History and PE Flashcards
What mnemonic is used to explore the etiology and significance of a patient’s concerns and symptoms?
OLDCARTS
Provide three open-ended questions that can be used to elicit the chief complaint from a patient.
‘What can I do for you today?’, ‘How can I help you?’, ‘Why did you seek consult?’
A patient presents with a cough lasting for 6 weeks. Classify this cough duration and state two possible diagnoses.
Subacute cough; possible diagnoses: post-infectious cough, exacerbations of underlying illnesses, upper airway cough syndrome
What specific symptom in a patient with cough should prompt immediate referral to the hospital?
Massive hemoptysis (>500ml/24 hrs or >100ml/hr)
Name three conditions that can cause paroxysmal nocturnal dyspnea.
Left ventricular failure, mitral stenosis, obstructive sleep apnea
What type of chest pain is described as sharp, burning, or catching, worsening with deep breaths, and associated with dyspnea?
Pleuritic pain
Apart from respiratory causes, list three other categories of disorders that can present with dyspnea.
Cardiac, hematologic, metabolic, neuromuscular
State three sleep-related symptoms that can indicate obstructive sleep apnea.
Loud snoring, witnessed apneas, awakening due to gasping
Give two examples of primary malignancies that could later manifest as lung metastases.
Breast cancer, colorectal cancer
Why is it important to inquire about a patient’s last antibiotic intake, particularly those taken within the past 3 months?
To assess for recent antibiotic use that might mask current infections and to identify potential drug-induced cough
Name three cardiometabolic diseases that could contribute to chest pain and/or difficulty breathing.
Coronary artery disease, heart failure, hypertension
What specific question about diabetes is important to ask, especially in relation to potential pulmonary infections?
Level of diabetes control; uncontrolled diabetes increases the risk of infections like tuberculosis
List three conditions, besides anemia and pregnancy, that could contribute to shortness of breath.
Obesity, chronic kidney disease, liver failure
Give two examples of inhalers used in the management of respiratory conditions and specify their drug classes.
Salmeterol (LABA), fluticasone (ICS)
What formula is used to calculate pack years in a smoker?
Pack years (PY) = pack per day x years of smoking
Name three occupational lung diseases.
Asbestosis, coal worker’s pneumoconiosis, silicosis
Give two examples of diseases endemic to specific regions in the Philippines that could present with pulmonary manifestations.
Paragonimiasis, Malaria
What aspects of a patient’s home environment should be inquired about during history taking?
Ventilation, presence of allergens/pollutants
List four signs of respiratory distress that can be observed during the general survey.
Inability to speak in full sentences, tachypnea, use of accessory muscles, cyanosis
What is the normal respiratory rate for an adult?
12-20 breaths per minute
Explain how to accurately measure a patient’s respiratory rate.
Observe the rate, rhythm, depth, and effort of breathing for a full minute while subtly palpating the radial pulse
Describe the correct positioning of both the patient and the examiner when inspecting the posterior chest.
Patient: seated with arms folded across the chest and hands resting on opposite shoulders; doctor: standing in a midline position behind the patient
What chest wall deformity is characteristically seen in patients with COPD?
Barrel chest
Describe the paradoxical movement of the thorax observed in traumatic flail chest.
Inspiration: injured area caves inward; expiration: injured area moves outward
What cardiac abnormality can be associated with a funnel chest?
Murmurs due to compression of the heart and great vessels
How do you assess for symmetrical chest expansion during palpation of the posterior chest?
Place thumbs at the level of the 10th ribs, grasp lateral rib cage with fingers, slide hands medially to raise a skin fold, ask the patient to inhale deeply, observe thumb divergence
What is tactile fremitus, and where is it typically most prominent?
Palpable vibrations transmitted through the bronchopulmonary tree; most prominent in the interscapular area
What does unilaterally decreased tactile fremitus suggest?
Unilateral pleural effusion, pneumothorax, mass
What are the three purposes of percussion in a respiratory exam?
Establish whether underlying tissues are air-filled, fluid-filled, or consolidated; produce audible sounds; produce palpable vibrations
List the five percussion notes and their corresponding characteristics in terms of intensity and pitch.
Flat (soft, high-pitched), dull (medium, medium), resonant (loud, low), hyperresonant (very loud, lower), tympanitic (loud, high)
Give two examples of conditions that would produce dullness on percussion.
Lobar pneumonia, pleural effusion
What percussion note is expected over a healthy lung?
Resonant
What is the significance of unilateral hyperresonance on percussion?
Large pneumothorax or bulla
Explain how to measure diaphragmatic excursion.
Percuss downward from resonance to dullness to find the diaphragm level on quiet respiration and full expiration; measure the distance between the two levels
State the normal range for diaphragmatic excursion.
3 to 5.5 cm
What does absent descent or an abnormally high level of diaphragmatic excursion indicate?
