4-Signs and Symptoms of respiratory medicine Flashcards
(121 cards)
1
Q
list the core respiratory symptoms
A
- -SOB
- -cough
- -hemoptysis
- -sputum production
- -pleuritic chest pain
- -wheezing
- -chest tightness
- -fever/chills
- -night sweats/rigors
- -weight loss
2
Q
what is the differential diagnosis of SOB?
A
- -COPD
- -CHF
- -asthma
- -PE
- -ILD
3
Q
what are the URT causes of cough?
A
- URTI
- Sinusitis
- Rhinitis
- Post nasal drip
4
Q
what is the post-nasal drip syndrome (Upper airway cough syndrome)?
A
Abnormally increased nasal mucus secretion that drips down the back of the throat and can lead to coughing, a feeling of obstruction in the throat, and throat clearing. Causes include allergies, cold temperatures, viral or bacterial infections, dry air, and certain medications. First-line treatment includes first-generation antihistamines (e.g., diphenhydramine). UACS was previously referred to as post-nasal drip syndrome.
5
Q
example of GI cause of cough?
A
GERD (especially nighttime cough)
6
Q
what are the LRT causes of cough?
A
- LRTI / Pneumonia
- TB
- Asthma
- COPD
7
Q
which medications are commonly associated with cough?
A
ACE inhibs, b-blockers, aspirin
8
Q
what are the causes of increased sputum production?
A
Upper respiratory tract • Post nasal drip Lower respiratory tract • LRTI / Pneumonia • TB • Bronchiectasis • COPD
9
Q
what are the causes of hemoptysis?
A
- Bronchogenic neoplasm
- Pneumonia
- TB
- Bronchiectasis
- PE
10
Q
what conditions should be ruled out before diagnosis of hemoptysis?
A
epistaxis, haematemesis
**CHF – pink frothy sputum
11
Q
what are the causes of pleuritic chest pain?
A
- Pulmonary Embolus
- Pneumonia
- Pneumothorax
12
Q
does pleural effusion cause pleuritic chest pain?
A
- chest discomfort, not classically pleuritic
13
Q
what is the night sweating?
A
Drenching sweats unrelated to room temperature, where the patient has to change clothes and bed clothes. Not just sweating at night!
** Prolonged symptom – weeks to months
14
Q
what are the causes of night sweating?
A
• TB
• Empyema
• Lung abscess
Non pulmonary DDx – Lymphoma, Renal cell carcinoma
15
Q
what are the causes of wheezing?
A
Hallmark of obstructive airways disease o Asthma o COPD o Bronchiectasis o Type 1 hypersensitivity allergic reaction
16
Q
what are the respiratory causes of rigors?
A
• Septicaemia (pneumonia) • TB • Empyema • Lung abscess Non pulmonary DDx - pyelonephritis
17
Q
what are the respiratory causes of weight loss?
A
• Is a very non-specific symptom, present in many non-pulmonary conditions. GI causes need to be out-ruled. • Bronchogenic neoplasm • TB • Empyema End stage COPD
18
Q
what are the features and characteristics of COPD?
A
- Smoker > 20 pack years
- Age > 50 years
- Duration of symptoms – years
- SOB on exertion ® SOB at rest
- ± Productive cough
- Acute exacerbations - SOB, wheeze, chest tightness
- Associated LRTI – dirty sputum
- Onset- days to weeks
- Relief with bronchodilators, steroids, antibiotics
- Frequent hospital & GP visits
19
Q
what is the acute exacerbation of COPD?
A
An acute worsening of the manifestations of chronic obstructive pulmonary disease (typically characterized by increased frequency or severity of cough, increased sputum volume or change in sputum consistency, and/or increased dyspnea). Caused by an underlying infection (e.g., viral or bacterial pneumonia) in ~ 80% of cases.
20
Q
what are the signs and symptoms of COPD?
A
- -Chronic cough with expectoration (expectoration typically occurs in the morning)
- -Dyspnea and tachypnea
1) Initial stages: only on exertion
2) Advanced stages: continuously - -Pursed-lip breathing
- -End-expiratory wheezing, crackles, muffled breath sounds, and/or coarse rhonchi on auscultation
- -Tachycardia
- -Cyanosis
- -Often weight loss and cachexia
21
Q
what are the clinical features of bronchiectasis?
