Signs And Symptoms Of Respirstory Disease

Question 1

List some diseases involved in: airways, Kung parenchyma, pulmonary circulation, pleura and chest wall shape/ neuromuscular

Answer 1

Airways- asthma, COPD, bronchiectasis, CF

Lung parenchyma (invoked in gas transfer alveoli/ resp bronchioles) - pulmonary fibrosis, pneumonia, TB

Pulmonary circulation - PE

Pleura - pneumothorax, pleural effusion

Chest wha, shape and neuromuscular - kyphoscoliosis, myasthenia gravis

Question 2

List cardinal signs and symptoms of respiratory disease

Answer 2

Dyspnoea

Chest pain

Coughing

Haemoptysis

Green mucous

Crackles/ wheeze

Question 3

What is dyspnoea, questions to ask, causes

Answer 3

Subjective awareness of increased effort of breathing (objective evidence could be raised RR, accessory muscle use)

common to all respiratory conditions but not specific e.g. anaemia, ❤️ failure, obesity, diabetic ketoacidosis

Explore:
Timing - sudden, acute, hours, months. Constant or intermittent
Progression - worse or better
Precipitating factors - when lying down (❤️failure), winter (asthma), flowers, pets (atopy)
Severity - can’t talk/ walk/ ascend/ leave house/ bed

Question 4

How to determine causes of chest pain and what it could be

Answer 4

Central vs non-central

Cardiac vs pleuritic

Pleuritic- irritation of parietal pleura, thoracic wall or shoulder tip- referred intercostal/ phrenic N. Sharp, well localised, worse coughing/ inspiration

Cardiac - central, dull, poorly localised, heavy, radiate shoulder/ jaw

Mediastinal:

• acute coronary syndrome
• pericarditis
• oseophagitis/ GORD
• aortic dissection

Pleura:

• infection (causing pleurisy)
• pneumothorax
• PE (causing infarct)

Chest wall:

• rib fracture
• costochondritis
• shingles (varicella zoster)

Question 5

How does coughing occur ?

Answer 5

Stimulation of mechanical &/or chemo-receptors within airway by any source of irritation e.g. inflammation, foreign body

Cough stimulus -> larynx/ trachea/ bronchi -> afferent limb Vargas nerves -> central control cough -> efferent limb motor nerves -> larynx and resp muscles contraction of ICs & abdo muscles increasing intrathoracic pressure with adduction then aBduction VCs-> cough

Question 6

Questions to ask about a cough

Answer 6

Dry or productive: colour, quantity, haemoptysis

Character: bovine (can’t adduct VCs), seal e.g. Croup

Timing - night, seasonal

Commonest causes URTI but can be a sign of more serious/ chronic disease

Question 7

What are different conditions coughs like?

Answer 7

Chronic bronchitis & COPD - clear sputum

Yellow/ green sputum (live/ dead neutrophils) with increasing volume - infection

Large volumes yellow/ green mucous - bronchiectasis

Haemoptysis 🚩 (TB, lung cancer, bronchitis, pneumonia, bronchiectasis)

Question 8

What are some non-respiratory causes of a cough?

Answer 8

LV heart failure
(Pink frothy sputum)

GORD (worse lying flat)

Drugs e.g. ACE- inhibitors

Question 9

What’s a wheeze

Answer 9

An abnormal breath sound indicating narrowing within airway causing turbulent air flow

• high pitched ‘musical’
  Mostly on expiration, narrowing in intrathoracic airways e.g. bronchial smooth muscle contraction/ oedema/ mucous

Exacerbated during expiration

Question 10

What is stridor?

Answer 10

Abnormal breathing sound indicating narrowing within airway causing turbulent airflow

High pitched, constant, loud mostly on inspiration, indicates narrowing in extrathoracic airway (supraglottis/ glottis/ infraglottis/ trachea)

Often audible without a stethoscope

Question 11

What might you find on inspection of someone with respiratory distress?

Answer 11

Raised RR

Cyanosis - lips/ face/ fingers

Clubbing - bronchiectasis, Lung cancer = chronic

Use of accessory muscles

Asymmetrical cysts expansion

Shape of chest e.g. barrel, lecture excavatum, pectus carinatum

Pursed lips breathing

Question 12

Types of cyanosis and causes

Answer 12

Bluish discolouration

Peripheral (feet, hands, nose, tips ears)

• cold exposure & decreased cardiac output
• slowing blood to peripheries (vasoconstriction)
• increased O2 extraction
• more deoxygenated blood present in that area

Central (lips and tongue - mucous memrbanes)

• significant cardiac or respiratory cause
• increased deoxygenated Hb arriving at tissues (dO2 blood leaving ❤️)

Question 13

Why might someone be doing pursed lips breathing, what’s a cause

Answer 13

Increases resistance to outflow on expiration - maintains intrathoracic airway pressures allowing for small airways to remain open for longer

Commonly seen in COPD

Question 14

What is a barrel shaped chest, what causes it

Answer 14

Increased AP diameter > lateral diameter

Chronic over-inflation of lungs (due to air trapping), hyperextending chest wall over time

Seen in severe COPD especially emphysema

Question 15

What might you find on palpation of someone with respiratory distress?

Answer 15

Tracheal position may be deviated towards pathology (pulmonary fibrosis) or away (tension pneumothorax, big pleural effusion)

Asymmetrical chest expansion

Question 16

What might you find on percussion of someone with respiratory distress?

Answer 16

Resonance might be hyperresonant increased air (pneumothorax, COPD)

Dull - consolidation (pneumonia, liver, heart disease)

Stony-dull (pleural effusion)

Question 17

What might you find on auscultation of someone with respiratory distress?

Answer 17

breath sounds:
Normal/ vesicular - rustling leaves, inspiration and first part expiration no gap

Bronchial breathing - blowing harsh sound, gap between inspiration and expiration e.g. consolidation, cavitation, tension pneumothorax, massive pleural effusion

Reduced or absent sounds e.g. simple pneumothorax

added sounds:
like wheeze e.g. asthma/ ❤️failure/ COPD

or stridor e.g. croup/ epiglottitis/ foreign body/ laryngeal cancer

Or crackles - snapping open of alveoli/ small bronchi. Fine -> pulmonary fibrosis, consolidation, course-> COPD, bronchiectasis

Or pleural rub - scratching, coarse, inflammation of pleura e.g. pleurisy, pleural effusion