Pleural effusion or elevated hemidiaphragm
What part of the stethoscope should be used for auscultation of the chest?
Diaphragm
Why should the stethoscope be placed directly on the skin during auscultation?
Clothing alters breath sounds and introduces extraneous sounds
Describe the characteristics of vesicular breath sounds, including their intensity, pitch, and inspiratory/expiratory ratio.
Soft, low-pitched, inspiration longer than expiration
Where are bronchovesicular breath sounds normally heard?
1st and 2nd intercostal spaces anteriorly and between the scapulae
What is the key characteristic that distinguishes bronchial breath sounds from vesicular and bronchovesicular sounds?
Expiratory sounds last longer than inspiratory sounds
What do abnormally located bronchovesicular or bronchial breath sounds suggest?
Replacement of air-filled lung by fluid-filled or consolidated lung tissue
Differentiate between fine and coarse crackles in terms of their sound quality.
Fine crackles: soft, high-pitched, very brief; coarse crackles: louder, lower in pitch
What underlying conditions can cause crackles?
Pneumonia, interstitial lung disease, bronchitis, bronchiectasis, heart failure
Describe the sound quality of wheezes and indicate their common causes.
High-pitched with hissing or shrill quality; asthma, COPD, bronchitis
What is stridor, and where is it loudest?
Audible high-pitched inspiratory whistling; loudest over the neck
What does the presence of egophony indicate?
Lung consolidation
Explain how to assess for bronchophony.
Ask the patient to say ‘ninety-nine’ while auscultating; louder voice sounds indicate bronchophony
What does whispered pectoriloquy suggest?
Consolidation
According to the sources, what is the diagnostic accuracy of a thorough history and complete physical examination in respiratory cases?
0.88
Q: What are crackles, and what causes them?
Crackles (or rales) are discontinuous, nonmusical, and brief adventitious breath sounds that resemble dots in time.
further characterized as fine crackles (soft, high-pitched, very brief) or coarse crackles (louder and lower in pitch).
Crackles arise from abnormalities in the lung parenchyma (e.g., pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart failure) or the airways (e.g., bronchitis, bronchiectasis).
Q: How can you differentiate between crackles caused by thickened secretions and those caused by lung tissue abnormalities?
Crackles that clear after coughing or a position change suggest thickened secretions, which can be seen in conditions like bronchitis or atelectasis
In contrast, fine, late inspiratory crackles that persist from breath to breath suggest abnormal lung tissue
Q: What are wheezes, and what conditions are commonly associated with them?
A: Common causes of wheezes include asthma, COPD, and bronchitis.
Wheezes are continuous, musical, and prolonged adventitious breath sounds that have a high-pitched, hissing or shrill quality.
Q: How does stridor differ from wheezes?
Stridor is a high-pitched inspiratory whistling sound that is loudest over the neck - upper airway obstruction
Wheezes can be inspiratory or expiratory and are typically heard over the chest.
Q: What is a barrel chest, and what condition is it commonly associated with?
A: A barrel chest is a chest wall deformity characterized by an increased anterior-posterior (AP) diameter. While normal during infancy, it is often seen in adults with COPD.
The increased AP diameter reflects chronic hyperinflation of the lungs seen in this condition.
Q: What is traumatic flail chest, and what causes it?
A: due to multiple rib fractures.
These fractures disrupt the structural integrity of the chest wall, leading to paradoxical movements of the thorax. During inspiration, when the diaphragm descends and intrathoracic pressure decreases, the injured area caves inward. Conversely, during expiration, the injured area moves outward.
Q: How can a funnel chest (pectus excavatum) affect the cardiovascular system?
A: A funnel chest is characterized by a depression in the lower portion of the sternum. In severe cases, this depression can compress the heart and great vessels, potentially causing heart murmurs.
Q: What is thoracic kyphoscoliosis, and what respiratory problem can it cause?
Thoracic kyphoscoliosis refers to abnormal spinal curvatures and vertebral rotation that deform the chest.
These deformities can distort the underlying lungs making it difficult to interpret lung findings.
Thoracic kyphoscoliosis can also lead to restrictive lung disease, where lung expansion is limited, resulting in breathing difficulties.
Q: Why is it important to assess transmitted voice sounds during a respiratory exam?
A: Transmitted voice sounds, such as egophony, bronchophony, and whispered pectoriloquy, are assessed when abnormally located bronchovesicular or bronchial breath sounds are heard. Increased transmission of voice sounds suggests that airways are blocked by inflammation or secretions, a finding often associated with lung consolidation
Q: What is the significance of absent breath sounds on auscultation?
A: Absent breath sounds can indicate
pneumothorax (air in the pleural space)
large pleural effusion (fluid in the pleural space)
atelectasis or lobar obstruction (collapsed lung or blockage of a lung segment).
