ALS Lecture 1 - Respiratory Symptoms and Signs DONE

Question 1

symptom

Answer 1

what pt complains of

Question 2

sign

Answer 2

abnormality O/E

Question 3

history

Answer 3

time course, relationship of symptoms

Question 4

diagnostic process (3 steps)

Answer 4

1. history
2. physical examination
3. investigations

Question 5

6 common respiratory symptoms

Answer 5

breathlessness, cough, sputum, haemoptysis, wheeze, chest pain

Question 6

other symptoms relevant to respiratory disease (8)

Answer 6

peripheral oedema, nighttime wakening, swelling of face or arms, nasal obstruction/discharge/sneezing, voice alteration, night sweats, fevers, weight loss

Question 7

peripheral oedema may be due to…

Answer 7

right heart failure, CHF, lung disease

Question 8

nighttime wakening/paroxysmal nocturnal dyspnoea may be due to…

Answer 8

heart failure, asthma

Question 9

swelling of the face/arms may be due to…

Answer 9

blocked SVC due to tumour on right lung apex (cancer)

Question 10

voice alteration may be due to…

Answer 10

larynx problems

Question 11

weight loss/anorexia may be due to…

Answer 11

malignancy

Question 12

breathlessness

Answer 12

unpleasant sensation of increased demand for breathing

Question 13

is breathlessness a symptom or sign?

Answer 13

symptom

Question 14

tachypnoea, hypoxaemia or hypercapnia have a poor correlation with

Answer 14

breathlessness

Question 15

breathlessness is related to work of breathing (3 points)

Answer 15

• increased ventilation
• respiratory muscle weakness
• often multiple factors

Question 16

with breathlessness we must

Answer 16

quantify exercise capacity (walking distance, flights of stairs, ADLs, work, etc.)

Question 17

sudden (minutes) causes of breathlessness (5)

Answer 17

pulmonary oedema, pneumothorax, PE, anaphylaxis, foreign body inhalation

Question 18

rapid (hours) causes of breathlessness (4)

Answer 18

acute asthma, pneumonia, pulmonary oedema, acute hypersensitivity pneumonitis

Question 19

subacute (weeks) causes of breathlessness (4)

Answer 19

heart failure, anaemia, pleural effusion, lung cancer

Question 20

slow (months/years) causes of breathlessness (4)

Answer 20

chronic bronchitis and emphysema (COPD), interstitial lung disease (e.g. idiopathic pulmonary fibrosis), pneumoconiosis, pulmonary arterial hypertension

Question 21

cough acts as a

Answer 21

defence system, prevent inhalation of foreign objects

Question 22

upper and lower respiratory tract are innervated by

Answer 22

sensory nerve endings to detect irritation

Question 23

irritation leads to

Answer 23

cough reflex to clear airway

Question 24

if cough reflex is heightened then…

Answer 24

airway nerves are hypersensitive

Question 25

causes of cough hypersensitivity (10)

Answer 25

infection, left heart failure, lung cancer, foreign body inhalation, interstitial lung disease, tracheal compression (by lymph nodes, tumour, AA), ACE inhibitors, asthma, COPD, acid reflux

Question 26

which 2 diseases come under COPD?

Answer 26

chronic bronchitis, emphysema

Question 27

why do ACE inhibitors cause cough? (2 steps)

Answer 27

1. metabolise bradykinin (as well as angiotensin), 2. accumulation increases sensitivity of airway nerve

Question 28

label the diagram of the airway nerves

Answer 28

done

Question 29

types of sputum colour (3)

Answer 29

mucoid, purulent, bloodstained

Question 30

mucoid sputum

Answer 30

clear/creamy

Question 31

purulent sputum

Answer 31

yellow/green

Question 32

why is purulent sputum yellow/green?

Answer 32

myeloperoxidase from granulocytes (eosinophils/neutrophils)

Question 33

in bacterial infection, sputum is green because of the

Answer 33

neutrophilic reaction

Question 34

in asthma (allergic) cough, sputum is green because of the

Answer 34

eosinophilic reaction

Question 35

bloodstained sputum

Answer 35

haemoptysis

Question 36

when investigating cough we must ask what 4 things about sputum?

Answer 36

colour, volume (how much, how often), taste, odour

Question 37

when taking a respiratory history, we must always ask

Answer 37

have you ever coughed up blood?

Question 38

causes of haemoptysis (6)

Answer 38

lung cancer, TB, bronchiectasis, pulmonary oedema, PE, pneumonia

Question 39

sputum in pulmonary oedema

Answer 39

pink, frothy

Question 40

sputum in pneumonia

Answer 40

rusty, blood mixed through purulent

Question 41

wheeze

Answer 41

musical noise due to narrowed airways

Question 42

wheeze happens upon

Answer 42

expiration

Question 43

why does wheeze happen upon expiration?

