history and examination

Question 1

chest pain - where from?

Answer 1

• lungs = asensate
• heart = autonomic , referred
• parietal pleura = intercostal
• bones, muscles, skin
• GI tract

Question 2

what to ask about

Answer 2

site
onset
character
radiation
associations
timing
exacerbating and alleviating factors
severity

Question 3

chest pain - cardiac pain

Answer 3

• 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

Question 4

chest pain - respiratory

Answer 4

• 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

Question 5

brethlessness

Answer 5

• symptom, not sign
• people get breathless because of
• exercise and weight
• fitness, cardiac function, respiratory function

Question 6

breathlessness questions

Answer 6

• 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?

Question 7

time frame for breathless ness

Answer 7

acute
- PE, pneumothorax, pulmonary oedema
subacute
- pneumonia, pulmonary oedema, pleural effusion, asthma
chronic
- COPD, pulmonary fibrosis, PE

Question 8

dry cough

Answer 8

• acute
• < 8 weeks
• almost always viral aetilogy
• very common
• sometimes just airway disease

Question 9

sinister cough

Answer 9

• lung cancer
• mesothelioma
• pulmonary metastases
• pulmonary fibrosis
• sarcoidosis
• pneumonitisis
• EAA

Question 10

chronic dry cough

Answer 10

• GORD
• ACE-1
• upper airway disease

increase in stimulus
- smoking, GORD, allergens, ACE-1

Question 11

productive cough

Answer 11

• productive of SPUTUM mainly
• suptum = neutrophils, eosinophils, bacteria/fungus, /virus
• airway secretion

Question 12

haemoptysis

Answer 12

coughing up blood
massive > 500ml in 24 hours
non massive < 500 ml in 24 hours

Question 13

causes of haemoptysis

Answer 13

• infection
• carcinoma
• pulmonary embolism
• bronchiectasis
• cardiac
• AVM
• anticoagulation

Question 14

general resp examinaation

Answer 14

• look at whole patient
• respiratory distress
• stridor = high pitched wheezing sound on inspiration
• cyanosis = bluish colour
• state of nutrition

Question 15

peripheral signs in resp exam

Answer 15

• mouth
• hands
• skin perfusion
• CO2 flap
• lymph nodes
• JVP
• chest - finally

Question 16

cyanosis

Answer 16

• central = tongue, peripheries warm, vasodilated
• there may be secondary polycythaemia
• peripheral = hands, feet, nose
• cardiovascular collapse
• peripheral vascular disease

Question 17

CO2 flap

Answer 17

• due to hypercapnic encephalopathy
• irregular flapping of hand when wrist hyperextended
• associated confusion
• peripheral vasodilation

Question 18

skin

Answer 18

yellow fingernail due to nicotime, tar, fungus

- eczema with atopic disease

Question 19

causes of clubbing

Answer 19

• bronchial carcinoma
• fibrosis alveolitis
• lung suppuration
• cyanotic congenital heart disease
• infective enocarditis
• malabsorption states
• congenital, idiopathic

Question 20

eyes

Answer 20

horners syndrome = small pupil, ptosis, enophthalmos, unilateral loss of sweating

Question 21

the neck

Answer 21

• super clavicular
• cervical chain
• submental, submandibular
• partotid
• post articular
• occipital

Question 22

examination of chest

Answer 22

• inspection
• palpation
• percussion
• auscultation

Question 23

inspection of chest

Answer 23

• chest wall deformity
• operation scars
• expansion

Question 24

pectus excavatum

Answer 24

• pulmonary artery flow murmur

- big dent near nipple

Question 25

palpation of chest

Answer 25

- tracheal deviation = towards collapse lung , towards consolidatoin, away from effusion - crepitation (crackles) = surgical emphysema

Question 26

percussion of chest

Answer 26

- hyper-resonance - emphysema, pneumothroax - impaired resonance = consolidatoin, pleural thickening - stony dull percussoins - pleural effusion

Question 27

auscultation of chest

Answer 27

low pitched = bell of stethoscope | high pitched = diaphragm of stethoscope

Question 28

auscultation - added sounds

Answer 28

- wheeze - air breathed out - localised - eg large airwau tumour - generalised - polyphinc, small airway obstructoin - squeak - bronchiolitis - crackles