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Respiratory > Signs and Symptoms in Respiratory Medicine > Flashcards

Signs and Symptoms in Respiratory Medicine Flashcards

1
Q

Symptoms vs sign

A

Symptoms is what the patient feels and tells you, signs is what you pick up on examination.

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2
Q

Secondary polycythaemia can cause

A

It is an abnormal increase in concentration of haemoglobin in the blood, through reduction of plasma volume or increase in red blood cells. Cause cyanosis

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3
Q

What can cause CO2 flap

A

Hypercapnic enchephalopathy

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4
Q

What is erythema nodosum

A

Swollen fat under skin causing red bumps and patches. Can be due to sarcoidosis or TB

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5
Q

What is lupus pernio

A

Chronic raised hardened lesion of skin, often purplish in colour. Often due to sarcoidosis

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6
Q

What can finger clubbing indicate

A

Bronchial carcinoma, fibrosing alveolitis, lung suppuration (bronchiectasis, lung abscess or empyema), cyanotic congenital heart disease, infective endocarditis, malabsorption states (ulcerative colitis, crohns disease, liver cirrhosis), congenital, idiopathic

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7
Q

What is horners syndrom

A

Nerve pathway from brain to eye is disrupted causing small pupil, ptosis (drooping or falling of upper eyelid), enophthalmos (posterior displacement of eye).

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8
Q

Cause of horner’s syndrome in respiratory medicine

A

Pancoast’s tumour - Tumour of pulmonary apex or cervical lymphadenopathy

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9
Q

Uveitis can be caused by?

A

Uveitis is inflammation of uvea, caused by sarcoidosis or tuberculosis

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10
Q

What can increased intracranial pressure due to chronically raised CO2 cause

A

Papilloedema, optic disc swelling

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11
Q

What is kyphoscoliosis

A

Abnormal curvature of the spine in coronal (kyphosis) and sagittal (scoliosis) plane

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12
Q

What is pectus excavatum

A

Congenital deformity of anterior thoracic wall in which the sternum and rib cage grow abnormally, producing a caved in or sunken appearance

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13
Q

What is thoracoplasty

A

Surgical procedure originally designed to permanently collapse cavities of pulmonary tuberculosis by removing the ribs from chest wall

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14
Q

Changes associated with pectus excavatum

A

Pulmonary artery murmur, right lower lobe changes on chest x-ray mimics pulmonary infiltrate, diminished lung volumes lead to reduced lung sounds

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15
Q

Cause of hyper-resonance on percussion

A

Emphysema, pneumothorax

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16
Q

Cause of impaired resonance

A

Pulmonary consolidation, pleural thickening, raised hemi-diaphragm

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17
Q

Stony dull percussion causes

A

Pleural effusion

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18
Q

Why is there impaired resonance over heart in obesity and commonly at right base

A

Due to fatty deposits over the heart in obesity. Over right base as the liver pushes diaphragm up

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19
Q

What condition has a normal chest cxr but may show signs on auscultation

A

Asthma, pulmonary embolus

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20
Q

What disease is auscultation generally normal

A

Tuberculosis

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21
Q

What part of stethoscope for low and high pitch sounds

A

Low pitch = Bell

High pitch = Diaphragm

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22
Q

What is aegophony

A

Increased resonance of voice sounds when auscultating the lungs. Low frequency noises are filtered out with high-frequency sounds transmitted across the fluid

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23
Q

Common causes of aegophony

A

Lung consolidation and fibrosis

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24
Q

What is whispered pectoriloquy

A

Increase loudness of whispering noted during auscultation. Usually, spoken words would not be heard by the clinician on auscultation.

