history and examination Flashcards
what is cough lying down in the evening characteristic of?
GORD
what is cough disrupting sleep typical of?
asthma
what is cough on rising in the morning typical of?
rhino sinusitis
post-nasal drip
why does a Fx of asthma, eczema and hay fever increase the chance of asthma?
predisposition to form excess IgE in response to allergen
what conditions are associated with birds?
hypersensitivity pneumonitis
psittacosis
what is farmers lung otherwise known as ?
ILD
causes of pulmonary fibrosis
asbestos (shipyard/construction workers)
quartz/silica (miners, quarry workers)
coal
what is used to predict mortality in community acquired pneumonia
CURB 65
c: confusion
u: >7mmol/L
r: >30/min
b: bp <60
age 65 or over
use of accessory muscles is characteristic of what condition?
severe COPD
acute severe asthma
what is cyanosis
blue colour caused by an absolute concentration of deoxygenated Hb of >50g/L
what does does central cyanosis reflect?
arterial hypoxaemia
what does peripheral cyanosis reflect?
circulatory disorders or cold
what is pulsus pardoxus
exaggeration of the normal variability of pulse volume with the respiratory cycle
what is erythema nodosum a feature of
acute sarcoidosis
Tb
what is clubbing associate d with?
thoracic disease (lung cancer, bronchiectasis, ILD) GI disorders
what is a fine finger tremor caused by?
excessive use of beta agonist or theophylline bronchodilator drugs
what is a coarse flapping tremor (asterixis) seen in
severe ventilatory failure and CO2 retention
what kind of heart failure is the JVP raised in
right sided heart failure
what does chronic hypoxia in COPD lead to
pulmonary arterial vasoconstriction
pulmonary hypertension
right heart dilatation
peripheral oedema
features of superior vena caval obstruction
raised and non pulsatile JVP
abdominojugular reflex absent
causes of superior vena caval obstruction
lung cancer compressing the vena cava
lymphoma
thymoma
mediastinal fibrosis
what is a barrel shaped chest defined as
the anteroposterior diameter being greater than the lateral diameter
what is a barrel shaped chest associated with
lung hyperinflation in patients with severe COPD
why do patients with kyphosis or scoliosis develop ventilatory failure?
reduced ventilatory capacity and increased work of breathing.
these patients develop progressive ventilatory failure with CO2 retention and cor pulmonale at a young age
what is pectus carinatum (pigeon chest)
localised prominence of the sternum and adjacent costal cartilages
what is pectus excavatum
developmental deformity with a localised depression of the lower end of the sternum
causes of tracheal deviation towards the side of the lung lesion
lung collapse
fibrosis
pneumonectomy
causes of tracheal deviation away from the side of the lung lesion
tension pneumothorax
massive pleural effusion
causes of unilateral reduced lung expansion
pleural effusion
lung/lobar collapse
pneumothorax
unilateral fibrosis
causes of bilateral reduced lung expansion
severe COPD
diffuse pulmonary fibrosis
resonant percussion note detected over….
normal lung
hyperresonant percussion note detected over…
pneumothorax
dull percussion note detected over…
pulmonary consolidation
pulmonary collapse
severe pulmonary fibrosis
stony dull percussion note detected over…
pleural effusion
haemothorax
reduced conduction causes of diminished vesicular breathing
- obesity/thick chest wall
- pleural effusion or thickening
- pneumothorax
if the breath sounds appear reduced, what should you ask the patient to do?
ask the patient to cough
if the reduced breath sounds are due to bronchial obstructions, what happens after the patient coughs?
likely to become more audible
what is aegophony
a bleating or nasal sound heard over the consolidated lung (pneumonia) or at the upper level of a pleural effusion
reduced airflow causes of diminished vesicular breathing?
generalised (e.g. COPD)
localised (collapsed lung)
Wells score for PE?
PE/DVT immobilisation cancer haemoptysis heart rate >100bpm signs of DVT
major risk factors for pulmonary thromboembolism?
- fracture of the hip, pelvis or leg
- hip or knee replacement
- major abode or pelvic surgery
- major trauma
- spinal cord injury
- malignancy
what produced crackles?
abrupt opening of distal airways on inspiration after they have collapsed on expiration
causes of early inspiration crackles?
small airways disease (bronchiolitis)
causes of middle inspiration crackles?
pulmonary oedema
causes of fine late inspiratory crackles (sound similar to hair rubbing)?
pulmonary fibrosis
causes of coarse late inspiratory crackles?
bronchial secretions in COPD, pneumonia, lung abscess,
causes of biphasic crackles?
bronchiectasis
what is a wheeze caused by?
continuous oscillation of opposing airway walls occurring during airway narrowing
why would a wheeze be loud on expiration?
because airways normally dilate during inspiration and narrow on expiration
where do high pitched wheezes arise from?
smaller airways (have a whistling quality)
where do low pitched wheezes arise from?
larger bronchi
what is a wheeze characteristic of?
asthma
COPD
cause of a pleural friction rub?
produced when inflamed parietal and visceral pleurae move over one another
cause of a pleural rub
pulmonary infarction (due to PE)
pneumonia
pulmonary vasculitis
