Approach to the Respiratory Patient

Question 1

What does an obstructive respiratory pattern entail and what conditions is it seen in?

Answer 1

Prolonged expiration

Seen in asthma and COPD

Question 2

What conditions cause bradypnea

Answer 2

• Drug-induced respiratory depression
• Diabetic coma (nonketotic)
• Increased ICP

Question 3

What is Kussmaul’s breathing and what causes it?

Answer 3

Fast and deep breathing

• Metabolic acidosis
• Exercise
• Anxiety

Question 4

What is Biot’s/ataxic breathing and what causes it

Answer 4

irregular with long apneic periods

• Drug-induced respiratory depression
• Increased ICP
• Brain damage (especially medullary)

Question 5

What is Cheyne-Stokes breathing and what causes it

Answer 5

changing rates and depths with apneic periods

• Drug-induced respratory depression
• Brain damage (especially cerebral)
• CHF
• Uremi

Question 6

What is apneustic breathing and what causes it

Answer 6

prolonged inspiratory pause

• Pontine lesion

Question 7

What are common causes of clubbing?

Answer 7

Pulmonary: 
Lung CA
bronchiectasis
pulmonary fibrosis
abscess
CF
TB
empyema
A-V fistula/malformation  
(NOT COPD) 

Cardiac:
Cyanotic congenital heart disease
endocarditis

GI: 
IBD
celiac
cirrhosis
neoplasm 

Endocrine:
Graves’ disease

Other: Other malignancy, primary hypertrophic osteoarthropathy

Question 8

What is the most common cause of hemoptysis

Answer 8

Most common cause is bronchitis

Question 9

What is massive hemoptysis and what is the source

Answer 9

• 90% of massive hemoptysis is from the bronchial arteries

* Considered “massive” if >600 mL/24 h or bleeding rate of >100 mL/h

Question 10

What are the Most Common Causes of Chronic Cough in the Non-smoking Patient (cough >3 mo with normal CXR)

Answer 10

• GERD 
• Asthma 
• Postnasal drip 
• ACEI
URTI