MEDI7111 Lecture Notes - Lecture 5: Sarcoidosis, Respiratory Sounds, Spirometry
Respiratory 5
Clinical Skills
Clinical Features of Asthma:
History:
●FHx of atopy
●Other allergies
oHay fever
oEczema
Signs:
●Wheezing
oAs a result of smooth muscle contraction, mucus hypersecretion and retention
●Cough
oYellow sputum
Symptoms:
●Dyspnoea and chest tightness
oGreater muscular effort to inflate lungs
oHarder to breathe out
●Tachypnoea and tachycardia
●Pulsus Paradoxis
oAppears as a consequence of hyperinflation
Investigation Findings:
●Hypoxemia
●Hypercapnia and respiratory acidosis
●Obstructive defects (found during pulmonary function testing)
oReduced FEV1/FVC ratio
oFEV1 significantly improved when given salbutamol
●CXR will be normal or hyper inflated
Treatment:
●Acute exacerbations
oSABA PRN (salbutamol)
●Prevention
oInhaled corticosteroid (fluticasone)
oSABA PRN
oLeukotriene receptor antagonist (not always)
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●If effecting sleep – LABA (salmetarol)
●Patient education
●Environmental control (avoidance of allergens)
Clinical Features of Sarcoidosis:
History:
●Recent onset
●Non-specific respiratory symptoms
Signs:
●Wheezing
Symptoms:
●Cough
●Dyspnoea
●Arthralgia
Investigation Findings:
●CXR
oHilar lymphadenopathy
●FBC – normal
oOccasionally anaemia or leukopenia
●High serum calcium
●LFT elevated
●Non-specific spirometry findings
●Negative TB test
Treatment:
●Oral corticosteroids
Clinical Features of Inhaled Foreign Body:
History:
●Sudden onset breathlessness
●In adults
oExcessive alcohol consumption/loss of consciousness
oRemembering inhaling something
●In children
oToys missing parts
oSudden onset quietness
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Document Summary
Wheezing: as a result of smooth muscle contraction, mucus hypersecretion and retention. Dyspnoea and chest tightness: greater muscular effort to inflate lungs, harder to breathe out. Pulsus paradoxis: appears as a consequence of hyperinflation. Obstructive defects (found during pulmonary function testing: reduced fev1/fvc ratio, fev1 significantly improved when given salbutamol. Cxr will be normal or hyper inflated. Prevention: inhaled corticosteroid (fluticasone, saba prn, leukotriene receptor antagonist (not always) Fbc normal: occasionally anaemia or leukopenia. In adults: excessive alcohol consumption/loss of consciousness, remembering inhaling something. In children: toys missing parts, sudden onset quietness. Localised dullness to percussion and lack of breath sounds. Adolescence presents a difficult time for health behaviours as adolescents are balancing a feeling of immortality and indestructability with an increased awareness of death and developing a sense of rationality. Death also becomes a concept that is properly constructed during this time; fully understanding its finality, irreversibility and universality as well as comprehending the biological causality of death.
