symptoms and signs of respiratory medicine Flashcards
(25 cards)
COMMON Respiratory symptoms:
Cough
Dysphonia (Hoarseness)
Wheeze
Stridor
Stertor
Sputum
Haemoptysis(coughing up blood)
Dyspnoea(breathlessness)
Chest Pain
RespiratoryPattern
WeightLoss
Rigor/Chills
NightSweats
Coughing is a characteristic sound due to forced —against a closed —.
Relatively — , indicates — anywhere from the — to the —-.
Acute cough: — weeks
Subacute: — weeks
Chronic cough: — weeks
The Character of the cough may give clues to the underlying cause:
1- Chronic dry cough : —- disease
2-A moist cough – Suggests — , —- and —-infections
3-Feeble non-explosive ‘bovine’ cough with hoarseness : —
4-“Barking” Cough – Croup (—-)
expulsion
glottis
non specific
irritation
pharynx to lungs
< 3
3-8
>8
interstitial lungs
secretions , bronchiectasis and lower respiratory tract infection
lung cancer
Laryngotracheobronchitis
red flags symptoms associated cough :
1- —
2- —
3- —
4- —-
5- —-
Haemoptysis (Coughing blood)
Breathlessness
Fever
Chest Pain
Weight Loss
Dysphonia (—-) :
Most commonly caused by — .
Damage to the — - impairs the ability of — to adduct to the — .
N.B —- at the left hilum compresses the left recurrent laryngeal nerve causing hoarseness and low pitched “—” cough.
hoarseness
laryngitis
left recurrent laryngeal nerve
vocal cord
midline
lung cancer
bovine cough
wheeze:
—-pitched — sound produced by air — ( — )through narrowed small airways.
Wheeze can be —- aka single note signifying — e.g., —
—- aka multiple notes – signifying —- , —- of airways of different calibre (—/—)
Can be brought on by exercise as in — and —
Waking at night with wheeze suggest — or “cardiac wheeze” in —
Wheeze after wakening in the morning suggests –
high
whistling
passing ( expired )
monophonic
partial obstruction
lung mass
polyphonic
widespread narrowing
COPD/asthma
COPD/asthma
asthma or heart failure
ashma
STRIDOR VS STERTOR:
Stridor: — pitched — — sound due to — of the — airways. (vocal cords, trachea, bronchus)
Obstruction may be due to:
1-Something within the — – Foreign body, tumour.
2- Within the — – oedema from anaphylaxis, acute epiglottitis
3- — – Goitre, Oesophageal lymphadenopathy.
Stertor: — “—-“ speech due to naso- or oropharyngeal —- – e.g. —- (quinsy)
high
harsh
inspiratory
partial obstruction
upper airways
lumen
wall
extrinsic
muffled “ hot potato “
bloakcgae
tonsil abscess
sputum:
Sputum is — produced from the —
The normal lung produces about — of sputum each day, which is normally brought to — and swallowed.
Changes in colour, volume, taste, smell and consistency can hint at underlying —.
Always inspect sputum! (However unpleasant this may be)
1- purulent has —- appearance and causes — , — , —
2- serous has — , —/— , and can be — and causes —-
3- mucoid is — and is —/— which causes ——/—
4- blood is —- and causes —–
mucus
respiratory tract
100 ml
orphonaynx
pathology
thick yellow/green
infections , pneumonia , abscess
frothy , clear/watery , can be pink
acute pulmonary oedema
mucoid
clear grey/white
COPD/asthma
red/rusty red
Lung cancer, rusty red – pneumococcal infection
Haemoptysis is coughing up — from the respiratory tract and nearly always requires — !
What to clarify?
1- — and — i.e., blood streaked or clots? Is it associated with pleurent sputum ? Is it a large or small volume – try to quantify – using teaspoons.
2- — and — – Single episode or multiple episodes?
3- Is it associated with any other — such as weight loss, night sweats in malignancy or breathlessness and pleuritic chest pain in pulmonary thromboembolism.
blood
investigations
amount and appearance
duration and frequency
other symptoms
Dyspnoea (—–):
From Latin for “—breathing”
Commonly referred to as “—-of breath”, “difficulty getting enough air in” or “tired breathing”
Questions to ask:
1- Mode of — – lying flat (orthopnoea), sitting up (platypnoea). Waking at night? On exertion? Triggers?
2- — of breathlessness – what level of exertion brings on shortness of breath?
3- Associated with —? Is it Pleuritic (worse on deep breath or cough)
Modified Medical research council (mmrc) dyspnoeascale:
grade 0 : Not troubled by breathlessness except on —
grade 1: Short of breath when — on the level or walking up a slight —
grade 2:Walks — than most people on the level, stops after a mile or so, or stops after —minutes walking at own pace
grade 3: Stops for breath after walking about – yds or after a few minutes on level ground
grade 4 : Too breathless to leave the house, or breathless when undressing
breathlessness
hard breathing
onset
severity
pain
strenuous exercise
hurrying
slight hill
slower
15 mins
100
Chest pain can be respiratory or cardiac.
