Respiratory Diseases Symptoms Quiz

Presenting Symptoms of Respiratory Diseases

• Chest pain is a frequent symptom of both cardiac and respiratory issues.

Differential Diagnosis of Chest Pain

Central Cardiac Issues

• Myocardial ischemia (angina)
• Myocardial infarction
• Myocarditis
• Pericarditis
• Mitral valve prolapse syndrome

Aortic Issues

• Aortic dissection
• Aortic aneurysm

Esophageal Issues

• Esophagitis
• Esophageal spasm
• Mallory-Weiss syndrome
• Massive pulmonary embolus

Mediastinal Issues

• Tracheitis
• Malignancy
• Anxiety/emotion

Peripheral Lungs/Pleura Issues

• Pulmonary infarct
• Pneumonia
• Pneumothorax
• Malignancy
• Tuberculosis
• Connective tissue disorders

Musculoskeletal Issues

• Osteoarthritis
• Rib fracture/injury
• Costochondritis (Tietze's syndrome)
• Intercostal muscle injury
• Epidemic myalgia (Bornholm disease)

Neurological Issues

• Prolapsed intervertebral disc
• Herpes zoster
• Thoracic outlet syndrome

Haemoptysis

• Coughing up blood is a serious symptom, and patients typically seek immediate medical attention.
• A proper history (excluding hematemesis, gum, or nose bleeding) is crucial.
• Assume all haemoptysis has a serious cause until proven otherwise.
• Many cases remain unexplained, often due to simple bronchial infections.
• Repeated small haemoptysis or blood-streaked sputum strongly suggests bronchial carcinoma.

Haemoptysis additional causes

• Tuberculosis
• Pneumococcal pneumonia (may cause rusty-coloured sputum and frank haemoptysis)
• Suppurative pneumonic infections (including lung abscess)
• Bronchiectasis and intracavitary mycetoma (can cause catastrophic haemorrhage, with history of TB/pneumonia)
• Pulmonary thromboembolism (a frequent cause).

Physical Examination

• Finger clubbing suggests bronchial carcinoma or bronchiectasis; other signs of malignancy (cachexia, hepatomegaly, lymphadenopathy) should be noted.
• Fever, pleural rub, or consolidation signs point to pneumonia or pulmonary infarction, often associated with unilateral leg swelling/pain (deep vein thrombosis).
• Rashes, haematuria, and digital infarcts suggest underlying systemic diseases (vasculitis).

Causes of Haemoptysis

Bronchial Disease

• Carcinoma (high risk)
• Bronchiectasis (high risk)
• Acute bronchitis
• Bronchial adenoma
• Foreign body

Parenchymal Disease

• Tuberculosis
• Suppurative pneumonia
• Lung abscess
• Parasites (e.g., hydatid disease, flukes)
• Trauma
• Actinomycosis
• Mycetoma

Lung Vascular Disease

• Pulmonary infarction (high risk)
• Goodpasture's syndrome
• Polyarteritis nodosa
• Idiopathic pulmonary haemosiderosis

Cardiovascular Disease

• Acute left ventricular failure
• Mitral stenosis
• Aortic aneurysm

Blood Disorders

• Leukemia
• Haemophilia
• Anticoagulants

Investigations

• Chest X-ray often crucial to view localized lesions (tumour, pneumonia, or tuberculosis).
• Full blood count and clotting screen (essential).
• Bronchoscopy (after acute bleeding subsides) can reveal central bronchial carcinoma and enable tissue sampling.
• CT pulmonary angiography (CTPA) useful for identifying pulmonary thromboembolism and other causes not visible on initial X-rays.

Management

• In severe haemoptysis:
  • Upright or side lying position (if bleeding location known)
  • High-flow oxygen
  • Haemodynamic resuscitation
• Bronchoscopy in acute phase may only show blood, making visualization difficult.
• Rigid bronchoscopy under general anesthesia may be an intervention to stop bleeding.
• Intubation with a divided endotracheal tube may allow for lung ventilation.
• Bronchial angiography/embolization or emergency pulmonary surgery may be life-saving.

Cyanosis

• Abnormal bluish skin discoloration due to reduced hemoglobin.
• Typically reflects arterial oxygen saturation of 85% or less (normal is ≥95%).

Central Cyanosis

• Often results from right-to-left shunting of blood, caused by:
  • Structural cardiac abnormalities (e.g., atrial or ventricular septal defects)
  • Pulmonary parenchymal or vascular disease (e.g., COPD, pulmonary embolism, pulmonary AV fistula).

Peripheral Cyanosis

• May result from systemic vasoconstriction or localized vascular/venous issues.
  • Venous or arterial thrombosis, arterial embolic disease, Raynaud disease.
• In childhood, it often indicates congenital heart disease with right-to-left shunting.

Incidental Pulmonary Nodule on Imaging

• A pulmonary nodule is a round opacity, less than 3 cm in diameter, with clear margins.
• Most are benign, but differential diagnosis extends to early malignant disease, potentially treatable.

Causes of Pulmonary Nodules (Common and Uncommon)

• Common: Bronchial carcinoma, single metastasis, localized pneumonia, lung abscess, tuberculoma.
• Uncommon: Benign tumors, lymphoma, arteriovenous malformation, hydatid cyst, bronchogenic cyst.

Clinical and Radiographic Features Distinguishing Benign from Malignant Nodules

• Risk status of the patient: Age and smoking history strongly affecting malignancy likelihood.
• Size: Nodules larger than 3 cm are almost always malignant.
• Margin: Usually smooth in benign lesions; a speculated margin in malignant lesions.
• Density: Partly solid lesions, ground glass lesions, and significant calcifications or fat tend to be benign.

Pleural Effusion

• Pleural effusion is the accumulation of fluid (typically serous) in the pleural space.
• Types of effusions:
  • Empyema (pus), haemothorax (blood), chylothorax (chyle).
• Transudative effusion often due to increased hydrostatic pressure or decreased osmotic pressure.
• Exudative effusion often due to increased microvascular pressure and/or injury to pleural surface.