History Taking and Examination Flashcards by Sasha Murdoch

What symptoms should you ask about when taking a respiratory history?

Dyspnoea
Wheeze
Cough
Sputum
Haemoptysis
Chest pain

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What is dyspnoea?

Sensation of being unable to breathe easily (breathlessness)

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What questions should be asked regarding dyspnoea

Speed of onset
Prgression
Periodicity
Precipitating and relieving factors
Severity (according to exercise tolerance)

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What is the term for dyspnoea when lying flat which is relieved on sitting up?

Orthopnoea

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What is orthopnoea a feature of

Pulmonary oedema or diaphragm paralysis

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What is the term used for a patient who wakes up breathless at night

Paroxysmal nocturnal dyspnoea (PND)

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What is PND most commonly associated with?

Pulmonary oedema

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What is wheeze?

A whistling or sighing noise that is characteristic of air passing through a narrow tube

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What is wheeze a characteristic feature of

Airways obstruction cause by asthma or COPD

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When is wheeze worse in asthma?

On wakening in the morning and may be precipitated by exercise or cold air

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What happens in occupational asthma

Wheeze improves on the eekends or on holiday away from work. It deteriorates when returning to work

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What is an inspiratory wheeze called

Stridor

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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

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Why do we cough

It is a protective reflex that removes secretions or inhaled solid material

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What 2 types of cough can we get

Dry

Productive

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What is purulent sputum a sign of?

A respiratory tract infection

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What is chronic bronchitis

A cough productive of sputum on most days for a least 3 months of 2 consecutive years

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What is bronchiectasis

The production of copious amounts of purulent sputum

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What can violent coughing result in?

A cough fracture of a rib

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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

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What is the name of black sputum

Melanoptysis

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Who is most likely to present with melanoptysis

Patients with coalworker’s pneumoconiosis

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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