The — do not cause pain (exclusively — innervation)
1- Pleural pain - — , — pain – worse on — and – . eg – —
2- Chest wall pain - — and — after — or — . Painful on — (does not rule out other causes) eg — injury
3- Mediastinal Pain – — , — and unrelated to — or — eg irritant – . Dull aching that disrupts sleep suggests — invading mediastinal lymph nodes
lungs
autonimic
sharp and stabbing
inspiration and coughing
pulmonary embolism
sudden and localised
vigrous coughing or trauma
palpation
MSK injury
central , retrosternal
inspiration or cough
dust
cancer
- respiratory patterns:
Ask about changes in the – or — of breathing
Is there respiratory rate increasing or decreasing.
Is there a — ? Eg: Dust, Dander, Inspiration
Does the patient have — ? If yes, ask the patients partner about apnoea, loud snoring, nocturnal restlessness - nigh sweat :
Drenching sweats unrelated to room temperature, where the patient mustchange clothes and bed clothes. Not just sweating at night!
—- symptoms – weeks to months
rate and pattern
trigger
daytime sleepiness
prolonged
rigors ( chills) :
-Bouts of — muscular — , often with chattering teeth, lasting for –
-They are associated with rapid temperature – and may be caused by — and — proteins resetting — temperatureset point.
-B Symptoms/Constitutional symptoms – Unintentional — , — and — . - ?Underlying malignancy or systemic involvement in — for example.
weight loss:
Weight loss on its own is a very — symptom
May present in — conditions
Questions:
Was the weight loss intentional or unintentional?
How much weight have they lost and in what period? If unable to quantify – changes in clothing sizes
Is the weight loss associated with any other symptoms example B symptoms (night sweats, fever)
uncontrollable
shaking
minutes
rises
cytokines and acute phase proteins
hypothalamic
weight loss , night sweat , fever
infection
non specific
non pulmonary
respiratory signs:
1- General Inspection
Accessory — use
—
—
Altered — Status
Thoracotomy —
2-Hands
—
— of nails and fingers
Signs of — retention
3-Closer inspection and palpation
Trachea – — or —
Chest —
–> Hyperinflated chest (Barrell chest), pectus excavatum, pectus carinatum.
Chest Expansion – Reduced/normal
Tactile Fremitus – Increased, Decreased, Normal
4- —- :
Resonant
Hyper resonant
Dull
Stony dull
5-Auscultation -
— vs —- Breathing
6-Added sounds
Crackles
Wheeze
Pleural Rub
muscle
cachexia
cyanosis
mental
scar ( Can be a sign of both pneumonectomy and lobectomy)
clubbong
discolouration
c02
central or displaced
shape
Percussion
viscular vs bronchial
general inspection:
1- RespiratoryRate &Accessory Muscle Use
Increase rate - —-
The use of muscles other than those typically used in breathing = accessory muscle use.Eg – SCM, Scalene
Indicates increasedwork of breathing(resp distress)
2-Cachexia
Extreme — and —
3-Cyanosis
Peripheral cyanosis : occurs in —- and —
Central cyanosis :occurs when deoxygenatedhaemoglobin rises above> – g/dL (more worrying clinical sign than peripheral cyanosis).
4-Mental Status
Agitation or drowsiness may be associated with —-
— also seen in infection
tachypoana
weight loss and muscle wasting
hypoxaemia and venous stasis
>5
c02 retention
confusion
hands:
Signs of CO2 retention:
- — pulse
- Warm — veins in hands
- Asterixis –describes the inability to maintain sustained — with subsequent brief, —-like, involuntary movements.
Clubbing:
Bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit with subsequent loss of the normal angle between the nail and nail bed.
Tar Staining and Nail Discoloration
bounding pulse
warm dilated
posture
shock like
trachea:
Description: — or —
If pulled — the abnormal side:
Atelectasis,pneumothorax, unilateral fibrosis, pneumonectomy
If pushed — from the abnormal side:
Large Pleural Effusion, Tension pneumothorax
chest expansion:
Description: — or —
If reduced, state whether — or —
Symmetrically reduced:
— lung disease
—- lung disease
Unilaterally reduced: —- or —
central or displaced
towards
away
normal or reduced
symmetrical or unilateral
obstructive
restrictive
pneumothorax and pleural effusion
Tactile Fremitus:
Feels the transmission of sound waves (vibrations) from the — to the —
Patient is asked to repeat a certain phrase while the examiner palpates the chest wall.
