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Respiratory > Clinical signs and symptoms of respiratory disease > Flashcards

Clinical signs and symptoms of respiratory disease Flashcards

1
Q

What are the different parts of the respiratory system that can be affected by disease?

A

Airways
Lung parenchyma
Pulmonary circulation
Pleura
Chest wall shape and neuromuscular

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2
Q

Diseases involving the airway

A

Asthma
COPD
Bronchiectasis
Cystic fibrosis

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3
Q

Diseases affecting the lung parenchyma

A

Pulmonary fibrosis
Pneumonia
TB

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4
Q

Diseases affecting the pulmonary circulation

A

Pulmonary embolism

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5
Q

Disease affecting the pleura of the lung

A

Pneumothorax
Pleural effusion

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6
Q

Disease affecting the chest wall shape and neuromuscular system

A

Kyphoscoliosis
Myasthenia gravis

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7
Q

Key signs and symptoms of respiratory disease

A

Dyspnoea
Chest pain
Cough
Haemoptysis
Sputum production
Wheeze
Stridor
Percussion - dull, hyper resonant, stoney dullness

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8
Q

How can the subjective symptom of breathlessness be confirmed with objective evidence?

A

Tachypnoea
Accessory muscle use

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9
Q

What other conditions can be associated with SOB?

A

Anaemia
Heart failure
Obesity

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10
Q

What are the accessory muscles of respiration?

A

Scalene
Sternocleidomastoid
Pectoralis major
Trapezius
External intercostals

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11
Q

How can we explore breathlessness in more detail?

A

ODPARAS

Onset - when, trigger? acute vs chronic
Duration
Progression - better/worse, worse at particular times?
Aggravating factors - eg cold air, lying down, pets/pollen
Relieving factors
Anything else
Severity - stairs difficult? cannot walk? cannot speak in full sentences?

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12
Q

Pleural causes of chest pain

A

Infection - pneumonia
Pneumothorax
Pulmonaru embolism

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13
Q

Mediastinal causes of chest pain

A

ACS
Pericarditis
Oesophagitis/GORD
Aortic dissection

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14
Q

Chest wall causes of chest pain

A

Rib fracture
Costochondritis
Shingles - varicella zoster

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15
Q

Two types and areas of chest pain

A

Pleuritis vs cardiac
Central vs non-central

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16
Q

Cardiac pain is…

A

Central, crushing pain which may radiate down left arm or jaw

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17
Q

What causes pleuritic pain?

A

Irritation of the parietal pleura

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18
Q

Pleuritic pain is…

A

Thoracic wall or shoulder tip pain - referred via intercostal nerve or phrenic nerve
Sharp, well localised - WORSE on inspiration and coughing

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19
Q

Why do we cough?

A

Explosive expulsion of air to ensure no inhalation of foreign particles - protective

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20
Q

Describe cough reflex

A

Stimulus is sensed by chemo/mechanoreceptors in larynx, trachea or bronchi
Afferent arm of vagus nerve stimulates central cough control centre in brain
Efferent vagus nerve fibres stimulate laryngeal and respiratory muscles to contract to adduct vocal cords and build intrathoracic pressure
Vocal cords then abduct and air is expelled as cough

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21
Q

Which muscles contract in cough reflex?

A

Diaphragm and internal intercostal muscles contract to build intrathoracic pressure

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22
Q

What happens to vocal cords in cough?

A

Initially adducted to build pressure of cough
Then abduct to allow expulsion of air

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23
Q

Types of cough

A

Productive - if sputum need to ask about colour, amount and if there is any blood
Character - bovine (epiglottitis) or barking (croup)
Timing - chronic? worse at night? seasonal?

24
Q

What can a prolonged cough suggest?

A

Cancer

25
Q

Commonest cause of cough

A

URTI

26
Q

What sputum does COPD/chronic bronchitis produce?

A

Clear - no active infection

27
Q

What sputum does a respiratory infection produce?

A

Yellow/green

28
Q

What conditions produce large amounts of sputum?

A

Bronchiectasis (could be CF causing this if in young person)

29
Q

What causes bloody sputum?

A

Potential red flag - could be lung cancer, Tb

30
Q

Respiratory causes of cough

A

Any irritation of:
Airways - upper and lower
Parenchyma
Pleura

31
Q

What causes wheeze and stridor?