Answer 43

airways narrow as lungs get smaller

Question 44

what is stridor?

Answer 44

wheeze sound on inspiration

Question 45

stridor tends to indicate

Answer 45

upper airway issues, e.g. epiglottis, larynx, trachea

Question 46

give 4 causes of wheeze

Answer 46

acute bronchitis, asthma, COPD, large airway obstruction (tracheal/laryngeal tumour)

Question 47

in asthma airway obstruction we see (5)

Answer 47

- eosinophils - basement membrane thickening - smooth muscle hypertrophy - goblet cell hyperplasia - mucus plugging

Question 48

chest pain important question

Answer 48

show me where it is

Question 49

pleurisy

Answer 49

pleuritic pain

Question 50

what causes pleuritic pain?

Answer 50

injured/inflamed pleura

Question 51

what kind of pain is pleuritic pain?

Answer 51

sharp, stabbing, worse on inspiration

Question 52

causes of pleuritic pain (3)

Answer 52

pneumonia, PE, pneumothorax

Question 53

we need to distinguish pleuritic pain from (6)

Answer 53

upper retrosternal pain, musculoskeletal pain, retrosternal pain, bony pain, spinal root pain, shingles (before rash)

Question 54

retrosternal pain could be due to

Answer 54

mediastinal tumour, constant/progressive, unrelated to exertion

Question 55

bony pain could be due to

Answer 55

rib metastases

Question 56

4 parts of respiratory exam

Answer 56

inspection, palpation, percussion, auscultation

Question 57

2 main features to look for upon inspection

Answer 57

central cyanosis, finger clubbing

Question 58

central cyanosis

Answer 58

lips, tongue, 20-30% of Hb deoxygenated

Question 59

peripheral cyanosis

Answer 59

fingers, toes

Question 60

give 4 features of finger clubbing

Answer 60

loss of angle between nail and nail bed, more spongy nail bed, curved nails, swollen end of fingers

Question 61

asterexis

Answer 61

flapping tremor, type 2 respiratory failure with CO2 retention

Question 62

respiratory distress can be indicated by

Answer 62

use of accessory muscles

Question 63

patients with apical lung tumour can develop

Answer 63

muscle wasting (hands, brachial plexus), Horner's syndrome

Question 64

give 3 types of chest deformities

Answer 64

kyphoscoliosis, pectus carinatum (pigeon), pectus excavatum (funnel)

Question 65

label the chest wall deformities

Answer 65

done

Question 66

expansion (2 points)

Answer 66

- compare sides | - reduced expansion always on side with pathology

Question 67

position of trachea to

Answer 67

assess mediastinal shift

Question 68

the trachea is pushed way by (2)

Answer 68

pleural effusion, pneumothorax

Question 69

the trachea is pulled towards (2)

Answer 69

collapse, fibrosis

Question 70

cricosternal distance

Answer 70

how many fingers can we get between cricoid cartilage and suprasternal notch

Question 71

normal cricosternal distance

Answer 71

3-4 fingers

Question 72

types of sound on percussion

Answer 72

resonant, dull, stony dull, hyperresonant

Question 73

normal percussion should be

Answer 73

resonant

Question 74

dull percussion can mean

Answer 74

consolidation (pneumonia) collapse, dense fibrosis

Question 75

stony dull percussion can mean

Answer 75

pleural effusion

Question 76

hyperresonant percussion can mean

Answer 76

pneumothorax, bulla

Question 77

normal breath sounds should be

Answer 77

vesicular

Question 78

types of breath sounds

Answer 78

vesicular, diminished vesicular, absent, bronchial

Question 79

breath sounds may be diminished vesicular in (2)

Answer 79

pneumothorax, collapse, effusion

Question 80

breath sounds may be absent in (2)

Answer 80

big effusion, big pneumothorax

Question 81

breath sounds may be bronchial in (1)

Answer 81

consolidation

Question 82

added sounds on auscultation may be (2)

Answer 82

wheeze, crackles

Question 83

crackles/crepitations are

Answer 83

explosive opening of multiple occluded small airways

Question 84

coarse crackles may be seen in (2)

Answer 84

pneumonia, bronchiecstasis

Question 85

pleural rub

Answer 85

creaking sound (like walking in fresh snow)

Question 86

vocal resonance/tactile vocal fremitus (1)

Answer 86

ask pt to say 99

Question 87

increased vocal resonance

Answer 87

bronchophony, sign of consolidation

Question 88

reduced vocal resonance

Answer 88

collapse, pneumothorax, effusion

Question 89

whispering pectoriloquy

Answer 89

whisper heard clearly through stethoscope, consolidation

Question 90

fill in the blanked out table

Answer 90

done