A
- Productive Cough, Viscid mucus
- Recurrent LRTIs
- Wheeze
- Haemoptysis
- Chronic/ long history
22
Q
what are the causes of bronchiectasis?
A
1) LOCALISED
- -Measles, pertussis
- -TB
- -Pneumonia
- -ABPA
2) GENERALISED
- -Cystic Fibrosis
- -Kartagener’s
- -Young’s Syndrome
- -Immunoglobulin deficiency
23
Q
what are the features of asthma?
A
- Younger age group, non-smokers
- New-onset vs. established Dx (years)
- Intermittent symptoms**
- SOB, wheeze, dry cough, chest tightness
- Nocturnal symptoms
- Relieved by b2 agonists
- Acute exacerbation: Onset: hours ® days
- Precipitating factors: URTI, dust, perfumes, food substances, animal dander, seasonal variation, stress, exercise-induced.
- Personal Hx: Eczema, hay fever, atopy
- Family history
24
Q
what are the precipitating factors of asthma?
A
Precipitating factors: URTI, dust, perfumes, food substances, animal dander, seasonal variation, stress, exercise-induced.
25
Does asthma occur in young or elderly?
Allergic asthma: typically in childhood
| Nonallergic asthma: typically > 40 years
26
what are the features of pulmonary embolus?
* Main symptoms: SOB++, Pleuritic chest pain+
* ± Cough, ±haemoptysis
* Unilateral calf swelling + tenderness
* Absence of obstructive airways disease or infective symptoms
27
what are the signs and symptoms of PE?
- -Acute onset of symptoms, often triggered by a specific event (e.g., on rising in the morning, sudden physical strain/exercise)
- -Dyspnea and tachypnea (> 50% of cases)
- -Sudden chest pain (∼ 50% of cases), worse with inspiration
- -Cough and hemoptysis
- -Possibly decreased breath sounds, dullness on percussion, split-second heart sound audible in some cases
- -Tachycardia (∼ 25% of cases), hypotension
- -Jugular venous distension
- -Low-grade fever
- -Syncope and shock with circulatory collapse in massive PE (e.g., due to a saddle thrombus)
- -Symptoms of DVT: unilaterally painful leg swelling
28
what is the idiopathic pulmonary fibrosis?
The most common interstitial lung disease. Characterized by irreversible pulmonary fibrosis and impaired pulmonary function. The conditions takes an insidious course that initially presents with exertional dyspnea that progresses to dyspnea at rest, persistent nonproductive cough, and fatigue. Progression to respiratory failure usually occurs within 3–7 years.
29
what are the features of idiopathic pulmonary fibrosis?
* Age > 60 years
* M > F
* Presenting symptom: SOB on exertion
* Onset of symptoms: 6 ® 12 months
* Progressive: from SOBoE to SOB at rest
* ± Dry cough
30
what are the features of URTI?
* Pharyngitis, sinusitis, rhinitis, coryza
* Short, acute Hx (1-3 days)
* Very common, all age groups
* Fever, chills, myalgia
* Sore throat
* Blocked/runny nose, sneezing
* Dry or productive cough
31
what are the signs and symptoms of atypical pneumonia
* Prolonged Hx - 2®4 weeks
* Malaise, myalgia, headaches
* Ear pain, diarrhoea
* Dry cough, SOB
* Unresponsive to penicillins/cephalosporins
32
why atypical pneumonia is unresponsive to penicillins?
cause common causes like chlamydia and mycoplasma lack cell wall
33
what are the features of lung cancer?
* Mainly smokers
* Symptom duration: Weeks ® Months
* Haemoptysis
* SOB (pleural effusion, atelectasis)
* Weight loss
* Prolonged dry cough
* Persistent hoarseness
* Bone pain, jaundice, headaches (metastases
34
what are the features of CHF?
* Age > 50 years
* Background: IHD, Valvular HD
* SOB on exertion - SOB at rest
* Orthopnoea, PND, ankle edema
* Relieved by diuretics
* Chronic CCF onset: weeks - months
* Acute pulmonary edema: minutes - hours
35
what is the orthopnea?
