Introduction to Respiratory Flashcards
Presenting complaints of respiratory disease.
Dyspnoea
Chest pain
Wheeze
Cough
Sputum
Haemoptysis
History of dyspnoea
MRC score
Exercise tolerance?
Triggers?
Relieving factors?
Diurnal variation?
Orthopnoea?
PND (paroxysmal…)
History of chest pain
Site?
Severity?
Radiation?
Triggers?
Relieving factors?
Associated symptoms
History of wheeze
Triggers?
Relieving factors?
Diurnal variation?
Associated cough?
History of cough
Dry/Prod?
Triggers
Relieving factors
Diurnal variation
Association with eating or dyspepsia?
Positional?
Nasal secretions?
Fever?
History of sputum
How much over 24h?
Colour?
Consistency?
History of haemoptysis
Quantity and frequency
Fever?
Night sweats?
Appetite?
Weight loss?
What is the MRC dyspnoea score?
1 - Not troubled by breathlessness except on strenous exercise
2 - Short of breath when hurrying or walking up a slight incline
3 - Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4 - Stops for breath after walking about 100m or after a few minutes on level ground
5 - Too breathless to leave the house, or breathless when dressing or undressing
What FH to specifically ask for in respiratory disease.
Respiratory disease
Cardiac disease
Cancer
Thrombophilia
CF
Social history of respiratory disease.
Smoking
Occupational history
Pets
Recent foreign travel
Immobility
Activities of daily living
Alcohol
Performance status (Cancer)
What is WHO performance status?
0 - Fully active without restriction
1 - Restricted in physically strenous activity but ambulatory and able to carry out light work-
2 - Ambulatory and capable of all self-care, but unable to carry out any work activities. Up and about more than 50% of waking hours.
3 - Capable of only limited self-care, confined to bed or chair more than 50% of waking hours.
4 - Completely disabled. Cannot self-care. Totally confined to bed or chair.
5 - Dead
Approach to a CXR.
Name, age and date of CXR
Type of CXR (PA or AP, erect or mobile)
Quality (Rotation, penetration, adequare inspiration)
ABC (Airways/lungs, Bones, Cardiac)
Trachea, apices, behind the heart, beneath diaphragm, soft tissues.
Cardiothoracic ratio
Give four common causes of a low PaO2.
Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch
What is the A-a gradient?
PAO2 = PIO2 - PaCO2/0.8
PAO2 = Alveolar partial pressure of oxygen
PIO2 = Room air (approx. 20 kPa)
PACO2 = Virtually the same as arterial partial pressure of carbon dioxide (PaCO2)
It shows the gradient between the alveolar partial pressure of oxygen and the arterial partial pressure of oxygen.
It is used to assess the severity of respiratory failure, particularly in ARDS.
What should the A-a gradient be in young healthy vs older healthy?
What implies lung pathology?
In young healthy = < 2kPa
In older = < 4kPa
Lung pathology = > 4kPa
A 26 year old femlare nurse thought to be hyperventilating.
pH = 7.56
pCO2 = 2.7
pO2 = 11.5
B.E. = -2
HCO3 = 23
What is the A-a gradient?
PAO2 = PIO2 - PaCO2/0.8
20 - 2.7/0.8
20 - 3.4 = 16.6 kPa
16.6 - 11.5 =5.1 kPa
This shows that there is a problem with the lungs, not only hyperventilation.
Give common clinical features of respiratory disease.
Runny, blocked nose and sneezing
Cough
Sputum
Haemoptysis
Dyspnoea
Wheezing
Chest pain
How much mucus is produced daily in a healthy, non smoking individual?
100 ml
100 ml is produced, but not usually coughed up. Where does it go?
It is usually swallowed
Most common cause of excess mucous produciton.
Cigarette smoking
Features of mucoid sputum.
Clear and white
Can contain black specks due to carbon inhalation.
Why might sputum be green or yellow?
Presence of cellular material like bronchial epithelial cells, neutrophils or eosinophil granulocytes.
Why might yellow sputum not indicate infection?
Granulocytes in the sputum from asthma can give the sputum a yellowish colour.

