SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES LEARNING OBJECTIVES:
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1 SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES LEARNING OBJECTIVES: By the end of this session, students should be able to: Enumerate the various symptoms of respiratory disorders. Enumerate the different signs ellicitied after a clinical examination of a patient with respiratory disorders. Correlate the symptoms with the signs of respiratory distress. Determine the cause of respiratory distress in a patient with particular sign or symptom The techniques of examination Be able to correlate the findings with common diseases
2 Cough Breathlessness / dysnea Chest pain Hemoptysis Syncope Palpitations Weight loss Fatigue SYMPTOMS SIGNS Tachypnea Tachycardia Cachexia Wheezing Sputum Use of accessory muscles of respiration Decreased chest expansion Vocal Resonance Decreased breath sounds crepitations COUGH To expel air suddenly and noisily from the lungs through the glottis, either as the result of an involuntary muscular spasm in the throat or to clear the air passages CAUSES: Asthma Allergies COPD (chronic obstructive pulmonary disease) GERD (gastroesophageal reflux disease) Smoking Throat disorders, such as croup in young children
3 Some medicines SPUTUM Sputum is matter that is expectorated from the respiratory tract, such as mucus or phlegm, mixed with saliva Types and causes: Serous e.g., Pulmonary edema Mucous e.g., chronic bronchitis, COPD, asthma Mucopurulent (brown, yellow, green) e.g., Infection Rusty e.g., pneumococcal pneumonia BREATHLESSNESS Shortness of breath; difficult or labored breathing. Associated sign: Tachypnea (increased respiratory rate) o Normal: 12/min CAUSES: Increased ventilatory drive and decreased ventilatory capacity DYSPNEA WITH CVS PATHOLGY: Ischemic heart Disease DYSPNEA WITH RESPIRATORY PATHOLOGY: Asthma COPD Emphysema Infections (pneumonia and T.B.) Hypoxia Acidosis/ metablic disorders
4 Disorder Acute cause of dyspnea Chronic cause of dyspnea Association with exercise Asthma Acute on chronic yes Increased (exercise induced) COPD No Yes Increased Emphysema Maybe Yes Increased Lung Infections Yes Yes (T.B.) (pneumonia) Increased Hypoxia Yes Yes (COPD) Increased Acidosis Yes Yes Increased CHEST PAIN Chest pain is a manifestation of a number of serious conditions and is generally considered a medical emergency. Associated sign: Tenderness on palpation (bone or muscular pathology) Decreased chest expansion (respiratory or cardiovascular pathology) CAUSES: CENTRAL: CVS pathology, e.g, IHD LATERAL CHEST PAIN: RESPIRATORY PATHOLOGY e.g., Pneumothorax pulmonary embolism
5 Pleurisy lung cancer HEMOPTYSIS Spitting or coughing up blood or bloody-stained sputum Causes: T.B. Lung carcinoma Pneumonia WEIGHT LOSS A reduction in body mass characterized by a loss of adipose tissue (body fat) and skeletal muscle Associated sign: Cachexia
6 CAUSES: T.B. Lung carcinoma Chronic diseases e.g., COPD, asthma etc SYNCOPE Temporary loss of consciousness due to generalized cerebral ischemia Causes: Pulmonary embolism Emphysema Internal bleeding High grade fever Vasovagal shock FATIGUE FATIGUE IS PHYSICAL AND/OR MENTAL EXHAUSTION THAT CAN BE TRIGGERED BY STRESS, MEDICATION, OVERWORK, OR MENTAL AND PHYSICAL ILLNESS OR DISEASE. CAUSES: Infection Inflammation Trauma Malignancy Chronic disease e.g., COPD Autoimmune diseases
