Sins And Synptoms O Resp Disease Flashcards
What are the main signs and symptoms of respiratory disease
Breathlessness, chest pain, cough, haemoptysis (blood from somewhere within airways - not vomited up), sputum, wheeze/stridor
some of these signs/symptoms are not necessarily ‘specific’ to the respiratory system
What is breathlessness
• Subjective awareness of increased effort required for breathing
• Symptom rather than a sign • …but objective evidence of breathlessness may be present (e.g. raised RR)
• Very common (often variably described)
• Common to all respiratory conditions • ..But not specific to respiratory conditions (e.g. anaemia, heart failure,
obesity)
What are causes of breathlessness
- Instant- Minutes - Pneumothorax, pe, acute asthma, FB
- Hours to Days - Pneumonia, acute exarcebatiom COPD, pleural effusion
- Weeks to months - Pleural effusion, lung cancer, anaemia
- Months to years- Copd, pulmonary fibrosis
What are further questions to explore dyspnoea
• Intermittent or constant?
Progression:
• Stable • Worsening over time
Preceipitating factors:
• Specific trigger(s)? • Factors exacerbating or relieving it? E.g. position, cold weather,
pets
Severity:
• Impact of breathlessness e.g. at rest, on exertion [how much
exertion?] • What does it stop you doing?
Where can chest pain come from
- Pleura
- Infection (causing pleurisy)
- Pneumothorax
- Pulmonary embolism (causing infarct)
- Chest wall
- Rib fracture
- Costochondritis
- Shingles (varicella zoster)
- Mediastinal structures
- Myocardial infarction
- Pericarditis
- Oesphagitis/GORD
- Aortic dissection
What is pleuritic chest pain
Irritation of parietal pleura causes pain that is sharp, localised and referred to thoracic wall (intercostal n) or shoulder tip (phrenic nerve)
What is a cough
- Important protective mechanism
- Triggered by stimulation of mechano- and/or chemo-receptors within airway
- By any source of irritation e.g. inflammation, foreign body!
- Forced expiratory effort against an initially closed glottis
- Build up intrathoracic pressure, followed by sudden opening of glottis
- Air expelled with high velocity!
Compare dry vs productive coughs
Asthma - eosinophils - whe/yellow - but for the most part dry
Pneumothorax - dry
Copd - chronic underlying oedema, mucus - productive
• Productive cough = sputum
• Volume, colour
• Presence of blood (haemoptysis)
• Character e.g. “bovine” (Bovine - weak - cant strongly adduct vocal chords), “seal-like” (croup)
• Timing e.g. nocturnal, time of the year
• Commonest cause is URTI
• But…can be a sign of more serious and/or chronic disease
What are resp I and non resp causes of cough
- Irritation of airways, lung parenchyma or pleura
- Acute infection (pneumonia)
- Bronchiectasis and cystic fibrosis
- Pulmonary fibrosis
- Lung cancer • Foreign body • Irritants e.g. smoking, occupational • Nasal and sinus disease (post-nasal drip)
- Non-respiratory causes
- LV heart failure (“pink frothy sputum”) • GORD • Drugs e.g. ACE-inhibitors
Describe sputum and haemoptysis
• Chronic bronchitis and COPD
What is a wheeze
• Wheeze: high pitched, “musical”
• Mostly on expiration
• Indicates narrowing in intrathoracic airways (small airways) - Turbulence of airflow
– E.g. from bronchial smooth muscle contraction, oedema, mucous
• Narrowing exacerbated during expiration
• May only be audible with stethoscope
What is stridor
- Stridor: high pitch, constant, loud
- Mostly on inspiration
- Indicates narrowing in extrathoracic airway
- Supraglottis, glottis, infraglottis or trachea
- Narrowing exacerbated during inspiration - Increasingly negative pressure as you expand the chest due to extrathorasic obstruction
- Often audible without stethoscope!
What are signs cuggetsive of respiratory disease
Inspection • Raised respiratory rate • Cyanosis • Central vs peripheral • Increased work of breathing • Accessory muscles • Pursed lip breathing • Barrel shaped chest • Clubbing - Lung cancer, bronchiectasis
Scribe use of accessory muscles
• Adequate ventilation not achieved by normal
inspiratory efforts
• More effort required to move air through airways
• e.g. narrowed
• Accessory muscles (SCM, scalenes, trapezius, abdominal muscles) help create greater negative intrathoracic pressure on inspiration
• Pulling more air in
• May cause tracheal tug
• Seen in patients with COPD and severe acute asthma
Describe cyanosis
• Peripheral can affect skin of feet, hands, nose and tips of ears
• Seen in cold exposure and decreased cardiac output
• Slowing of blood to peripheries (due to vasoconstriction)
- Increased oxygen extraction
- More deoxygenated blood present in that area
Eg when cold Blood vessels in fingers vasoconstriction, slows flow, so oxygen can be taken out much more effectively - proportion of does Hb starts o rise
• Central cyanosis: lips and tongue (mucous membranes).- Left the heart with not enough oxygen - far more concerning
• Indicates significant cardiac or respiratory cause
• Caused by increase in amount of deoxygenated Hb in blood
arriving at tissues [deoxygenated blood is leaving the heart]
