Acute Respiratory Diseases
Clinical Medicine: Chapters 23, 24 (p. 1029-1035, 1066-1074) and Essential Surgery:
Chapter 43 (p. 540) and “Community-acquired pneumonia” by Musher on Nestor
Respiratory symptoms
Clinical Medicine: Chapter 24 (p. 1066-1074)
Note: Marked in italics are diagnoses that are likely with the named symptom.
Nose
Runny nose: allergic rhinitis, viral infection (common cold).
Nasal blockage and loss of smell: nasal polyp.
Cough
Most commonly seen in lower respiratory tract disease.
Smokers have a morning cough with a little sputum.
Productive cough: think of chronic bronchitis.
Dry cough: (at night → ) asthma or acid reflux. ACE inhibitors.
Worsening cough: lung cancer.
Sputum
Most common cause: cigarette smoking → clear white sputum, maybe with black
specks.
Yellow or green sputum: cellular material due to inflammation or infection.
Large amounts of yellow/green sputum: bronchiectasis.
Haemoptysis (blood-stained sputum): most common cause is acute infection (esp. in
COPD), pulmonary infarction (!!), bronchial carcinoma (!!), tuberculosis.
Rusty sputum: lobar pneumonia.
Pink, frothy sputum: pulmonary oedema.
Breathlessness
● Dyspnoea: awareness of increased respiratory effort
● Orthopnea: breathlessness on lying down (think of heart failure).
● Tachypnoea: fast breathing rate. Hyperpnoea: increased ventilation.
● Hyperventilation: inappropriate overbreathing.
● Paroxysmal nocturnal dyspnoea: acute breathlessness at night (think of heart
failure).
Wheezing
Due to airflow limitation: asthma, vocal chord dysfunction, bronchiolitis, COPD.
Chest pain
Sharp, localised = “pleuritic”. Worse on deep breathing.
Localised anterior chest pain: costochondritis.
Shoulder tip pain: irritation of diaphragmatic pleura.
Central chest pain with radiation to arm and neck: cardiac problem.
Examination of chest
, Inspection
Tremor/flapping of outstretched hand: CO2 intoxication.
Prominent chest veins: SVC obstruction.
Cyanosis with central cause: cyanosis on tongue and lips + peripheral cyanosis.
Finger clubbing: respiratory or cardiovascular disease.
Auscultation
Normal breath sounds are vesicular.
High-frequency breathing is called bronchial breathing: consolidation or collapse.
Wheeze, heard during expiration: asthma, COPD.
Crackles
Pleural rub: groaning sound indicating inflammation and roughening of pleural surface.
Chest X-ray
Imaging of the lungs
CT:
● Staging of cancers, esp. bronchial carcinomas
● High-resolution CT: diffuse inflammatory and infective parenchymal disease
MRI:
● Staging of lung cancer
● Assessing vascular structures
PET-CT:
● Lymph nodes and metastatic disease
Perfusion scan (technetium-99m):
● Pulmonary blood flow (e.g. in PE)
Ventilation-perfusion scan (xenon-133):
● Pulmonary blood flow (e.g. in PE)
Ultrasound:
● Diagnosis of small pleural effusions
● Guided biopsies
● Placing intercostal drains
Respiratory function tests
Spirometry:
Measures 1-second forced expiratory volume (FEV1) and total exhaled gas (forced vital
capacity, FVC)
● Normal FEV1/FVC = 75%. Reduced in airflow limitation. Increased (or normal) in
restrictive lung disease.
Peak expiratory flow rate (PEFR):
Full inspiration followed by full expiration.
● Diagnose asthma
Flow-volume loops:
● Shows site of airflow limitation.
Clinical Medicine: Chapters 23, 24 (p. 1029-1035, 1066-1074) and Essential Surgery:
Chapter 43 (p. 540) and “Community-acquired pneumonia” by Musher on Nestor
Respiratory symptoms
Clinical Medicine: Chapter 24 (p. 1066-1074)
Note: Marked in italics are diagnoses that are likely with the named symptom.
Nose
Runny nose: allergic rhinitis, viral infection (common cold).
Nasal blockage and loss of smell: nasal polyp.
Cough
Most commonly seen in lower respiratory tract disease.
Smokers have a morning cough with a little sputum.
Productive cough: think of chronic bronchitis.
Dry cough: (at night → ) asthma or acid reflux. ACE inhibitors.
Worsening cough: lung cancer.
Sputum
Most common cause: cigarette smoking → clear white sputum, maybe with black
specks.
Yellow or green sputum: cellular material due to inflammation or infection.
Large amounts of yellow/green sputum: bronchiectasis.
Haemoptysis (blood-stained sputum): most common cause is acute infection (esp. in
COPD), pulmonary infarction (!!), bronchial carcinoma (!!), tuberculosis.
Rusty sputum: lobar pneumonia.
Pink, frothy sputum: pulmonary oedema.
Breathlessness
● Dyspnoea: awareness of increased respiratory effort
● Orthopnea: breathlessness on lying down (think of heart failure).
● Tachypnoea: fast breathing rate. Hyperpnoea: increased ventilation.
● Hyperventilation: inappropriate overbreathing.
● Paroxysmal nocturnal dyspnoea: acute breathlessness at night (think of heart
failure).
Wheezing
Due to airflow limitation: asthma, vocal chord dysfunction, bronchiolitis, COPD.
Chest pain
Sharp, localised = “pleuritic”. Worse on deep breathing.
Localised anterior chest pain: costochondritis.
Shoulder tip pain: irritation of diaphragmatic pleura.
Central chest pain with radiation to arm and neck: cardiac problem.
Examination of chest
, Inspection
Tremor/flapping of outstretched hand: CO2 intoxication.
Prominent chest veins: SVC obstruction.
Cyanosis with central cause: cyanosis on tongue and lips + peripheral cyanosis.
Finger clubbing: respiratory or cardiovascular disease.
Auscultation
Normal breath sounds are vesicular.
High-frequency breathing is called bronchial breathing: consolidation or collapse.
Wheeze, heard during expiration: asthma, COPD.
Crackles
Pleural rub: groaning sound indicating inflammation and roughening of pleural surface.
Chest X-ray
Imaging of the lungs
CT:
● Staging of cancers, esp. bronchial carcinomas
● High-resolution CT: diffuse inflammatory and infective parenchymal disease
MRI:
● Staging of lung cancer
● Assessing vascular structures
PET-CT:
● Lymph nodes and metastatic disease
Perfusion scan (technetium-99m):
● Pulmonary blood flow (e.g. in PE)
Ventilation-perfusion scan (xenon-133):
● Pulmonary blood flow (e.g. in PE)
Ultrasound:
● Diagnosis of small pleural effusions
● Guided biopsies
● Placing intercostal drains
Respiratory function tests
Spirometry:
Measures 1-second forced expiratory volume (FEV1) and total exhaled gas (forced vital
capacity, FVC)
● Normal FEV1/FVC = 75%. Reduced in airflow limitation. Increased (or normal) in
restrictive lung disease.
Peak expiratory flow rate (PEFR):
Full inspiration followed by full expiration.
● Diagnose asthma
Flow-volume loops:
● Shows site of airflow limitation.