A sensation of shortness of breath that occurs upon lying down and is relieved by sitting up. Left ventricular failure is a common cause.
36
what is the paroxysmla nocturnal dyspnea?
A symptom characterized by nocturnal bouts of coughing and acute shortness of breath resulting from the effect of lying in a supine position, which increases pulmonary venous congestion as well as reabsorption and redistribution of edema.
37
what is the pneumothorax?
A collapsed lung caused by the loss of negative pressure between the visceral and parietal pleural membranes that occurs when air abnormally enters the pleural space. Manifestations include pleuritic chest pain, dyspnea, tachycardia, and reduced breath sounds on the ipsilateral side.
• Acute unilateral pleuritic pain
• Acute SOB
Any age group
Marfanoid features (rare)
Definite clinical signs (± CXR) – confirm diagnosis
38
what is the primary spontaneous pneumothorax?
1) Ruptured subpleural apical blebs
2) Risk factors
- -Family history
- -Male gender
- -Asthenic body habitus (slim, tall stature) (e.g., in Marfan syndrome)
- -Smoking: 90% of cases; up to 20-fold increase in risk (risk increases with cumulative number of cigarettes smoked)
- -Homocystinuria
39
what are the features of empyema?
* Pus in the pleural space
* Duration: weeks to months
* Fever, chills, rigors, night sweats, weight loss, chest discomfort, SOB
* At risk: Elderly, intellectual disability, long term care, aspiration/swallowing difficulties, poor dentition, alcohol abuse.
40
who is at risk for empyema?
Elderly, intellectual disability, long term care, aspiration/swallowing difficulties, poor dentition, alcohol abuse.
41
what are the P/E signs of CO2 retention on hands?
warm bounding pulse, dilated veins, asterixes – almost exclusive to chronic severe COPD
42
what is the clubbing?
A physical finding characterized by painless swelling of the distal phalanges. Often defined by an angle ≥ 180° between the base of the nail and its surrounding skin (Lovibond angle). The nailbed often feels spongy when pressed and springs back when released. Typically associated with chronic hypoxemia (e.g., cardiac shunts, interstitial lung disease, lung cancer, cystic fibrosis), though patients with COPD alone typically do not develop this finding. Thought to be due to fibrovascular proliferation in the region of the nail bed due to accumulation of megakaryocytes in digital vessels that are normally filtered in the lung.
43
what are the causes of nail clubbing?
--Commonly chronic hypoxemia (including congenital heart disease, cardiac shunts, interstitial lung disease, cystic fibrosis, and lung cancer)
• Malignancy – lung carcinoma, mesothelioma
• Pulmonary fibrosis - cryptogenic fibrosing alveolitis, asbestosis
• Suppurative lung diseases – empyema, lung abscess, bronchiectasis
- -COPD does not cause nail clubbing and a COPD patient with nail clubbing is concerning for underlying malignancy.
- -Can also be seen in hypertrophic osteoarthropathy: a syndrome (either hereditary or paraneoplastic) that manifests with painful nail clubbing, synovial effusions, and periostitis
44
does COPD cause clubbing?
COPD does not cause nail clubbing and a COPD patient with nail clubbing is concerning for underlying malignancy.
45
in what conditions trachea is pulled towards the abnormal site?
atelectasis, pneumothorax, unilateral fibrosis, pneumonectomy
46
in what conditions trachea is pushed towards the normal site?
large pleural effusion, tension pneumothorax
47
what are the causes of symmetrically reduced chest expansion?
* Obstructive lung disease
| * Restrictive lung disease
48
what are the causes of asymmetrically (unilaterally) reduced chest expansion?
* Pneumothorax
| * Pleural effusion
49
what is the tactile fremitus?
A part of the pulmonary examination used to evaluate the conduction of vibrations to the chest wall produced during speech. Palpate the posterior chest wall with the ulnar aspects of both hands while the patient says a phrase such as "toy boat". Fremitus becomes more pronounced in the presence of consolidation and less pronounced in the presence of effusion or pneumothorax. The examiner can also assess fremitus with a stethoscope on the chest wall (vocal fremitus).