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25
Q

What can the patient be asked to say to identify aegophony or whispered pectoriloquy

A

99, 1-1-1, toy boat, scooby doo

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26
Q

What is ronchi

A

Low pitched wheeze; musical sound as air passes through narrowed airways

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27
Q

What can localised wheeze be sign of

A

Large airway tumour

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28
Q

What can general wheeze be a sign of

A

General wheeze is usually polyphonic (multiple sounds) due to small airway obstruction such as asthma and bronchitis

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29
Q

What can squeaks and crackles be a sign of

A

Bronchiolitis

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30
Q

What can cause crackles or crepitations

A

Explosive re-opening of small airways blocked by exudate, inflammation or fibrosis upon inspiration

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31
Q

What can cause fine crackles

A

Pulmonary fibrosis, late inspiratory

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32
Q

What can cause moderate/coarse crackles

A

Pulmonary oedema, consolidation, bronchiectasis

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33
Q

What is pleural rub

A

Leathery, creaking sound made by inflammed pleural surfaces rubbing together

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34
Q

What can cause pleural rub

A

Pneumonia, pulmonary embolus, viral or auto-immune pleurisy

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35
Q

When can you hear a pleural click

A

Pneumothorax

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36
Q

What can cause reduced vocal resonance of voice sounds

A

Pleural effusion, atelectasis, bronchial occlusion, pneumothorax, emphysema

37
Q

What can increase vocal resonance of voice sounds

A

Consolidation such as in pnemonia

38
Q

What transmits whispering pectoriloquy

A

Consolidation without bronchial obstruction

39
Q 
75 year old man
Cough for 8 weeks
Streaky haemoptysis
Increasingly breathless
Stopped smoking 6 weeks ago
Takes aspirin and simvastatin
Back pain for about a month
Tar stained fingers
Clubbing
Cachexia
Stony dull PN left lower zone
Decreased breath sounds left lower zone
Tender L5
A

Cancer

40
Q 
21 year old girl
Increasing breathlessness over 6/52
Worse in the mornings
Nocturnal cough
Just bought a cat
Sister has eczema
Never smoked
Drinks socially
Slightly overweight
Widespread wheeze
Excoriations over flexor surfaces of arms
A

Asthma

41
Q 
66 year old man
3 month history of increasing breathlessness
Dry cough
No chest pain
Stopped smoking 5 months ago
Retired bin man
Drinks 2 pints of beer a night
Keeps 15 racing pigeons
55
Mild clubbing
Crackles through the chest, more in the  apices
Reduced chest expansion
PN normal
A

Hypersensitivity pneumonitis - Bird fancier’s lungs

42
Q 
35 year old man
Itchy, painful red eye for 6/52
Gradual increase in breathlessness for 3  weeks
Raised red lesions on both shins
Non smoker
Red eyes bilaterally
Normal breath sounds
Normal chest expansion
Raised red lesions on both shins
A

Sarcoidosis

43
Q

Calgary cambridge guide to consultation

A

Initiating the session, gathering information, physical examination, explanation & planning, closing session

44
Q

SOCRATES

A

Site, Onset, Character, Radiation, Associated symptoms, Time, Exacerbating/relieving symptoms, Severity

45
Q

What is referred pain

A

Pain felt in the body other than its actual source

46
Q

How does pleuritic pain refer

A

Sharp stabbing pain worse on inspiration (especially deep breaths). non specific but easy to locate (using finger)

47
Q

What are juxtacapillary (J) receptors

A

Sensory nerve endings located within alveolar walls in juxtaposition to pulmonary capillaries of the lungs and innervated by vagus nerve. Involved in sensation of dyspnea

48
Q

Chest pain history can be classified under?

A

Cardaic, resp, GI and MSK

49
Q

Differences in chest pain presentation in different system

A

Cardiac - Tight
GI - Burning
Resp - Hurts when breathing in
Muscular - Hurts during movement

50
Q

Cause of acute breathlessness

A

Pulmonary embolism, pneumothorax, pulmonary oedema

51
Q

Cause of chronic breathlessness

A

COPD, pulmonary fibrosis, pulmonary embolism, Asthma

52
Q

What is pneumonitis also known as

A

Extrinsic allergic pneumonitis or hypersensitivity pneumonitis

53
Q

What does sputum usually contain

A

Neutrophils, eosinophils, bacterial, fungi, virus, airway secretion

54
Q

Massive vs non-massive haemoptysis

A

Non-massive < 500 ml in 24 hours

Massive > 500 ml in 24 hours

55
Q

4 common causes of haemoptysis

A

Infection, carcinoma, pulmonary embolism and bronchiectasis

56
Q

What is pulmonary arteriovenous malformations (PAVM)

A

They are rare vascular anomalies of the lung in which abnormal dilated vessels provide a right to left shunt between pulmonary artery and vein

