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Respiratory (LECTURE NOTES) > History Taking and Examination > Flashcards

History Taking and Examination Flashcards

1
Q

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

A 
Dyspnoea
Wheeze
Cough
Sputum
Haemoptysis
Chest pain
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2
Q

What is dyspnoea?

A

Sensation of being unable to breathe easily (breathlessness)

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3
Q

What questions should be asked regarding dyspnoea

A 
Speed of onset
Prgression
Periodicity
Precipitating and relieving factors
Severity (according to exercise tolerance)
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4
Q

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

A

Orthopnoea

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5
Q

What is orthopnoea a feature of

A

Pulmonary oedema or diaphragm paralysis

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6
Q

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

A

Paroxysmal nocturnal dyspnoea (PND)

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7
Q

What is PND most commonly associated with?

A

Pulmonary oedema

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8
Q

What is wheeze?

A

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

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9
Q

What is wheeze a characteristic feature of

A

Airways obstruction cause by asthma or COPD

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10
Q

When is wheeze worse in asthma?

A

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

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11
Q

What happens in occupational asthma

A

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

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12
Q

What is an inspiratory wheeze called

A

Stridor

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13
Q

What is stridor a feature of

A

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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14
Q

Why do we cough

A

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

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15
Q

What 2 types of cough can we get

A

Dry

Productive

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16
Q

What is purulent sputum a sign of?

A

A respiratory tract infection

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17
Q

What is chronic bronchitis

A

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

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18
Q

What is bronchiectasis

A

The production of copious amounts of purulent sputum

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19
Q

What can violent coughing result in?

A

A cough fracture of a rib

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20
Q

What is bronchorrhoea

Who would often have bronchorhoea

A

the excessive discharge of watery mucus from the air passages of the lung. Patients with alveolar cell carcinoma

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21
Q

What is the name of black sputum

A

Melanoptysis

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22
Q

Who is most likely to present with melanoptysis

A

Patients with coalworker’s pneumoconiosis

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23
Q

What is haemoptysis

A

Coughing up blood

24
Q

What is haemoptysis a red flag for?

A

Bronchial carcinoma

25
Q

What should all patients presenting with haemoptysis have?

A

A chest Xray, bronchoscopy, CT, sputum cytology

26
Q

What else can cause haemoptysis

A 
Bronchial carcinoma
TB
Bronchitis
Pulmonary infarction
Pulmonary oedema 
Pulmonary vasculitis
Bronchiectasis
27
Q

What is pleuritic chest pain

A

Pain that is aggravated by inspiration or coughing

28
Q

What can cause irritation of the pleura

A

Inflammation of the pleura
Infection
Infarction
Tumour

29
Q

What are 2 symptoms of carcinoma or lung abscess

A

Weight loss and anorexia

30
Q

What are 2 symptoms of infection

A

Pyrexia and sweating

31
Q

What are 3 other symptoms of hypoxaemia

A

Lethargy
Confusion
Malaise

32
Q

What is headaches in the morning a symptom of?

A

Hypercapnia

33
Q

What might oedema indicate

A

Cor pulmonale

34
Q

What is cor pulmonale

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

35
Q

What are indications of sleep apnoea

A

Snoring and daytime somnolence

36
Q

What can hoarseness be a sign of

A

Damage to the recurrent laryngeal nerve by a tumour

37
Q

What should you ask for in the past medical history

A

Major illness in childhood

Ever been admitted with a chest disease

38
Q

What should you ask for in family history

A

Previous history of lung disease

39
Q

What should you ask for in social history

A 
Smoking status 
Passive smoking 
Pets
Participation in any sports or hobbies 
Occupation over the years 
Asbestos exposure
40
Q

What should you look for in general examination of a respiratory patient?

A 
Character of breathing - use of accessory muscles
Shape of the chest 
Hoarseness of the voice 
Stridor or wheeze 
Respiratory rate
41
Q

What should you look for in the hands of a respiratory patient

A 
Finger clubbing 
tar staining 
features of rheumatoid arthritis
Carbon Dioxide retention 
Asterexis (tremmor)
Pulse
42
Q

What should you look for in the head and neck of a respiratory patient

A

Cyanosis
Anaemia
JVP
Lympadenopathy

43
Q

What can finger clubbing signify?

A 
Bronchial carcinoma 
Fibrotic lung disease 
Idiopathic pulmonary fibrosis 
Asbestosis
Mesothelioma 
Bronchiectasis
Cystic fibrosis 
Chronic empyema
Lung abscess
Fibrosis 
Bacterial endocarditis
44
Q

What can cyanosis be an indication of

A

Hypoxamia

45
Q

Where is the JVP most easily seen

A

Along the surface of the sternocleidomastoid muscles

46
Q

When would the JVP be elevated?

A

In right heart failure as a result of pulmonary embolism

cor pulmonale in COPD

47
Q

What should you look for during the chest inspection

A 
Shape 
Asymmetry 
Scars 
Skeletal abnormality
Movement of the chest as the patient breaths in and out 
Abdominal paradox
48
Q

What should you palpate during the chest palpation?

A

Expansion - equal either side (symmetrical
Trachea - any deviation
Apex beat

49
Q

What should you percuss for in a chest examination?

A

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

50
Q

What should you get the patient to do when going to examine the back

A

Cross their arms to bring the scapula out of the way

51
Q

What should you be listening for during auscultation?

A 
Intensity and character of the breath sounds 
Added sounds  (wheeze, crackles, pleural rub)
52
Q

What does wheeze on one side or area of the lung indicate

A

Obstruction of a bronchus by a carcinoma or a foreign body

53
Q

What do crackles indicate

A

Pulmonary oedema
Lung fibrosis
Bronchiectasis

54
Q

What do pleural rubs sound like?

A

Creaking they indicate roughening of the normally slippery pleural surfaces

55
Q

What is the pitch of consolidated lungs during vocal resonance

A

Higher than normal

56
Q

What is bronchial breathing

A

The harsher breath sounds normally heard over the trachea and main bronchi
It can be heart over consolidated lung areas also

Respiratory (LECTURE NOTES) (19 decks)

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