Signs and Symptoms of Respiratory Disease

Question 1

What Respiratory diseases affect the airway?

Answer 1

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

Question 2

What respiratory diseases affect the lung parenchyma?

Answer 2

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

Question 3

What respiratory diseases affect the pulmonary circulation?

Answer 3

1. Pulmonary Embolism.

Question 4

What respiratory diseases affect the pleura?

Answer 4

1. Pneumothorax.

2. Pleural effusion.

Question 5

what respiratory diseases affect the chest wall and neuromuscular?

Answer 5

1. Kyphoscleoliosis.

2. Myasthenia graves.

Question 6

What are the signs and symptoms of respiratory disease?

Answer 6

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

Question 7

What is breathlessness/dyspnoea?

Answer 7

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).

Question 8

How should you exposure breathlessness?

Answer 8

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

Question 9

Which conditions develop breathlessness instantly-minutes?

Answer 9

PE, acute attack asthma, pneumothorax, foreign body.

Question 10

Which conditions develop breathlessness hours-days?

Answer 10

Pneumonia, acute exacerbation of COPD.

Pleural effusion days-weeks,

Question 11

Which conditions develop weeks-months?

Answer 11

Pleural effusion, HF, lung cancer, anaemia.

Question 12

Which conditions develop months-years?

Answer 12

COPD, pulmonary fibrosis, bronchiectasis.

Question 13

What are the causes of chest pain?

Answer 13

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

Question 14

Describe parietal pain.

Answer 14

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

Question 15

What is a cough?

Answer 15

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.

Question 16

How does a cough occur?

Answer 16

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.

Question 17

What are the different ways of describing a cough?

Answer 17

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`).

Question 18

What is a bovine cough?

Answer 18

Weak cough due to vocal cords.

Question 19

What is the commonest cause of a productive cough?

Answer 19

URTI.

Question 20

What are the respiratory cause of cough?

Answer 20

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.

Question 21

What are the non-respiratory cause of cough?

Answer 21

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

Question 22

Describe the sputum of chronic bronchitis and COPD patients.

Answer 22

Clear sputum there is no active infection.

Question 23

Describe the sputum in an infection.

Answer 23

Yellow/green sputum (live/dead neutrophils).

Question 24

Describe the sputum in bronchiectasis.

Answer 24

Large volumes (yellow/green).

Question 25

When can haemoptysis (red flag) occur?

Answer 25

1. Pulmonary. embolism. 2. TB. 3. Lung cancer.

Question 26

What is a wheeze?

Answer 26

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.

Question 27

What is stridor?

Answer 27

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.

Question 28

What signs are suggestive of respiratory disease?

Answer 28

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.

Question 29

Why do patients use accessory muscle?

Answer 29

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.

Question 30

When are accessory muscles used?

Answer 30

COPD and severe acute asthma.

Question 31

What are accessory muscles?

Answer 31

Scalenes, SCM, abdominal muscles and trapezius.

Question 32

What is peripheral cyanosis?

Answer 32

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.

Question 33

What is central cyanosis?

Answer 33

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.

Question 34

What is barrel shaped chest and why does it occur?

Answer 34

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.

Question 35

What is pursed lip breathing and why does it occur?

Answer 35

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.

Question 36

What signs on palpation suggest respiratory disease?

Answer 36

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

Question 37

What signs on percussion suggest respiratory disease?

Answer 37

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.

Question 38

What is the percussion of someone with Normal respiratory health?

Answer 38

Most areas resonant. Liver and heart dull.

Question 39

What signs on auscultation suggest respiratory disease?

Answer 39

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.