50
what are the causes of increased and decreased tactile vocal fremitus?
* Increased – only one condition: consolidation (pneumonia)
| * Decreased or absent – pleural effusion, pneumothorax, atelectasis
51
percussion of the lung fields assesses?
A part of the pulmonary examination. Hyperextends your nondominant middle finger and place the distal interphalangeal joint over the lung fields. Strike the joint with the other middle finger and evaluate the elicited sound. Pathologic findings include hyperresonance (e.g., in pneumothorax) and dullness (e.g., in pleural effusion, consolidation).
52
what is the interpretation of lung percussion?
* Assesses the density of whatever is under the chest wall (doesn’t have to be lung)
* Hyper-resonant/ Resonant/ Dull/ Stony dull
* Air > lung > consolidation > fluid
* Hyper-resonant - pneumothorax, COPD
* Resonant – normal
* Dull – pneumonia, atelectasis, tumour
* Stony dull – pleural effusion (includes haemothorax, chylothorax, empyema).
53
hyper resonant percussion indicates...
- -Louder and hollower than normal
| - -Sign of increased air inside the thoracic cavity: emphysema, bronchial asthma, pneumothorax
54
dull percussion indicates...
- -Muffled and softer note
| - -Sign of fluid inside the thoracic cavity: pneumonia, pleural effusion
55
what are the physiological breath sounds?
1) Vesicular breathing
- -Soft and low pitched, through inspiration and part of expiration
- -Heard over both lungs
2) Bronchovesicular breathing
- -Intermediate intensity and pitch, through both inspiration and expiration
- -Heard over 1st and 2nd intercostal spaces
3) Bronchial breathing
- -Loud and high pitched, through part of inspiration and all of expiration
- -Heard over the sternum
4) Tracheal breathing
- -Very loud and high pitched, through both inspiration and expiration
- -Heard over the neck
https://www.easyauscultation.com/ listen to the breath sounds here
56
what are the pathological breath sounds?
1) Crackles or rales: discontinuous, intermittent
- -Fine : soft, high-pitched
- -Coarse : loud, low-pitched
2) Wheezes: musical, prolonged
3) Rhonchi: low-pitched, snoring
4) Stridor: high-pitched, over trachea which may occur on:
- -Inspiration (inspiratory stridor): narrowing of the extrathoracic airway; characteristic of epiglottitis, pseudocroup, foreign body aspiration, bilateral vocal cord palsy
- -Expiration (expiratory stridor): obstruction of the intrathoracic airways; characteristic of bronchial asthma, COPD
- -Inspiration and expiration (biphasic stridor): obstruction at the level of the glottis
5) Pleural friction rub: scratchy, high-frequency sound
6) Muffled or absent breath sounds: suggest presence of air or fluid between the lung and the chest wall
57
do crackles influence by cough?
no
Caused by the sudden opening of small airways, classically described as velcro being separated, typically heard mid-to-late inspiration, uninfluenced by cough, gravity, or body position
58
what are the causes of fine crackles?
normal, asbestosis, sarcoidosis (ILD)
59
coarse crackles are typically heard during expiration or inspiration?
Both, more expiration
Produced by pockets of air passing through airways as they open and close intermittently. Tend to occur early during inspiration and throughout expiration with popping quality
60
fine crackles are typically heard during inspiration or expiration?
late inspiration!!!!
61
what are the causes of coarse crackles?
COPD, pulmonary edema
62
what are the causes of wheezing?
asthma, bronchitis, bronchiectasis, anaphylaxsis
63
do rhonchi affected by cough?
Yes
| secretions, typically clear with coughing
64
what are the causes of bronchial breathing?
normal over the sternum
- -Direct transmission of tracheal sounds to the chest wall
- -i.e. very loud and clear
- -Due to consolidation
65
wheezing is expiratory or inspiratory?
* is always an expiratory sound although there may also be an inspiratory component in severe disease
* Is almost always bilateral
* Indicates obstructive airways disease i.e. Asthma, COPD, bronchiectasis, type 1 allergic reaction
66
crackles are inspiratory or expiratory?
