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3 - Respiratory > Symptoms and Signs of Respiratory Disease > Flashcards

Symptoms and Signs of Respiratory Disease Flashcards

1
Q

State the 6 common symptoms of respiratory disease

A
  • Dyspnoea
  • Cough
  • Chest pain
  • Sputum production
  • Haemoptysis
  • Wheeze
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2
Q

State the common causes of dyspnoea

A
  • Anaemia
  • Obesity
  • Instantaneous
    • Pulmonary embolism
    • Pneumothorax
  • Acute (minutes to hours)
    • Asthma
    • Pulmonary embolism
    • Pneumonia
    • LVF/MI
  • Gradual (days)
    • Lobar collapse (lung cancer)
    • Pleural effusion
  • Chronic (months to years)
    • COPD
    • Idiopathic pulmonary fibrosis
    • Bronchiectasis - persistent inflammation leads to loss of elastin, causing dilation of airways
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3
Q

Outline how coughing is stimulated

A
  • Irritation in the respiratory epithelium, oesophagus (reflux) or diaphragm (hiccups)
  • Irritation detected by mechano and/or chemoreceptors
    • Eg. When a pathogen becomes caught in the cilia, movement of the cilia detected by mechanoreceptors and cough occurs
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4
Q

State the common causes of cough

A
  • Respiratory - viral, bronchopneumonia, bronchiectasis, post nasal drip, asthma, COPD, lung cancer
  • Cardiovascular - left ventricular failure
  • Gastrointestinal - gastro-oesophageal reflux
  • Drugs - ACE inhibitors, inhaled drugs
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5
Q

Describe the common causes of chest pain

A
  • Cardiac - tight, heavy, constricting
  • Pericarditis - central pain relieved by sitting forward, viral
  • Oesophageal pain - burning pain from reflux, ‘nutcracker’ oesophagus from oesophagus spasm in elderly
  • Chest wall - costochondritis (localised tenderness from pain in sterno-chondral joints), rib fracture, Herpes Zoster
  • Pleuritic chest pain - pleurisy, pulmonary embolism, pneumothorax, pericarditis
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6
Q

Define wheeze and state causes of it

A
  • Wheeze refers to a noisy musical sound produced by turbulent flow through narrow small airways mostly in expiration
    • Asthma
    • COPD
      • Bronchiolitis
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7
Q

Explain why and when wheezing occurs

A
  • Bronchial smooth muscle contraction, oedema and mucus production induces turbulent flow through narrow airways
  • Prominent on expiration as increased pressure intra-thoracic compresses against airway
  • Nocturnal wheeze - increased parasympathetic tone at night so airways are narrower (asthma)
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8
Q

Define stridor and state causes of it

A
  • Coarse inspiratory wheeze
  • Caused by extra-thoracic upper airways obstruction
  • Epiglottitis, croup, aspirated foreign body, extrinsic compression (large goitre)
  • During inspiration, negative pressure within trachea causes narrowing of airway
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9
Q

List causes of sputum production

A
  • Allergy
  • Infection - yellow or green sputum
  • Bronchiectasis - foul smelling sputum
  • COPD
  • Pneumonia
  • Smoking/pollution
  • Acute asthma
  • Lung cancer
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10
Q

List causes of haemoptysis

A
  • Infection - pneumonia, TB, bronchiectasis, bronchitis
  • Lung cancer
  • Pulmonary embolism
  • Anticoagulation
  • LVF
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11
Q

What should be asked in a patient history of respiratory disease

A
  • Childhood illness
  • Pets
  • Occupation
  • Travel
  • Smoking
  • Medication
  • Allergic symptoms
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12
Q

Describe the causes of cyanosis

A
  • Central - cardiac or respiratory cause where failure to oxygenate blood
    • Congenital cardiac disease with right to left shunt
    • Severe respiratory diseases - COPD, severe pneumonia, severe bronchospasm (asthma attack)
  • Peripheral cyanosis - cold exposure, Raynaud’s disease
    • Patients with central cyanosis will have peripheral cyanosis
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13
Q

List causes of clubbing in the fingers

A
  • Cyanotic heart disease
  • Lung cancer, mesothelioma
  • Bronchiectasis
  • Empyema - presence of pus in pleural cavity
  • Idiopathic pulmonary fibrosis
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14
Q

Describe when accessory muscles of breathing are used

A
  • Accessory inspiratory muscle used of adequate pulmonary ventilation cannot be achieved by normal inspiratory efforts
    • Emphysema, asthma attach, stridor due to laryngeal or tracheal obstruction
  • Accessory expiratory muscle used if the elastic recoil of the lungs is insufficient to empty the alveoli or in expiratory airway obstruction
    • Emphysema, chronic bronchitis, asthma
    • Grasp a table to fix the shoulder and use accessory expiratory muscles to aid expiratory breathing
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15
Q

Explain why patients have pursed lip breathing

A

Not letting alveoli from deflating fully allows it to more easily inflate in the next breath (emphysema)

