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5
Q

what respiratory diseases affect the chest wall and neuromuscular?

A
  1. Kyphoscleoliosis.

2. Myasthenia graves.

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6
Q

What are the signs and symptoms of respiratory disease?

A
  1. Dyspnoea,
  2. Chest pain,
  3. Cough,
  4. Haemoptysis,
  5. Sputum,
  6. Wheeze.
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7
Q

What is breathlessness/dyspnoea?

A

Subjective awareness of increased effort required for breathing as a symptom.
Objective evidence for breathlessness may be present.
Common in all respiratory conditions but not specific to respiratory conditions (e.g. anaemia, heart failure, obesity).

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8
Q

How should you exposure breathlessness?

A
  1. Onset, timing and duration.
  2. Progression.
  3. Precipitating factors.
  4. Severity.
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9
Q

Which conditions develop breathlessness instantly-minutes?

A

PE, acute attack asthma, pneumothorax, foreign body.

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10
Q

Which conditions develop breathlessness hours-days?

A

Pneumonia, acute exacerbation of COPD.

Pleural effusion days-weeks,

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11
Q

Which conditions develop weeks-months?

A

Pleural effusion, HF, lung cancer, anaemia.

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12
Q

Which conditions develop months-years?

A

COPD, pulmonary fibrosis, bronchiectasis.

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13
Q

What are the causes of chest pain?

A
  1. Pleura: infection, pneumothorax, pulmonary embolism.
  2. Chest wall: rib fracture, costochondritis, shingles.
  3. Mediastinal structures: myocardial infarction, pericarditis, GORD, aortic dissection.
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14
Q

Describe parietal pain.

A

Irritation of parietal pleura causes pain. that is sharp, localised and referred to thoracic wall (intercostal nerve) or shoulder tip (phrenic nerve).

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15
Q

What is a cough?

A

A short, explosive expulsion of air, key protective mechanism. It is triggered by stimulation of mechano- and/or chemo-receptors within airway by any source of irritation, e.g. inflammation or foreign body.

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16
Q

How does a cough occur?

A

There is a cough stimulus on the larynx, trachea and bronchi causing the vagus afferent limb to stimulate the central control cough. Causes the laryngeal respiratory. muscles and thus a cough.
There is a forced expiratory effort against an initially closed glottis. There is a build up of intrathoracic pressure followed by a sudden opening of the glottis so the air is expelled with high velocity.

17
Q

What are the different ways of describing a cough?

A
  1. Productive/non-productive cough.
  2. Volume, colour, blood of sputum.
  3. Character of the cough: bovine, seal-like.
  4. Timing: nocturnal (asthma), time of year (COPD winter`).
18
Q

What is a bovine cough?

A

Weak cough due to vocal cords.

19
Q

What is the commonest cause of a productive cough?

A

URTI.

20
Q

What are the respiratory cause of cough?

A

Irritation of airways, lung parenchyma or pleura.

  1. Acute infection (pneumonia).
  2. Brochiectasis and cystic fibrosis.
  3. Pulmonary fibrosis.
  4. Lung cancer.
  5. Foreign body.
  6. Irritants, e.g. smoking, occupational.
  7. Nasal and sinus disease.
21
Q

What are the non-respiratory cause of cough?

A
  1. LV heart failure-> pink frothy sputum.
  2. GORD.
  3. Drugs, e.g. ACEi.
22
Q

Describe the sputum of chronic bronchitis and COPD patients.

A

Clear sputum there is no active infection.

23
Q

Describe the sputum in an infection.

A

Yellow/green sputum (live/dead neutrophils).

24
Q

Describe the sputum in bronchiectasis.

A

Large volumes (yellow/green).

25
Q

When can haemoptysis (red flag) occur?

A
  1. Pulmonary. embolism.
  2. TB.
  3. Lung cancer.
26
Q

What is a wheeze?

A

Abnormal breath sounds indicating narrowing within the airway causing turbulent air flow. It is high pitched and musical, mostly on expiration, indicating narrowing in the intrathoracic airways from the bronchial smooth muscle contraction, oedema or mucous. The narrowing is exacerbated during expiration and may only be audible when listening in a stethoscope.

27
Q

What is stridor?

A

Abnormal breath sounds indicating narrowing within the airway causing turbulent air flow. Stridor is high pitch, constant and loud, mostly in inspiration. It indicates extrathoracic airway problems such as in the supra glottis, glottis or subglottis or trachea. Narrowing is exacerbated during inspiration. Often audible without the stethoscope.

28
Q

What signs are suggestive of respiratory disease?

A
  1. Raised RR.
  2. Cyanosis: central vs peripheral.
  3. Increased work of breathing, accessory muscles.
  4. Pursed lip breathing.
  5. Barrel shaped chest.
  6. Clubbing- TB, lung cancer, bronchiectasis, CF.
29
Q

Why do patients use accessory muscle?

A

Adequate ventilation not achieved by normal inspiratory efforts. More effort required to move air through airways e.g. narrowed.
Accessory muscles help create greater negative intrathoracic pressure on inspiration to pull more air om and cause tracheal tug.

30
Q

When are accessory muscles used?

A

COPD and severe acute asthma.

31
Q

What are accessory muscles?

A

Scalenes, SCM, abdominal muscles and trapezius.

32
Q

What is peripheral cyanosis?

A

Affect skin of feet, hands, nose and tips of ears blue discolouration.
Seen in cold exposure and decreased cardiac output.
Slowing of blood to peripheries due to vasoconstriction increasing oxygen extraction and more deoxygenated blood is thus present in this area.

33
Q

What is central cyanosis?

A

Lips and tongue mucous membrane bluish decolorisation.
Indicates significant cardiac or respiratory cause. Caused by increase in amount of deoxygenated Hb in blood arriving at tissues.

34
Q

What is barrel shaped chest and why does it occur?

A

Associated with lung hyperinflation, in severe COPD (especially emphysema). The AP diameter is greater than the lateral diameter.
It is the result of chronic over-inflation of the lungs due to air trapping. It hyper expands the chest wall overtime.

35
Q

What is pursed lip breathing and why does it occur?

A

Breathing out slowly through mouth and pursed breathing. Commonly seen in COPD. Pursing lips increases resistance to outflow on expiration, maintaining intrathoracic pressure so that the small airways can remain open for longer. This allows the gas exchange to occur for longer so more air can empty rather than be trapped.

36
Q

What signs on palpation suggest respiratory disease?

A

Chest expansion measured.
If symmetrically reduced: severe COPD, diffuse pulmonary fibrosis.
If asymmetrically reduced: unlateral abnormality, collapse, pneumothorax and effusion e.g.

37
Q

What signs on percussion suggest respiratory disease?

A

Dull: consolidation (solidification due to filling of lungs. with solid material). Percussion over area of pleural effusion, stony dull.
Hyper-resonant: area of increased air, e.g. hyperinflation and pneumothorax.

38
Q

What is the percussion of someone with Normal respiratory health?

A

Most areas resonant. Liver and heart dull.

39
Q

What signs on auscultation suggest respiratory disease?

A

Additional abnormal breath sounds:
Crackles: abrupt snapping open of alveoli and small bronchi. Interrupted, non-musical. Fine: soft, high pitch->pulmonary fibrosis. Coarse: loud, low pitch-> COPD, bronchiectasis (air bubbling, through mucous secretions may reduce on cough).
Pleural rub: scratching, coarse sound. Inflammation of pleura, e.g. pleurisy.

Respiration (2 decks)

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