* usually an inspiratory sound
* Indicative of fluid in the alveoli
* Pneumonia, fibrosis, bronchiectasis, pulmonary oedema
67
rub indicates...
* Indicates pleural inflammation
* Is heard throughout inspiration and expiration
* Pulmonary infarct, pneumonia, chest drain
68
bilateral lung signs are seen with what conditions?
* COPD
* CCF
* Idiopathic pulmonary fibrosis
* Pulmonary embolism
* Bronchiectasis
69
unilateral lung signs are seen with what conditions?
* Pleural effusion
* Pneumothorax
* Pneumonia
* Atelectasis
* Empyema
* Lung cancer
* Old TB
* Pneumonectomy
70
bibasilar crepitations are characteristic for?
- -common: CHF and Cryptogenic fibrosing alveolitis
| - -uncommon: bilateral pneumonia, bronchiectasis
71
what are the causes of unilateral crepitations?
- -common: pneumonia, bronchiectasis
| - -uncommon: CHF and Cryptogenic fibrosing alveolitis
72
what are the causes of bilateral pleural effusions?
CHF
liver failure
renal failure
73
are CHF caused pleural effusions transudative or exudative?
transudative
74
what are the causes of unilateral pleural effusions?
- -parapneumonic effusion
- -neoplasia
- -TB
- -pulmonary infarction usually due to PE
75
effusion in PE is transudative or exudative?
exudative!!!!!!!
76
what are the signs of CO2 retention in COPD?
```
• Warm sweaty palms/Dilated veins
• Bounding pulse
• Chemosis
• Asterixes
(only in chronic severe COPD)
```
77
what are the P/E signs of hyperinflation in COPD?
* Barrell shaped chest
* Decreased cricosternal distance
* Reduced chest expansion
* Impalpable apex beat
* Hyper-resonance on percussion
* Absent cardiac dullness on percussion
* Liver ptosis (on percussion)
78
what happens to tactile fremitus in COPD?
normal or decreased
79
what is the cricosternal distance?
The cricosternal distance is the distance between the inferior border of the cricoid cartilage and the sternum. ... A reduction in the crico-sternal distance and tracheal tug signify marked chest hyperexpansion, usually COPD.
80
what are the findings on auscultation in COPD?
diminished intensity vesicular breath sounds bilaterally, with expiratory wheeze throughout both lung fields
81
does mediastinum is displaced in COPD?
no
| but there is long narrow heart shadow
82
what are the P/E findings in CHF
* Tachypnoea, tachycardia, low volume pulse, ± hypotension
* Palpation, fremitus, percussion: unimpressive
* Auscultation Diminished intensity vesicular breath sounds bilateral, with crepitations bibasally
* Peripheral signs: JVP, ± hepatomegaly (mild, tender), ± ascites, bilateral ankle edema or sacral edema
83
din CHF, what happens to tactile fremitus?
Palpation, fremitus, percussion: unimpressive
84
in CHF, auscultation reveals...
Diminished intensity vesicular breath sounds bilateral, with crepitations bibasally
85
what are the peripheral P/E signs in CHF?
Peripheral signs: JVP, ± hepatomegaly (mild, tender), ± ascites, bilateral ankle edema or sacral edema
86
what is the JVP?
A physical examination technique to estimate jugular venous pressure. The patient is placed in supine position with the torso elevated to 45 degrees and the head rotated away from the examiner. Determine the vertical distance between the upper limit of visible distention of the internal jugular vein and the sternal angle. A distance > 4 cm is considered elevated. Conditions associated with elevated JVP include right-sided heart failure, fluid overload, pulmonary hypertension, cardiac tamponade, and constrictive pericarditis.
87
what are the P/E signs in cryptogenic fibrosing alveolitis?
* Tachypnoea, clubbing
* Chest expansion
* Tactile fremitus, percussion: unremarkable
* Auscultation: diminished intensity vesicular breath sounds with fine end-inspiratory creps bibasally
88
auscultation in cryptogenic fibrosing alveolitis reveals coarse crackles. True/False
False
| Auscultation: diminished intensity vesicular breath sounds with fine end-inspiratory creps bibasally
89
what are the P/E signs in PE?