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16
Q

Explain why patients have barrel chest

A

Emphysema, loss of elastin allows chest expansion and diaphragm to lower and become flat

17
Q

Describe causes of brachial and mediastinum deviation

A
  • Tracheal deviation away from affected side - tension pneumothorax, pleural effusion
  • Tracheal deviation towards affected side - lung or lobar collapse, pulmonary fibrosis
    • Lung loses its elasticity causing collapse
    • In obstruction of lung, remaining air is absorbed into the blood and the affected lung is collapsed onto by other areas of lung
18
Q

Describe areas of normal dull percussion on the chest

A
  • Anterior - over bones and muscle over shoulder, liver, stomach, heart
  • Posterior - over viscera, scapula, liver
19
Q

Distinguish between normal breath sound types

A
  • Tracheal breath sounds - loud, harsh, hollow
  • Bronchial breath sounds - loud, less harsh, hollow
  • Vesicular breath sounds - softer sound longer in inspiration
20
Q

Describe how breath sounds differ in lung conslidation

A
  • Increasing the density of the conducting medium increases sound conductance
    • Bronchial loud sounds heard in consolidation
  • Lung consolidation - solidification of lung tissue due to the filling of the lungs with liquid and solid material
21
Q

Describe abnormal sounds heard in breath sounds

A
  • Crackles - snapping open of airways or fluid in airways
    • Fine crackles - loud, low-pitched sounds found at end of inspiration, pulmonary fibrosis, consolidation, LVF
    • Coarse crackles - soft, high-pitched sounds in COPD, bronchiectasis
  • Wheeze - asthma, COPD, bronchiectasis
  • Pleural friction rub - grating sound found in pleurisy, pulmonary infarction
22
Q

Describe the chest abnormalities examined in pleural effusion

A
  • Stony dull percussion
  • Little chest movement
  • Mediastinal shift away from effusion
  • Softer breath sounds
  • Meniscus sign
23
Q

Describe the chest abnormalities examined in pneumothorax

A
  • Hyper-resonant percussion
  • Softer (or no) chest sounds
  • Little chest wall movement
  • Mediastinal shift away if tension
24
Q

Describe the chest abnormalities examined in consolidation

A
  • Dull percussion
  • Louder chest sounds, bronchial breathing
  • Crackles in chest sound
  • Little wall movement
  • No mediastinal shift
25
Q

Describe the chest abnormalities examined in lobar collapse

A
  • Mediastinal shift towards collapse
  • Dull percussion
  • Softer chest sounds
  • Little wall movement
26
Q

Describe the chest abnormality examined in left ventricular failure

A
  • Late to mid inspiratory fine crackles
27
Q

Define pleural effusion and state causes of it

A
  • Accumulation of excess fluid in the pleural space
  • Causes
    • Failure of absorption - hypoproteinaemia such as liver failure and nephrotic syndrome decreasing oncotic pressure
      • Congestive heart failure - venous end pressure increases so failure to absorb water
28
Q

Define empyema, haemothorax, chylothorax

A
  • Empyema - pus accumulation in the pleural cavity
  • Haemothorax- blood accumulation in the pleural cavity
  • Chylothorax - lymph accumulation in the pleural cavity due to disruption of obstruction of thoracic duct
29
Q

Distinguish between transudate and exudate and the causes of each

A
  • Transudate - due to increased hydrostatic pressure and decreased oncotic pressure
    • Low protein content
    • Clear appearance
    • Eg. Heart failure, nephrotic syndrome
  • Exudate - due to inflammation which increases vascular permeability
    • Increased protein content
    • Cloudy appearance
      • Eg. Infection, cancer, pulmonary infarction due to pulmonary embolism
30
Q

Describe the risk factors and cause of primary pneumothorax

A
  • Primary pneumothorax - most common in young, tall, thin males
  • Increased risk from smoking
  • Commonly has a small subpleural bulla (air filled sac) that bursts, allowing air into the pleural cavity
31
Q

List the causes of pneumothorax secondary to underlying disease

A
  • COPD
  • Asthma
  • Bronchiectasis
  • Lung cancer
  • Lung infections - pneumonia, TB
32
Q

Describe tension pneumothorax and its signs, symptoms and treatment

A
  • One way flap allowing air in during inspiration but not out during expiration
  • Leads to cardiac arrest due to compressed veins and vena cava from mediastinum shift
  • Signs and symptoms
    • Deviated mediastinum and trachea away from affect side
    • Hyper-resonate percussion sound
    • Breathless, cough, collapse, sweating
  • Treatment - cannula inserted into second intercostal space mid-clavicular line just above the rib below
33
Q

Explain the use of a chest drain

A
  • Inserted into the 5th intercostal space mid-axillary line
  • Used to remove air, fluid, blood, lymph, pus from the pleural space
  • Lets air out but not air back in
  • Chest drain is removed at the end of expiration (prevent air from re-entering)

3 - Respiratory (16 decks)

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