history and examination Flashcards
1
Q
chest pain - where from?
A
- lungs = asensate
- heart = autonomic , referred
- parietal pleura = intercostal
- bones, muscles, skin
- GI tract
2
Q
what to ask about
A
site onset character radiation associations timing exacerbating and alleviating factors severity
3
Q
chest pain - cardiac pain
A
- all referred pain
- central, crushing, heavy, tight band
- usually left sided
- can be epigastric
- often radiates = left arm, neck, jaw/teeth
- autonomic symptoms
- usually exertion
4
Q
chest pain - respiratory
A
- pleuritic = sharp, worse on inspiration, usually located easily, non-specific
- lungs = contain no pain receptors, do contain J receptors, cough, pleurisy if the pathology reaches the pleura
- GI = oesophageal spasm, trapped wind, rflux oesophagus
- muscloskeletal = usually worse on movement, recent trauma, reproducible
5
Q
brethlessness
A
- symptom, not sign
- people get breathless because of
- exercise and weight
- fitness, cardiac function, respiratory function
6
Q
breathlessness questions
A
- what do you mean by breathlessness?
- cant breath in or out?
- when?
- doing what?
- orthopnoea?
- paroxysmal noctunal dyspnoea?
- associated symptoms eg wheeze, stridor, cough
- time frame?
7
Q
time frame for breathless ness
A
acute - PE, pneumothorax, pulmonary oedema subacute - pneumonia, pulmonary oedema, pleural effusion, asthma chronic - COPD, pulmonary fibrosis, PE
8
Q
dry cough
A
- acute
- < 8 weeks
- almost always viral aetilogy
- very common
- sometimes just airway disease
9
Q
sinister cough
A
- lung cancer
- mesothelioma
- pulmonary metastases
- pulmonary fibrosis
- sarcoidosis
- pneumonitisis
- EAA
10
Q
chronic dry cough
A
- GORD
- ACE-1
- upper airway disease
increase in stimulus
- smoking, GORD, allergens, ACE-1
11
Q
productive cough
A
- productive of SPUTUM mainly
- suptum = neutrophils, eosinophils, bacteria/fungus, /virus
- airway secretion
12
Q
haemoptysis
A
coughing up blood
massive > 500ml in 24 hours
non massive < 500 ml in 24 hours
13
Q
causes of haemoptysis
A
- infection
- carcinoma
- pulmonary embolism
- bronchiectasis
- cardiac
- AVM
- anticoagulation
14
Q
general resp examinaation
A
- look at whole patient
- respiratory distress
- stridor = high pitched wheezing sound on inspiration
- cyanosis = bluish colour
- state of nutrition
15
Q
peripheral signs in resp exam
A
- mouth
- hands
- skin perfusion
- CO2 flap
- lymph nodes
- JVP
- chest - finally