7 TRACHEAL DEVIATION Towards the side of lesion: Lung collapse (with or without pneumothorax on opposite side) Fibrosis e.g., in bronhiectasis or cavitation Away from the side of lesion: Space occupying lesion Fluid in the space: plueral effusion or empyema Air in the space: pneumothorax USE OF ACCESSORY MUSCLES OF RESPIRATION Scalene muscles Sternocleidomastoid Trapezius Serratius anterior Pectoralis major and minor Latissimus dorsi CAUSES: 1. COPD 2. Decreased vital capacity (Emphysema) 3. Spinal cord injury (cervical) DECREASED CHEST EXPANSION CAUSES:
8 1. Consolidation 2. Lung collapse 3. Fibrosis 4. Cavitation 5. Pleural effusion 6. Empyema 7. Pneumothorax PERCUSSION NOTE DULL: 1. Consolidation 2. Collapse 3. Pleural effusion (stony dull) IMPAIRED: 1. Fibrosis 2. Cavitation 3. Bronchopneumonia HYPER-RESONANT (presence of air): 1. Pneumothorax 2. Emphysema VOCAL RESONANCE The prolongation and intensification of sound produced by transmission of its vibrations to a cavity
9 INCREASED: Air present in the alveoli/ consolidation/ fibrosis in the lung parenchyma e.g, Pneumonia, bronhiectasis DECREASED: Fluid or air present in pleural space e.g, pleural effusion, pneumothorax BREATH SOUNDS INCREASED: Consolidation Interstitial lung disease (prolonged expiration) VESICULAR (PROLONGED EXPIRATION): Bronchitis Asthma Pneumonia Emphysema WHEEZING Wheezing is a high-pitched whistling sound during breathing. It occurs when air flows through narrowed breathing tubes
10 PALPITATIONS and TACHYCARDIA TACHYCARDIA: A rapid heart rate, usually defined as greater than 100 beats per minute. PALPITATIONS: A sensation in which a person is aware of an irregular, hard, or rapid heartbeat. WEIGHT LOSS A reduction in body mass characterized by a loss of adipose tissue (body fat) and skeletal muscle Associated sign: Cachexia Causes: T.B. Lung carcinoma Chronic diseases e.g., COPD, asthma etc FATIGUE Fatigue is physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease. CAUSES: Infection Inflammation Trauma malignancy chronic disease e.g., COPD autoimmune diseases
11 CREPITATIONS A noise produced by pressure upon tissues containing abnormal amounts of air, the rubbing of fractured ends of bones, and by cracking joints CAUSES: Consolidation Localized fibrosis Cavitation Pneumothorax VITALS: GENERAL PHYSICAL EXAMINATION Pulse B.P. Respiratory Rate Temperature HANDS: Clubbing and Cyanosis
12 HEAD AND NECK: Tracheal Deviation Lymph nodes and Thyroidgland MOUTH: Central cyanosis BACK: Vertebrae, kyphosis and scoliosis
13 IMPORTANCE OF GENERAL PHYSICAL EXAMINATION Pursed lips breathing: COPD Respiratory rate: increased / decreased Pulse: tachycardia Cyanosis: central in respiratory failure Clubbing: emphysema, JVP: cor pulmonale Chest deformity: kyphosis, scoliosis Tracheal deviation: towards or away from side of lesion Lymphadenopathy: carcinoma, T.B., sarcoidosis Leg edema: cor pulmonale Horner s syndrome: pancoast tumor 4 COMPONENTS: Tracheal deviation Cervical lymphadenopathy Apex beat Chest expansion PALPATION PERCUSSION Done seperately in each space Note can be:
14 Dull Stony dull Resonant Impaired Tactile Vocal Fremitus Areas of percussion AUSCULTATION Listen in each space for: Breath sounds (normal, bronchial, vesicular, loud or diminshed) Wheezes Crackles/ crepitations Vocal Resonance (dull, stony dull, hyper resonant) REFERENCES Davidson s Principles and Practice of medicine Hutchison s Clinical Methods Medlineplus.com Britannica online dictionary Merriam-Webster dictionary
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