Common findings
• Tachypnoea, tachycardia
• Normal chest findings
```
Rare findings
• Pleural rub
• Minor bibasal atelectasis
• Small pleural effusion
• Signs of right heart failure
```
90
why pleural rub can be seen with PE?
due to pulmonary infarction
91
what are the P/E findings in bronchiectasis?
* Clubbing, copious amounts of dirty sputum
* Expansion, fremitus, percussion: nonspecific
* Auscultation: decreased intensity vesicular BS over affected areas, coarse creps over affected areas
92
auscultation in bronchiectasis reveals fine crackles. True/False
False
| Auscultation: decreased intensity vesicular BS over affected areas, coarse creps over affected areas
93
what are the P/E findings in pleural effusion?
* Trachea: pushed to the opposite side
* Expansion: decreased on the side of the effusion
* Tactile fremitus: decreased over the effusion
* Percussion: stony dull over the effusion
* Auscultation: decreased or absent breath sounds; ± bronchial breathing above a large effusion
94
auscultation in pleural effusion reveals...
decreased or absent breath sounds; ± bronchial breathing above a large effusion
95
tactile fremitus in pleural effusion is increased.True/False
False
| decreased
96
what are the P/E examination findings in pneumothorax?
* Trachea: undisplaced or pulled towards pneumothorax (exception: tension pneumothorax – trachea pushed to the opposite side)
* Expansion: decreased on the side of the pneumothorax
* Tactile fremitus: decreased over the pneumothorax
* Percussion: hyper-resonant
* Auscultation: decreased or absent breath sounds
97
in pneumothorax, the trachea is pushed towards...
undisplaced or pulled towards pneumothorax (exception: tension pneumothorax – trachea pushed to the opposite side)
98
in pneumothorax, auscultation of affected lung reveals...
Auscultation: decreased or absent breath sounds
99
what are the P/E examination findings in pneumonia?
Extensive right mid & lower lobe pneumonia
• Trachea: central
• Expansion: variable
• Tactile fremitus: increase over affected areas
• Percussion: dull over affected areas
• Auscultation: decreased intensity vesicular breath sounds or bronchial breathing, coarse creps++
100
Does pneumonia cause fine or coarse crackles?
Auscultation: decreased intensity vesicular breath sounds or bronchial breathing, coarse creps++
101
in pneumonia, tactile fremitus is decreased. True/False
False
| Increased due to consolidation
102
percussion in pneumonia is hyper resonant. True/False
False
| It is dull
103
P/E findings in fibrosis due to old TBare...
* Biapical fibrosis, and typically asymmetrical
* Patient looks well
* Trachea: deviated to the side of maximal fibrosis
* Fremitus: mild decreased
* Percussion: slight dullness
* Auscultation: bronchial breathing, no creps
104
what happens to the trachea in fibrosis due to old TB?
deviated to the side of maximal fibrosis
105
what are the P/E findings in atelectasis?
Complete atelectasis of the right lung
• Trachea: pulled to the right
• Expansion: decreased on the right
• Tactile fremitus: decreased on the right
• Percussion: dull
• Auscultation: decreased or absent vesicular breath sounds
**Findings similar to pleural effusion except for the quality of the percussion note, and tracheal deviation
106
in atelectasis, the trachea is shifted towards the normal side. True/False
False
| towards the affected side
107
percussion in atelectasis is hyper resonant. True/False
False
| dule as no air in lung
108
what are the causes of complete atelectasis
```
Complete atelectasis is rare, and is due to complete obstruction of either the right or left main bronchus
Causes
• Bronchogenic neoplasm
• Mucus plug
• Foreign body
```
109
what is the atelectasis?
A loss of lung volume caused by deflation of alveoli and subsequent collapse of part of the lung. May be categorized according to etiology as obstructive (e.g., tumor), nonobstructive (e.g., pleural effusion, pneumothorax, and surfactant deficiency), postoperative (within 72 hours of surgery), or rounded (e.g., asbestosis).
110
what are the causes of nonobstructive atelectaiss?
