Common Respiratory Presentations Flashcards
What are the specific respiratory symptoms which must be enquired about in a respiratory history?
- Dyspnoea
- Wheeze
- Cough
- Sputum / haemoptysis
- Chest pain
- Fever / rigors / night sweats
- Weight loss
- Sleepiness
What are the possible origins of dyspnoea?
- Cardiac causes
- Respiratory causes
- Non cardio-respiratory causes
Which conditions can cause onset of dyspnoea over minutes?
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Which conditions can cause onset of dyspnoea over hours to days?
- Pneumonia
- Asthma
- Exacerbation of COPD
Which conditions can cause onset of dyspnoea over weeks to months?
- Anaemia
- Pleural effusion
- Respiratory neuromuscular disorders
Which conditions can cause onset of dyspnoea over months to years?
- COPD
- Pulmonary fibrosis
- Pulmonary TB
A 23 year old male patient presents to A&E with sudden pleuritic chest pain and breathlessness. His X-ray is shown in the reference box. What is the diagnosis?
Pneumothorax
A 33 year old female who gave birth ten days previously presents to A+E with acute SOB and pleuritic chest pain. On examination she has a HR of 120, BP of 96/50, a raised JVP and you can hear a pleuritic rub on auscultation. What is the likely diagnosis?
Pulmonary embolism
A 73 year old with breathlessness that has worsened over several months. They have also noticed increased ankle swelling, and are waking up overnight feeling breathless. What is the likely diagnosis?
Left ventricular failure
A 70 year old male presents with SOB on exertion and a dry cough. On examination you note he has finger clubbing, appears cyanosed and you hear fine end-inspiratory crackles on auscultation. What is the likely diagnosis?
Idiopathic pulmonary fibrosis
How do you distinguish between haemoptysis and haematemesis?
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What are the causes of haemoptysis?
- Cancers
-
Infective causes
- Bronchiectasis
- Pneumonia
- TB
- COPD
-
Parenchymal causes
- Fibrosis
- CF
- Sarcoidosis
-
Vascular causes
- PE
- Vasculitis
-
Traumatic
- Foreign body
-
CV causes
- Pulmonary oedema
- Mitral stenosis
- Anticoagulants
What is the problem with using CXR to investigate patients with haemoptysis?
May be negative of any findings in up to 30% of patients with haemoptysis.
Under what circumstances would you perform an acid fast bacillus test?
Suspicion of TB
What questions should be asked of a patient presenting with hoarseness?
- Duration
- Onset
- Precipitating factors (shouting / singing)
- Reflux symptoms
- Alcohol
- Smoking
- Other associated symptoms
- Red flag - any patient who is ≥45 and has persistent unexplained hoarseness should be referred for suspect laryngeal cancer for an appointment in under 2 weeks.
