ICP Flashcards
what does a large volume of sputum suggest?
Bronchictasis
what does white or grey sputum suggest?
smoker
what does yellow or green sputum suggest?
infection as eosinophils are green
what is rusty (red-brown) sputum characteristic of?
pneumococcal pnuemonia
what does serous (very watery) sputum suggest?
acute pulmonary oedema
possibly bronchioalveolar cell carcinoma but this is very rare
what does mucoid sputum (too much mucous) suggest?
chronic bronchitis or chronic asthma
what does an unpleasant taste to sputum suggest?
anaerobic infection
how might haemoptysis present in malignancy?
may be first presentation
may present during infection but then not go away
can be intermittent or persistent
how may haemoptysis present in pulmonary infarction?
bright red first and then darker
pleuritic chest pain
what infections may cause haemoptysis?
TB
aspergillosis
chronic bronchiectasis
what to ask about for a history
- History of the presenting complaint
- Past medical history
- Systemic enquiry
- Family history
- Social history
- Drug history
- Allergies
whats important to remember when conducting a history?
Let the patient speak – let them exhaust the symptoms
Guide, don’t lead
Use appropriate language
how does a cough present in asthma?
o Usually dry and irritating – can be a little productive
o Early morning
o Don’t forget about possible occupational or environmental cause
how does a cough present in chronic bronchitis?
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
how does a cough present in bronchial carcinoma?
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
how does a cough present in bronchiectasis?
brings up a lot of sputum which can be pale, yellow or green
what are some causes of cough to remember?
o G-O-R-D (gastro-oesophageal reflux disease)
o ACE inhibitors
o Chronic sinusitis – post nasal drip
what are some causes of chest pain
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
describe types of wheeze
usually heard in expiration
polyphonic - asthma and bronchitis
monophonic - fixed lesion such as carcinoma
descibe stridor
o Predominantly inspiratory
o Partial obstruction of a major airway
what are some causes of sudden dyspnoea?
Pneumothorax
Pulmonary embolism
Paroxysmal nocturnal dyspnoea
• Acute left ventricular failure – waking people up
Can be acute MIwhat are some causes of dyspnoea arising in hours?
Pneumonia Asthma attack Left ventricular failure Exacerbation of COPD Acute alveolitis
what are some causes of dyspnoea arising in days/weeks?
Pleural effusion – usually weeks Carcinoma of the lung Sub-acute alveolitis Congestive cardiac failure Anaemia
what are some causes of dyspnoea arising in months/years?
COPD Congestive cardiac failure Parenchymal lung disease Don’t forget anaemia Can be a manifestation of panic attacks
