What is dypnoea?
The sensation of shortness of breath
What is orthopnoea?
Shortness of breath that occurs when lying flat and is due to the abdominal contents pressing on the diaphgragm and displacing blood from bases of lungs
What is paroxysmal nocturnal dyspnoea?
- Manifestation of left heart failure
- Patient wakes up gasping for breath
- Often sleeps with several pillows
- Severe interstitial pulmonary oedema can accumulate
- Because sensory awareness id depressed during sleep
What investigations can be done for acute breathlessness?
- CXR
- Pulse oximetry
- ECG
- ABG
- FBC
- U&E
- Glucose and troponin (& D-dimers)
What investigations can be done for chronic breathlessness?
- Lung function tests
- Pulse oximetry
- FBC
- CXR
Give differential diagnoses for acute breathlessness
- Acute asthma
- Exacerbation of COPD
- Pneumothorax
- Pulmonary embolism
- Pneumonia
- Hypersensitivity pneumonitis
- Upper airway obstruction: foreign body or anaphylaxis
- Left heart failure
- Cardiac tamponade
- Panic w/ hyperventilation
Give differential diagnoses for chronic breathlessness
- Asthma
- COPD
- Diffuse parenchymal lung disease
- Pleural effusion
- Cancer of the bronchus/trachea
- Heart failure
- Severe anaemia
What is the mechanism of a cough?
- Cough initiated by a mechnical or chemical stimulation
- Of specialised epithelium of resp tract
- Afferents signal to the cough centre in medulla
- Efferents signal via the phrenic and vagus nerves
- To expiratory musculature
- To generate cough
Give common causes (differentials) for persistant cough
- Asthma
- GORD aspirations
- Postnasal drip (rhinitis, acute nasopharyngitis, sinusitis)
- Chronic cough w/ sputum is common in smokers
What are some less common causes for persistent cough?
- Lung airway disease: COPD, bronchiectasis, tumour/foreign body
- Lung parenchymal disease: interstitial lung disease, lung absess, ACE Inhibitors
- Worsening cough may be presenting symptom of bronchial carcinoma
What is a wheeze?
Wheeze is the result of airflow limitation due to localised or generalised obstruction of airways. It is commonly caused by obstructive/restrictive airway diseases asthma, COPD and bronchiolitis.
What is stridor, how is it different to a normal wheeze?
A harsh inspiratory wheeze caused by obstruction of the trachea or main bronchi
Give differential diagnoses for wheezing
- Asthma
- COPD
- Emphysema
- GORD
- Heart failure
- Lung cancer
- Sleep apnoea
- Anaphylaxis
- Resp tract infection
- Pneumonia
- Bronchitis
What is haemoptysis?
Haemoptysis is the coughing of blood from a source below the glottis.
Give differential diagnoses for haemoptysis
- Bronchiectasis
- Bronchial carcinoma
- Pulmonary embolism
- Bronchitis
- Pneumonia (rust coloured sputum)
- TB and abscesses
- Pulmonary oedema (pink frothy sputum)
- Wegener’s granulomatosis and Goodpasture’s Syndrome
What is pleuritic chest pain?
Localised, sharp pain made worse by breathing or coughing
Give differential diagnoses for pleuritic chest pain
- Pulmonary embolism
- Pneumothorax
- Pneumonia
- Pericarditis
- MI
- Aortic dissection
- Infection
Give respiratory causes for finger clubbing
- Bronchial carcinoma, especially squamous cell
- Bronchiectasis
- Lung abscess
- Empyema
- Pulmonary fibrosis
- Pleural and mediastinal tumours
- Cryptogenic organising pneumonia
Give cardiovascular and miscellaneous causes for finger clubbing
- Cyanotic heart disease
- Subacute infective endocarditis
- Atrial myxoma
- Congenital (ie no disease)
- IBD
- Cirrhosis
Give a differential diagnosis for cough productive of sputum
- Infections
- Bronchitis
- Pneumonia
- Smoking
- COPD
- Bronchiectasis
- Cystic Fibrosis
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Respiratory (differentials)22
-
Asthma37
-
COPD28
-
Respiratory failure36
-
Tuberculosis16
-
Pneumothorax16
-
Pneumonia22
-
Deep Venous Thrombosis22
-
Pulmonary Embolus17
-
Carcinoma of Bronchus28
-
Pleural effusion + disease11
-
Chest trauma + haemothorax10
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Bronchiectasis and CF8
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Sarcoidosis6
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Interstitial Lung Disease8
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Obstructive Sleep Apnoea5
-
Occupational lung disease0
