Cardiac & Resp History Taking Flashcards
What are the cardinal symptoms for cardiac history?
Chest pain Breathlessness Paliptations Syncope/presyncope Oedema
Associated symptoms with chest pain
SOB Autonomics (nausea, vomiting, sweating) Palpitations Syncope Ankle/calf swelling Haemoptysis Sputum Trauma
Exacerbating relieving factors with chest pain
Exercise Food Position GTN Analgesia Pleuritic? Pain on movement/pressing
Relevant PMH w/cardiac symptoms
MI Previous cardiac procedures Diabetes Hypercholesterolaemia Peripheral vascular disease Stroke Rheumatic fever
Risk factors for PE
Clinically suspected DVT Alternative diagnosis less likely than PE Tachycardia >100 Immobilisation/surgery in last 4 weeks History of PE/DVT Haemoptysis Malignancy
Difference between unstable angina, NSTEMI and STEMI?
Unstable angina occurs with increasing frequency or at rest but lasts less than 20mins, troponin is normal
NSTEMI >20mins chest pain, ST depression/T wave changes and troponin is elevated
STEMI >20mins chest pain, ST elevation>2mm in chest leads, >1mm in limb leads and troponin significantly elevated
What would cause chest pain that is worse on lying down and gives a PR depression?
Pericarditis
May also be able to hear pericardial rub (fresh snow)
Classic history of pneumothorax?
Sudden onset SOB and pleuritic chest pain
young, tall, thin, cigarette smokers (marfan’s, COPD, asthmatics)
Classic history of PE?
SOB, pleuritic chest pain, haemoptysis, dizziness, syncope
Classic history of aortic dissection?
Sudden onset, tearing, excruciating chest pain radiating to the back
More common in hypertensives
What is relieved by GTN spray?
Angina/unstable angina/oesophageal spasm
Immediate treatment of ACS?
ROMANCE Reassure Oxygen (high-flow, non-rebreathing mask) Morphine Aspirin GTN Clopidogrel Enoxaparin
Cardinal symptoms in respiratory history?
Chest pain SOB Stridor Wheeze Cough Sputum Haemoptysis
Breathlessness differential
Acute (asthma, pneumonia, pneumothorax, PE)
Intermediate (bronchial carcinoma, pleural effusion, TB)
Chronic (COPD, interstitial lung disease)
Describe classical respiratory chest pain
Unilateral
Aggravated by deep inspiration
Chest wall/shoulder tip if diaphragmatic
What is stridor?
High pitched musical sound heard on inspiration, aggravated by coughing
What needs to be differentiated between with possible haemoptysis?
Blood stained sputum
Frothy pink sputum
Haematemesis
Nose bleeds
How do you ask about volume of blood?
drop/teaspoon/tablespoon/cup/bucket
Relevant PMH with respiratory symptoms
Childhood asthma/wheeze/bronchiolitis Malignancy Infections (TB, pneumonia) Chest trauma/operations Asthma/COPD PE/DVT
What social history is relevant with a cough?
Travel
Pets (pigeon racing)
Illicit drugs
Sexual (HIV/AIDS)
Systemic enquiry Qs for respiratory history
Loss of appetite/malaise/weight loss Night sweat/fevers/rigors Nasal obstruction/bleeding/discharge Stress incontinence when coughing Cardiac? Neuromuscular disease
Further investigations in respiratory patient?
Blood tests (FBC, U&Es, LFTs, CRP) ECG Peak flow ABGs Chest Xray/CT Sputum culture Spirometry Bronchoscopy
What score is used to grade community acquired pneumonia?
CURB 65 Confusion Urea (>7mmol/l) Resp rate (>30) BP (
