11. Signs And Symptoms Of Respiratory Disease

Question 1

What are the signs and symptoms of respiratory disease?

Answer 1

Breathlessness
Chest pain
Cough
Sputum 
Haemoptysis
Wheeze, stridor

Question 2

Give some examples of conditions not relating to respiratory system that present with breathlessness

Answer 2

Anaemia
Heart failure
Obesity

Question 3

What further questions should be asked about breathlessness?

Answer 3

Onset, timing and duration
Precipitating factors (better or worse)
Progression
Severity

Question 4

What can cause chest pain?

Answer 4

Pleura - infection, pneumothorax, PE
Chest wall - rib fractures, costochondritis, shingles
Mediastinal structures - ACS, pericarditis, oesophagitis/GORD, aortic dissection

Question 5

How is chest pain classified?

Answer 5

Central vs non-central

Cardiac (dull, central, radiating) vs pleuritic (sharp, well localised, worse with breathing in/coughing)

Question 6

Describe the cough reflex

Answer 6

Cough stimulus in larynx, trachea, bronchi
Afferent limb (vagus nerve) carries to central control cough
Efferent limb (motor nerves) carry to laryngeal and respiratory muscles
Cough

Question 7

How are coughs classified?

Answer 7

Productive - sputum (colour, consistency, blood)
Character - bovine, croup
Timing - night, weather

Question 8

What does clear sputum suggest?

Answer 8

chronic bronchitis or COPD

Question 9

What does a yellow/green sputum suggest?

Answer 9

Infection

Question 10

What does a large volume of yellow/green sputum suggest?

Answer 10

Bronchiectasis

Question 11

What are the non-respiratory causes of cough?

Answer 11

LV heart failure
GORD
Drugs - ACE inhibitors

Question 12

When is wheezing generally heard?

Answer 12

Expiration

Question 13

What physiological changes causes wheezing?

Answer 13

Narrowing in intrathoracic airways - bronchial smooth muscle contraction, oedema, mucus
Narrowing exacerbated during expiration
May only be audible with stethoscope

Question 14

What does stridor sound like?

Answer 14

High pitched, loud, constant

On inspiration

Question 15

What does stridor indicate?

Answer 15

Narrowing in extrathoracic airway - supraglottis, glottis, infraglttis, trachea
Narrowing exacerbated during inspiration

Question 16

What is inspected in a respiratory disease examination?

Answer 16

Raised RR
Clubbing
Peripheral cyanosis
Accessory muscle use 
Pursed lip breathing 
Barrel shaped chest

Question 17

What is palpated in resp examination?

Answer 17

Tracheal position

Chest expansion - symmetrical

Question 18

Describe percussion in resp examination

Answer 18

Resonant - normal
Hyper-resonant - increased air
Dull - consolidation (pneumonia)
Stony-dull - pleural effusion

Question 19

Describe the different auscultations in resp exam

Answer 19

Normal (vesicular) - rustling leaves, no gap between inspiratory and expiratory components
Bronchial - blowing harsh sound, inspiration and expiration, gap between
Reduced or absent
Wheeze or stridor
Crackles - snapping open of alveoli/small bronchi
Pleura rub - scratching, coarse sound, pleurisy

Question 20

When are fine crackled heard?

Answer 20

Pulmonary fibrosis

Question 21

When are coarse crackles heard?

Answer 21

COPD

Bronchiectasis