57
Q

What is atopy

A

It is the genetic tendency to develop allergic disease such as allergic rhinitis, asthma and atopic dermatitis

58
Q

How should be included in history taking

A

Occupation/history (asbestos/coal mining/farming/pigeon birds), tobacco, cannabis, foreign travel, pets, smoker, alcohol

59
Q

Non infective mucous is generally what colour

A

Clear or yellow, COPD

60
Q

Purulent mucous is

A

Green, pneumonia or bronchiectesis

61
Q

What can cause pleuritic chest pain

A

Worse on inspiration, due to pneumonia, infarction, pneumothorax

62
Q

Cause of chest wall pain

A

Chronic due to malignant invasion of soft tissue and ribs

63
Q

What is tight chest pain associated with

A

Radiating to arms and jaw, angina

64
Q

What is burning chest pain associated with

A

Oesophageal reflux

65
Q

Common pattern of asthma symptoms

A

Episodic non-productive cough and wheeze with diurnal variation in young non-smoker with history of atopy such as hay fever or eczema

66
Q

Common pattern of COPD

A

Chronic productive cough, wheeze and dyspnoea in elderly smoker

67
Q

Common pattern of bronchiecstasis

A

Daily productive cough with lots of green sputum in non-smoker with past history of pneumonia

68
Q

Common pattern of community acquired pneumoniae

A

Acute productive cough, pleuritic pain, dyspnoea and fever in any age

69
Q

Common pattern of pulmonary embolus

A

Acute pleuritic pain with dyspnoea and swollen leg (DVT) following recent hip replacement surgery

70
Q

Common pattern of pneumothorax

A

Acute onset pleuritic pain with dyspnoea in young adult male

71
Q

Common pattern of bronchial cancer

A

Cough, haemoptysis, weight loss, hoarseness in middle aged or elderly smoker

72
Q

Common pattern of mesothelioma

A

Intractable chronic chest pain with weight loss in ship yard worker with asbestos exposure

73
Q

Common pattern of tuberculosis

A

Haemoptysis, weight loss, night sweats in young asian adult who has just moved to the UK from India

74
Q

Common pattern of interstitial lung disease

A

Also called fibrosis alveolitis. Progressive dyspnoea without cough or wheeze in non-smoker with rheumatoid disease

75
Q

Large pleural effusion is heard as what on auscultation

A

Stony dull

76
Q

Emphysema vs large pneumothorax on examination

A

Emphysema is hyper-resonant symetrically where pneumothorax is hyperresonant with unilateral reduced breath sounds

77
Q

Mediastinal shift in pleural effusion and pneumothorax

A

Opposite side

78
Q

Acute cough can be a sign of?

A

Lower respiratory tract infection

Pneumonia

79
Q

Chronic cough can be

A

Chronic bronchitis

Bronchiestasis

80
Q

What is known as the 100 day cough

A

Pertusis

81
Q

How can sputum be quantified

A

Volume -
Thimble, egg cup, tea cup, bowl, bucket
Colour -
White, yellow, clear

82
Q

Signs of tonsilitis

A

Swollen tonsils, erythematous, dysphagia, dysphonia, recurrent tonsillitis

83
Q

What is quinsy

A

Peritonsillar abscess, a complication of tonsilitis

84
Q

Upper tract infections

A

Coryza, pharyngitis, quinsy, epiglottitis, sinusitis

85
Q

Lower respiratory tract infections

A

Acute bronchitis, COPD acute exacerbatons, pneumonia, influenza, fungal infection

86
Q

Treatment of sinusitis

A

Self-limiting resolves in 10 days. Might need nasal decongestant such as Oxymetazoline

87
Q

Acute bronchitis chest examination and x-ray

A

Normal, may have transient wheeze

88
Q

Wheeze vs stridor

A

Wheeze is high-pitched, continuous lung sounds produced by a narrow lumen in airways. Stridor is a special kind of musical wheeze at a constant pitch in patients with laryngeal and tracheal obstruction

89
Q

IV antibiotics in the old

A

When the oral route isn’t available
Drug-resistant organism
Deep-seated infection - Abscess, bone, endocarditis, meningitis
First dose - Rapid increase in plasma concentration

Respiratory (26 decks)

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