GP Student Handbook Chest Common Presentations Flashcards
Dyspnoea
SoB
Dyspnoea associated features?
Cough Chest pain Wheeze Weight loss Haemoptysis Night sweats Finger clubbing (e.g. mesothelioma, emphysema and TB, chronic pulmonary disorders like COPD)
Red flags in acute and chronic dyspnoea?
Acute: Sudden onset Severe symptoms Low O2 sats Increase RR
Chronic: Weight loss >3kgs SoB >3weeks Haemoptysis Clubbing of nails Night sweats
Acute causes of dyspnoea?
Chest infection (pneumonia, acute bronchitis) PE MI Acute pulmonary oedema Pneumothorax Pleural effusion Upper airway obstruction Acute asthma exacerbation Acute exacerbation of COPD
Pneumonia presentation
Dyspnoea Wheeze Pleuritic pain Dull on percussion Bronchial breath sounds on auscultation Coarse crackles
Auscultation of acute bronchitis…
Crackles
Differential diagnosis for chronic dyspnoea
Asthma COPD Hyperventilation / anxiety Anaemia CHF Lung cancer Intestinal lung disease
Management of COPD
STOP SMOKING
If breathless and exercise limitation: SABA or SAMA as required
If exacerbations or persistent breathlessness
FEV1> 50% : LABA or LAMA (stop SAMA)
FEV1< 50% : LABA + ICS or LAMA (stop SAMA)
If persistent exacerbations or breathlessness: LAMA + LABA + ICS
Acute cough (<3 weeks) causes
Upper RTI
Lower RTI
Acute exacerbation of COPD, asthma, bronchiectasis
Inhalation of foreign body
Define bronchiectasis
Bronchiectasis is a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. The most common symptoms of bronchiectasis include: a persistent cough that usually brings up phlegm (sputum)
Chronic cough (>3 weeks) causes?
Exposure to cigarette smoke – active or passive
Post-infective cough – dry intermittent cough post URTI/bronchitis.
Post-nasal drip – secondary to nasal infection or allergy. Persistent cough, worse in the morning. Dry or purulent.
Asthma - Diurnal variation of dry cough. Wheeze.
Gastro-oesophageal reflux – persistent dry cough. Can be present without other symptoms.
ACE inhibitors –persistent dry cough after starting medication
Lung cancer – persistent cough is the most common presenting symptoms. May be associated with haemoptysis, weight loss and breathlessness.
Bronchiectasis – recurrent LRTI with purulent sputum and cough.
TB – persistent cough associated with night sweats and weight loss.
Whooping cough – Increasing prevalence. Persistent spasms of coughing, often precipitated by exercise and change in temperature. Cough can last for months afterwards
Features of a cough that need to be established during the history?
Dry vs purulent Acute vs chronic Time of day Precipitation factors e.g. exercise, medication Infectious contacts
Chronic cough red flags
Weight Loss >3kg Cough persisting > 3 weeks Haemoptysis Finger clubbing Night sweats.
Causes of acute cough
Inhalation of foreign particle URTI e.g. pharyngitis, common cold LRTI e.g. Pneumonia, acute bronchitis COPD/Asthma exacerbation Bronchiectasis exacerbation Pertussis (Whooping cough): Persistent spasms of coughing, often precipitated by exercise and change in termperature
What is the CURB-65 score?
The CURB-65 score is a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality.
Confusion Urea > 19 mg/dL (> 7 mmol/L) Respiratory Rate ≥ 30 BP: Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg Age ≥ 65
Broad spectrum antibiotic?
Amoxicillin