Increased/ normal/ decreased/ absent
Increased – Only one condition: –
Decreased or absent – — , — , —
Percussion:
Assesses the — of whatever is — the chest wall (doesn’t have to be the lung)
Resonant / Hyper–resonant / Dull / Stony Dull
Air > lung > consolidation > fluid
Resonant = —
Hyper Resonant – — , — ( —-)
Dull –—, — , —
Stony Dull – — (includes haemothorax, chylothorax, empyema)
trachea to chest wall
consoidation
Pleural effusion, pneumothorax, atelectasis
destiny
under
normal
pneumothorax , COPD ( emphysema)
pneumonia , atelectasis , tumour
pleaural effusion
Auscultation:
Intensity of breath sounds:
Normal or decreased (— in any lung pathology)
Nature of Breath Sounds : — or—
Added sounds
Wheeze
Creps
Rub
nature of breath sounds:
1- Vesicular Breath Sounds — , —-pitched sounds.
Heard throughout the lungs.
These are — breath sounds.
Inspiratory time is — longer thanexpiratory time.
2-Bronchial Breath Sounds
— transmission of tracheal sounds to the chest wall.ie. very—, — and —.
Due to—.
Inspiratory time is — to expiratory time.
decreased
vesicular or bronchial
soft , low pithced
normal
2x
direct
very loud , harsh , clear
cosndildation
equal
added sounds:
Wheeze:
Always an — sound
Almost always —
Example – COPD,Asthma,Type 1 allergic reaction
Creps (Crackles / Rales) :
Always an — sound
Indicative of — in the alveoli
Pneumonia, fibrosis, bronchiectasis, pulmonary oedema
Rub:
is —
Is heard throughout — and —
Indicates —
Pulmonary infarct,pneumonia, chest drain
expiratory
bilateral
inspiratory
fluid
rare
inspiration and expiration
pleural inflammation
1- pneumonia:
Symptoms
Productive cough, purulent sputum,± haemoptysis
Respiratory rate increased
Confusion
Fevers (Rigors)
Central Cyanosis
Pleuritic Chest Pain
Signs
Reduced chest expansion
Tactile vocal fremitus increased over affected areas
Dull percussion
Auscultation: decreased intensity vesicular breath sounds or bronchial breathing, —–
2- COPD:
Symptoms
Wheeze
Shortness of breath
± Productive Cough
Plethoric
—-
Signs
— staining of fingers
Using Accessory Muscles / Increased respiratory rate
Hyperinflated “Barrell Chest”
Tactile Vocal Fremitus: Normal
Decreased chest expansion bilaterally
—- on percussion
Reduced air entry on auscultation, wheeze
coarse creps
central cyanosis
tobacco staining
hyperresoancne
lung cancer:
1- Symptoms
Haemoptysis
SOB
Weight Loss
Prolonged dry cough
Persistent Hoarseness
Night sweats, weight loss, lack of appetite
Bone pain, headaches, jaundice (metastases to liver)
Findings are — and often —
Often there are no — findings on exam
General Inspection:
Clubbing
Cachexia
— Syndrome – Ptosis (drooping of the upper eyelid), miosis (constricted pupil),ipsilateralanhidrosis (absence of facial sweating on one side) - Pancoasttumour
— Lymphadenopathy
Signs of effusion:
— expansion
—- percussion (suggests pleural effusion or atelectasis)
Reduced absent breath sounds
SVC Obstruction (Mediastinal Involvement):
Dilated anterior chest veins
Distended, non-pulsatile jugular veins
+/- Hoarseness
Positive —- sign
variable and non specific
+Ve
horners
cervical
reduced
stony dull
Pemberton’s
asthma:
Symptoms
is —-
Shortness of breath, Cough, wheeze, chest tightness
Nocturnal, occupational, exercise induced symptoms
Signs
Wheeze
Difficulty completing full sentences
Silent chest in life threateningdisease
Central Cyanosis
Agitation orDrowsiness in severe asthma
Intercostal drawing (childr
Rapid pulse
idiopathic pulmonary fibrosis :
Symptoms
—- shortness of breath on exertion initially but eventually at rest also.
± Dry cough
Signs
—-
Finger Clubbing
Decreased Chest Expansion
Fine inspiratory – bilaterally
intermittent
progressive
tachypnea
creps
Pulmonary thromboembolism (PE):
Symptoms
—- chest pain
Shortness of breath
Haemoptysis/ Cough
±Symptoms of underlying malignancy
±Unilateral — swelling and tenderness
Common findings — , — — chest findings
Rare findings:
Pleural –
Signs of —
Bronchiectasis:
Symptoms
Productive cough,
Copious amounts of purulentsputum
Recurrent LRTIs
Haemoptysis
Chronic/Long history (Years)
Signs
Clubbing (especially in cystic fibrosis bronchiectasis),
Expansion, fremitus, percussion : Non-specific
Auscultation: decreased intensity, vesicular BS over affected areas, coarse crepitations over affected areas
pleuritic
calf
tachyponea and tachycardia
normal chest findings
pleural rub
right heart failure
Pleural Effusion:
Symptoms
Shortness of breath
Cough
Signs
Trachea: Pushed to the — side (in larger Pl Eff)
Expansion: — on the side of effusion
Tactile Fremitus: — over effusion
Percussion: — over the effusion
Auscultation: — or — breath sounds +/- bronchial breathing above a large effusion
opposite side
decreased
decreased
stony dull
decreased or absent