- -Compression atelectasis: external space-occupying lesion (e.g., pleural effusion) that compresses the lung → forcefully pushes air out of the alveoli
- -Adhesive atelectasis: surfactant deficiency or dysfunction → increases surface tension of alveoli → instability and collapse (e.g., acute respiratory distress syndrome (ARDS) in adults, respiratory distress syndrome in premature infants)
- -Cicatrization atelectasis: parenchymal scarring that leads to contraction of the lung (e.g., chronic destructive lung processes such as tuberculosis and fibrosis)
- -Relaxation atelectasis: loss of contact between parietal and visceral tissue (e.g., pneumothorax, pleural effusion)
- -Replacement atelectasis: All the alveoli in an entire lobe are replaced by tumor (e.g., bronchioloalveolar cell carcinoma) → loss of volume → lung collapse
111
tactile fremitus in atelectasis is increased or decreased?
decreased
112
what is the most common form of atelectasis?
This is the most common form of atelectasis, particularly post abdominal surgery
Signs
• Fremitus: ¯bibasally
• Percussion: ¯bibasally
• Auscultation: ¯ or absent breath sounds
113
what are the P/E findings in lung cancer?
• Findings are variable and often non-specific
• May cause atelectasis, pneumonia, pleural effusion
• Findings over an area of the tumour are similar to that of atelectasis: decreased fremitus, dull percussion note, auscultation: decreased or absent breath sounds
• Tidal percussion may be absent if there is phrenic nerve involvement (decreased chest expansion)
General inspection
• Clubbing
• Cachexia
• Horner’s syndrome
```
SVC obstruction (mediastinal involvement)
• Dilated anterior chest veins
• Distended, non-pulsatile jugular veins
• ± Hoarseness
• +ve Pemberton’s sign
```
114
SVC obstruction with lung cancer causees...
Superior vena cava syndrome
A condition caused by compression of the superior vena cava, which impairs venous backflow to the right atrium and results in upper venous congestion. Features include a feeling of fullness in the head, dyspnea, edema of the upper extremities, and distention of the superficial veins of the chest, face, and upper extremities.
115
why hoarseness occurs in SVC syndrome?
Involvement of the recurrent laryngeal nerve occurs in approx. 10% of cases, typically of the left nerve. Hoarseness usually predicts a worse outcome because it is a sign of advanced growth and thus inoperability.
116
what is the Pemberton's sign?
The Pemberton maneuver is a physical examination tool used to demonstrate the presence of latent pressure in the thoracic inlet. The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face. A positive Pemberton's sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute
A positive Pemberton's sign is indicative of superior vena cava syndrome (SVC), commonly the result of a mass in the mediastinum. Although the sign is most commonly described in patients with substernal goiters where the goiter “corks off” the thoracic inlet, the maneuver is potentially useful in any patient with adenopathy, tumor, or fibrosis involving the mediastinum.
117
what are the P/E findings of the chest over the area of the tumor?
Findings over an area of the tumour are similar to that of atelectasis: decrease fremitus, dull percussion note, auscultation: decreased or absent breath sounds
118
what are the metastatic signs of lung cancer?
* Jaundice
* Bone pain, pathological fractures
* Signs of ICP
119
what are the common paraneoplastic syndromes associated with lung cancer?
* Neuro – cerebellar syndromes, myopathies
* Hypercalcemia – abdominal discomfort, bone pain, depression
* Thromboplebhitismigrans
* Skin – acanthosis nigricans
* SIADH, Cushing’s syndrome
120
what are the P/E examination signs in pneumectomy?
• Thoracotomy scar
• Trachea: deviated to the side of the pneumonectomy
• Expansion: decreased on that side
• Fremitus: decreased on that side
• Percussion: dull
• Auscultation: absent breath sounds or soft bronchial breathing*
(*Auscultation findings vary depending on the duration of time post pneumonectomy)
121
after lobectomy, P/E reveals decreased fremitus, dull percussion note, auscultation: decreased or absent breath sounds. True/False
False
• Thoracotomy scar
• Chest findings – normal !!*
* This is because the remaining lobes re-expand to fill the hemithorax
