ICP

Question 1

what does a large volume of sputum suggest?

Answer 1

Bronchictasis

Question 2

what does white or grey sputum suggest?

Answer 2

smoker

Question 3

what does yellow or green sputum suggest?

Answer 3

infection as eosinophils are green

Question 4

what is rusty (red-brown) sputum characteristic of?

Answer 4

pneumococcal pnuemonia

Question 5

what does serous (very watery) sputum suggest?

Answer 5

acute pulmonary oedema

possibly bronchioalveolar cell carcinoma but this is very rare

Question 6

what does mucoid sputum (too much mucous) suggest?

Answer 6

chronic bronchitis or chronic asthma

Question 7

what does an unpleasant taste to sputum suggest?

Answer 7

anaerobic infection

Question 8

how might haemoptysis present in malignancy?

Answer 8

may be first presentation
may present during infection but then not go away
can be intermittent or persistent

Question 9

how may haemoptysis present in pulmonary infarction?

Answer 9

bright red first and then darker

pleuritic chest pain

Question 10

what infections may cause haemoptysis?

Answer 10

TB
aspergillosis
chronic bronchiectasis

Question 11

what to ask about for a history

Answer 11

• History of the presenting complaint
• Past medical history
• Systemic enquiry
• Family history
• Social history
• Drug history
• Allergies

Question 12

whats important to remember when conducting a history?

Answer 12

Let the patient speak – let them exhaust the symptoms
Guide, don’t lead
Use appropriate language

Question 13

how does a cough present in asthma?

Answer 13

o Usually dry and irritating – can be a little productive
o Early morning
o Don’t forget about possible occupational or environmental cause

Question 14

how does a cough present in chronic bronchitis?

Answer 14

o Productive cough for most days during at least 3 consecutive months in 2 successive years
o “during winter months?
o “does this happen for several months each year”
o Look for history of repeated winter chest infections
o Can usually sleep undisturbed

Question 15

how does a cough present in bronchial carcinoma?

Answer 15

o may be difficult as patients often have COPD – already cough
o may be different quality cough to before
o persistent
o can be blood stained
o central tumour in left lung can encroach on left recurrent laryngeal nerve – hoarse voice and bovine cough

Question 16

how does a cough present in bronchiectasis?

Answer 16

brings up a lot of sputum which can be pale, yellow or green

Question 17

what are some causes of cough to remember?

Answer 17

o G-O-R-D (gastro-oesophageal reflux disease)
o ACE inhibitors
o Chronic sinusitis – post nasal drip

Question 18

what are some causes of chest pain

Answer 18

o Parietal pleura – pleuritic pain
o Bone – fractures, crush fractures of vertebrae, tumour invasion
o Costochondral joints – Tietze’s syndrome
o Nerve – compression, Herpes Zoster
o Oesophagus – gastro-oesophageal reflux
o Cardiovascular

Question 19

describe types of wheeze

Answer 19

usually heard in expiration
polyphonic - asthma and bronchitis
monophonic - fixed lesion such as carcinoma

Question 20

descibe stridor

Answer 20

o Predominantly inspiratory

o Partial obstruction of a major airway

Question 21

what are some causes of sudden dyspnoea?

Answer 21

	Pneumothorax
	Pulmonary embolism
	Paroxysmal nocturnal dyspnoea
               •	Acute left ventricular failure – waking people up
	Can be acute MI

Question 22

what are some causes of dyspnoea arising in hours?

Answer 22

	Pneumonia
	Asthma attack
	Left ventricular failure
	Exacerbation of COPD
	Acute alveolitis

Question 23

what are some causes of dyspnoea arising in days/weeks?

Answer 23

	Pleural effusion – usually weeks
	Carcinoma of the lung
	Sub-acute alveolitis
	Congestive cardiac failure
	Anaemia

Question 24

what are some causes of dyspnoea arising in months/years?

Answer 24

	COPD
	Congestive cardiac failure
	Parenchymal lung disease
	Don’t forget anaemia
	Can be a manifestation of panic attacks

Question 25

how is dyspnoea classified?

Answer 25

grading system 1-5
1 is normal and 5 is breathless on very little exertion

important to remember that patients often modify their lifestyle to avoid activities which make them breathless.

used to measure response to treatment

Question 26

what kind of history is relevant for adulthood asthma?

Answer 26

Childhood asthma, hayfever or eczema

Question 27

what kind of history is relevant for bronchiectasis and COPD

Answer 27

Childhood pneumonia, measles, whooping cough and tuberculosis

Question 28

what kind of history is relevant for PE

Answer 28

recent operation

Question 29

what does a pack year equal

Answer 29

20 a day for a year

Question 30

what may morning headaches indicate?

Answer 30

respiratory failure

Question 31

what may ankle swelling indicate?

Answer 31

cor-pulmonale - right sided failure

Question 32

what may anorexia and weight loss indicate?

Answer 32

lung cancer

Question 33

what is important to consider in asthma?

Answer 33

nasal polyps

Question 34

what is important to consider in cough?

Answer 34

may be caused by nasal drip

Question 35

what is important to consider in recurrent pneumonia?

Answer 35

may be aspiration pneumonia

caused by difficulty swallowing or vomiting

Question 36

what environmental factors may lead to asthma?

Answer 36

pets - cats, dogs, birds

hobby - soldering, painting, pigeon fanciers

occupation - coal miners, farm workers, mushroom pickers, asbestos, sandblasters

travel - legionnaires, TB

housing - damp, mould

Question 37

what else is important to find out from patients?

Answer 37

Who is at home – who cares for you, earns money, cooks cleans
What support is available – nurse, family, home help
stairs in the home?