History Taking and Examination Flashcards
What symptoms should you ask about when taking a respiratory history?
Dyspnoea Wheeze Cough Sputum Haemoptysis Chest pain
What is dyspnoea?
Sensation of being unable to breathe easily (breathlessness)
What questions should be asked regarding dyspnoea
Speed of onset Prgression Periodicity Precipitating and relieving factors Severity (according to exercise tolerance)
What is the term for dyspnoea when lying flat which is relieved on sitting up?
Orthopnoea
What is orthopnoea a feature of
Pulmonary oedema or diaphragm paralysis
What is the term used for a patient who wakes up breathless at night
Paroxysmal nocturnal dyspnoea (PND)
What is PND most commonly associated with?
Pulmonary oedema
What is wheeze?
A whistling or sighing noise that is characteristic of air passing through a narrow tube
What is wheeze a characteristic feature of
Airways obstruction cause by asthma or COPD
When is wheeze worse in asthma?
On wakening in the morning and may be precipitated by exercise or cold air
What happens in occupational asthma
Wheeze improves on the eekends or on holiday away from work. It deteriorates when returning to work
What is an inspiratory wheeze called
Stridor
What is stridor a feature of
Disease of the central airways - usually caused by an obstruction of the trachea by a carcinoma or a foreign object in children
Why do we cough
It is a protective reflex that removes secretions or inhaled solid material
What 2 types of cough can we get
Dry
Productive
What is purulent sputum a sign of?
A respiratory tract infection
What is chronic bronchitis
A cough productive of sputum on most days for a least 3 months of 2 consecutive years
What is bronchiectasis
The production of copious amounts of purulent sputum
What can violent coughing result in?
A cough fracture of a rib
What is bronchorrhoea
Who would often have bronchorhoea
the excessive discharge of watery mucus from the air passages of the lung. Patients with alveolar cell carcinoma
What is the name of black sputum
Melanoptysis
Who is most likely to present with melanoptysis
Patients with coalworker’s pneumoconiosis
What is haemoptysis
Coughing up blood
What is haemoptysis a red flag for?
Bronchial carcinoma
What should all patients presenting with haemoptysis have?
A chest Xray, bronchoscopy, CT, sputum cytology
What else can cause haemoptysis
Bronchial carcinoma TB Bronchitis Pulmonary infarction Pulmonary oedema Pulmonary vasculitis Bronchiectasis
What is pleuritic chest pain
Pain that is aggravated by inspiration or coughing
What can cause irritation of the pleura
Inflammation of the pleura
Infection
Infarction
Tumour
What are 2 symptoms of carcinoma or lung abscess
Weight loss and anorexia
What are 2 symptoms of infection
Pyrexia and sweating
What are 3 other symptoms of hypoxaemia
Lethargy
Confusion
Malaise
What is headaches in the morning a symptom of?
Hypercapnia
What might oedema indicate
Cor pulmonale
What is cor pulmonale
abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.
What are indications of sleep apnoea
Snoring and daytime somnolence
What can hoarseness be a sign of
Damage to the recurrent laryngeal nerve by a tumour
What should you ask for in the past medical history
Major illness in childhood
Ever been admitted with a chest disease
What should you ask for in family history
Previous history of lung disease
What should you ask for in social history
Smoking status Passive smoking Pets Participation in any sports or hobbies Occupation over the years Asbestos exposure
What should you look for in general examination of a respiratory patient?
Character of breathing - use of accessory muscles Shape of the chest Hoarseness of the voice Stridor or wheeze Respiratory rate
What should you look for in the hands of a respiratory patient
Finger clubbing tar staining features of rheumatoid arthritis Carbon Dioxide retention Asterexis (tremmor) Pulse
What should you look for in the head and neck of a respiratory patient
Cyanosis
Anaemia
JVP
Lympadenopathy
What can finger clubbing signify?
Bronchial carcinoma Fibrotic lung disease Idiopathic pulmonary fibrosis Asbestosis Mesothelioma Bronchiectasis Cystic fibrosis Chronic empyema Lung abscess Fibrosis Bacterial endocarditis
What can cyanosis be an indication of
Hypoxamia
Where is the JVP most easily seen
Along the surface of the sternocleidomastoid muscles
When would the JVP be elevated?
In right heart failure as a result of pulmonary embolism
cor pulmonale in COPD
What should you look for during the chest inspection
Shape Asymmetry Scars Skeletal abnormality Movement of the chest as the patient breaths in and out Abdominal paradox
What should you palpate during the chest palpation?
Expansion - equal either side (symmetrical
Trachea - any deviation
Apex beat
What should you percuss for in a chest examination?
Should be resonant over air filled lungs
Percussion over organs should sound dull
Abnormal dullness is dfound over areas of lung consolidatin
Hyper-resonance may be present over an area of collapsed lung
What should you get the patient to do when going to examine the back
Cross their arms to bring the scapula out of the way
What should you be listening for during auscultation?
Intensity and character of the breath sounds Added sounds (wheeze, crackles, pleural rub)
What does wheeze on one side or area of the lung indicate
Obstruction of a bronchus by a carcinoma or a foreign body
What do crackles indicate
Pulmonary oedema
Lung fibrosis
Bronchiectasis
What do pleural rubs sound like?
Creaking they indicate roughening of the normally slippery pleural surfaces
What is the pitch of consolidated lungs during vocal resonance
Higher than normal
What is bronchial breathing
The harsher breath sounds normally heard over the trachea and main bronchi
It can be heart over consolidated lung areas also