A

Narrowing within the airway causes turbulent air flow

32
Q

What is a wheeze?

A

High pitched sound caused by narrowing of INTRATHORACIC airways (after bifurcation into L and R main bronchus, deeper than this)

Mostly on/exacerbated by EXPIRATION

May only be audible with stethoscope

33
Q

What can cause a wheeze?

A

Bronchial smooth muscle contraction - asthma, oedema, mucus - COPD

34
Q

What is stridor?

A

High pitched, constant loud sound

Mostly on/exacerbated by INSPIRATION

Indicates narrowing of EXTRATHORACIC airways - eg supraglottis, glottis infraglottis, or trachea

Often audible without stethoscope

35
Q

Clinical examination of patient for respiratory

A

Patient comfortable
Breathless at rest? or when speaking?
Elevated resp rate
Closer inspection of hands, face and chest

36
Q

What do you look for on hands and face for respiratory patients?

A

Peripheral cyanosis - feet, hands, nose and tips of ears

Central cyanosis - lips and tongue

37
Q

Cause of peripheral cyanosis

A

Cold exposure or decreased cardiac output
= slowing of blood to peripheries (due to vasoconstriction)
Increased O2 extraction - has more time as slower
So more deoxygenated O2 is present there

38
Q

Cause of central cyanosis

A

Significant cardiac or respiratory cause - O2 sats need to be below 85%
Increased amount of deoxygenated Hb in blood arriving at tissues - deoxygenated blood is leaving the heart

39
Q

3 visible signs showing respiratory problem

A

Clubbing
Accessory muscles of respiration being used
Barrel chest
Pursed lip breathing

40
Q

Causes of clubbing

A

Cyanotic heart defect/cystic fibrosis
Lung cancer/abscess
Ulcerative colitis
Bronchiectasis
Benign mesothelioma
Infective endocarditis/idiopathic pulmonary fibrosis
Neurogenic tumours
GI disease

CLUBBING

41
Q

In what disease does purse lip breathing occur?

A

COPD

42
Q

Why does pursed lip breathing occur?

A

Increases resistance to outflow on expiration
Maintains intrathoracic airway pressures allowing for small airways to remain open for longer
This prolongs gas exchange period and allows more air to empty (rather than get trapped)

43
Q

What is barrel chest?

A

Increased anterior-posterior diameter
AP > lateral diameter (shoulder to shoulder)
Associated with hyperinflated lungs in severe COPD (esp emphysema)

44
Q

Why does barrel chest occur?

A

Chronic over inflation of lungs due to air trapping hyper expands the chest wall over time

45
Q

What do you palpate in respiratory exam?

A

Trachea - is it central or deviated? deviated can suggest tension pneumothorax/mass/something pushing it over

Chest expansion - is it symmetrical? asymmetry could suggest pneumothorax

46
Q

What are some results of percussion of chest?

A

Resonant = normal
Hyper-resonant = increased air so pneumothorax
Dull = consolidation so pneumonia etc
Stoney dull = pleural effusion/liquid present

47
Q

What are normal sounds on auscultation of lungs known as?

A

Vesicular - normal sounds

48
Q

What is vesicular lung sounds?

A

Rustling leaves
Hear inspiration and first part of expiration - and no gap between the two
Inspiration is longer and louder

49
Q

What does bronchial breathing sound like?

A

Blowing harsh sound
Inspiration and expiration heard fully - same length and loudness of both, with a GAP between the two

50
Q

4 types of lung sounds

A

Vesicular - normal
Bronchial - blowing
Reduced/absent - pneumothorax?
Added sounds - wheeze or stridor, crackles, pleural rub

51
Q

`What causes bronchial breathing?

A

Consolidated alveoli act like a solid
Conduct the breath sounds from the larger airways more readily

52
Q

What causes crackles in lungs?

A

Snapping open of alveoli/small bronchi

53
Q

What causes fine crackles?

A

Pulmonary fibrosis

54
Q

What causes course crackles?

A

COPD
Bronchiectasis

from air bubbling through mucus secretions, sound more concrete than fine crackles

55
Q

What is a pleural rub?

A

Caused by inflammation of the pleura eg pleurisy
Scratching, course sound

56
Q

4 steps of examination

A

Inspection
Palpation
Percussion
Auscultation

Respiratory (21 decks)

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