Basic respiratory semiotics 3

Question 1

SYMPTOMS AND SIGNS

Dyspnea

Answer 1

Abnormally uncomfortable awareness of breathing appearing at rest or moderate effort, effort that normally doesn’t develop the symptom.

Acute Dyspnea

• Asthma
• Pulmonary embolism -Pneumothorax -Pleurisy -Acute pneumonitis -Inhalation of foreign body -Acute left ventricular failure

Chronic Dyspnea

• Chronic Obstructive Lung Disease (COLD) -Interstitial diffuse lung diseases
  
  • Chronic pulmonary hearth disease -Chronic left ventricular failure (LVF)

-Nocturnal Dyspnea

• Asthma (AB) -Left ventricular failure
• Inspiratory Dyspnea
  
  • Acute pneumonia -Interstitial diffuse lung diseases
  • Pleurisy
  • Left ventricular failure
• Expiratory Dyspnea
• Chronic Obstructive Lung Disease (COLD)-Asthma (AB)

Question 2

SYMPTOMS AND SIGNS

Cough

Answer 2

Sudden forced expiration, producing the expulsion of tracheo-bronchial tree secretions and of the foreign bodies
May be reflex or voluntary
Could be:
Productive
Dry
-Pneumothorax -Pleurisy -Pulmonary fibrosis -Lung cancer, etc..

Acute cough

- Acute upper airway infections -Asthma -Pulmonary embolism -Acute exacerbation of chronic bronchitis -Inhalation of irritant gases -Acute left ventricular failure  - Chronic cough (older than 3 weeks) 
- Chronic bronchitis -Bronchectasie -Lung cancer -Gastro esophageal reflux -Drugs: (Conversion enzyme inhibitors) - Nocturnal cough 
	- Asthma 	-Left ventricular failure  	-Gastro esophageal reflux

Question 3

SYMPTOMS AND SIGNS

Chest pain

Answer 3

• Chest pain caused by chest diseases occur when the two pleural foils are interested (lung parenchyma doesn’t contains pain receptors)
• Occurs in:
  
  • Pneumonia -Pulmonary embolism -Cancer -Plevritis, etc.

Question 4

Characteristics of pleural pain

Extra pulmonary causes of chest pain:

Answer 4

-Characteristics of pleural pain
-Located in a hemi thorax -Emphasized by the chest movements, including
respiratory movements
-High intensity (chest stabbing)
-Extra pulmonary causes of chest pain:
-Myocardial ischemia -Neuralgia -Esophageal Diseases -Other chest wall diseases

Question 5

SYMPTOMS AND SIGNS

Expectoration

Answer 5

Serous
-Acute pulmonary edema (rosacea) -Lung cancer
-Mucous
-Acute viral bronchitis -Chronic bronchitis
-Purulent
-Greenish yellow -> indicates the presence of
bacterial infection:
-Pneumonia (red), -Infection in acute and chronic bronchitis -Bronchectasie (over 100 ml/24h)

Question 6

SYMPTOMS AND SIGNS

Haemoptysis

Answer 6

-Sputum in allergic asthma is mucous, viscous, pearl, adherent to vessel
Haemoptysis
-Blood in the expectoration or blood expectoration
-In quantitative terms could be
-Small (-Medium (50-200ml) -Large (> 200ml)

• Occurs in:
  - Lung cancer -Pulmonary embolism (black blood indicates lung infarction) -Tuberculosis -Bronchectasie -Chronic bronchitis -Mitral stenosis -Left ventricular failure -Disorders of haemostasis

Question 7

INSPECTION

Cyanosis

Answer 7

• Central:
  - Chronic obstructive bronchitis
  - Chronic Obstructive Lung Disease (COLD)
  - Pneumonia -Pulmonary fibrosis
  - Peripheral:
  - Chronic pulmonary hearth disease

Question 8

INSPECTION
Hippocratic fingers
-Anti-Dyspnea attitudes

Answer 8

• Hippocratic fingers
  - Lung cancer -Bronchectasie -Tuberculosis -Chronic Obstructive Lung Disease (COLD)
• Anti-Dyspnea attitudes
  - Asthma (orthopnea) -Pleurisy (lie on the sick side)

Question 9

-Frequency of breathing

Answer 9

Nv: 12-16/min, (adult at rest)

		- 16/min - polypnea (in all cases of acute 			  respiratory failure) 
			- Pneumonia 
			- Pleurisy 
			- Pulmonary embolism (PE) 
			- Chronic Obstructive Lung Disease (COLD) 			 COPD 
			- Asthma
			- Left ventricular failure - -Central Nervous System Injury 
	- Dyspnea occurred by bronchospasm is 	 respiratory and is accompanied by a 	 	 sound ( "ping" - wheezing)

Question 10

PERCUSSION

Answer 10

Normally at the chest percussion - lung sonority (between tympanic and mat)

• Lung sounds is determined by the presence of air in lung tissue
• Mat sound - is present in:
  - Pneumonia
  - Pleurisy
• Tympanic sound
  - Pneumothorax (presence of air in pleural cavity)

Question 11

AUSCULTATORY FINDINGS

Answer 11

At the physiological lungs auscultation there are two noises
-Tubal breath -Vesicular murmur
Tubal breath
-Produced by the air passing through the straits of larynx
-It sounds to inspire and out
-Suprasternal Location (trachea, larynx)
-High intensity, high pitch -Is pathological when it hears in other areas: pneumonia

Vesicular murmur

	- Produced by the air passing terminal 	    	 airways  in pulmonary alveoli 
	- Mild intensity
	- It sounds to inspire and expire on the 	 entire surface of the chest in contact with 	 the lungs 
	- Reduced: pulmonary emphysema, 	 	 obesity 
	- Abolished: pleurisy

Question 12

AUSCULTATORY FINDINGS

-Pathological rales at lung auscultation

Answer 12

Crepitant rales (alveolar rales)

		- Produces at the sudden opening of 				 pulmonary alveoli 
		- Heard only in inspire 
		- Could be 
			- Bilateral: broncho-pneumonia, 				 pulmonary fibrosis, acute and chronic 			 left ventricular failure 
			- Unilateral: pneumonia, lung 					 infarction, lung cancer

• Under-crepitant rales (bronchial rales)
  - Acoustically resembles to crepitant rales
  - Heard in inspire and expiry
  - Present in:
  - Acute and chronic bronchitis -Bronchectasie -Bronchopneumonia
  
  • Sibilant rales (bronchial rales)
    
    • Heard in inspire and expiry
    • It resembles a whistling
    • Present in:
      
      • Asthma -Acute and chronic spastic bronchitis -Pulmonary emphysema -Cardiac asthma (acute form of LVF)
• Sibilant rales (bronchial rales)
  - Present in inspire and expiry -It resembles a whistling -Present in:
  - Asthma -Acute and chronic spastic bronchitis -Pulmonary emphysema -Cardiac asthma (acute form of LVF)
  
  • Ronflant Rales (bronchial rales)
    
    • Present in inspire and expiry -Resembles to snoring noise -Present in the same diseases as sibilant rales