M101 Respiratory History Taking

Question 1

What are the symptoms of respiratory disease?

Answer 1

Breathlessness (dyspnoea)
Cough
Sputum
Haemoptysis (coughing blood)
Wheeze
Pain

Question 2

What does the onset of breathlessness indicate?

Answer 2

Sudden pulmonary embolism, pneumothorax
Over hours asthma, pneumonia, LVF
Over days pneumonia, LVF
Over weeks pleural effusion, anaemia
Over months tumours, lung fibrosis, muscle weakness
Over years COPD, lung fibrosis, muscle weakness

Question 3

What causes coughing?

Answer 3

stimulation of irritant receptors in the airways

Question 4

How often is a cause for coughing up blood found?

Answer 4

60% of the time

Question 5

What are the most common causes for coughing up blood?

Answer 5

bronchitis
pulmonary embolism
lung cancer
tuberculosis 
bronchiectasis

Question 6

What are examples of conditions that cause pleuritic pain?

Answer 6

pneumonia / pleurisy
peripheral pulmonary embolism (infarction)
pneumothorax

Question 7

What are examples of conditions that cause mediastinal pain?

Answer 7

tumour
cardiac pain
large pulmonary embolism

Question 8

What is an example of a condition that can cause chest wall pain?

Answer 8

rib fracture

Question 9

What is mediastinal pain caused by?

Answer 9

disease of central mediastinal structures

Question 10

What is weight loss a major symptom of?

Answer 10

lung cancer

TB

Question 11

What are two major symptoms of pneumonia?

Answer 11

fever

Question 12

What is a symptom of TB?

Answer 12

night sweats

Question 13

What are the potential symptoms for respiratory disease that can be seen from the end of the bed?

Answer 13

emotional distress
using oxygen? 
noisy breathing
pursed-lips breathing in COPD
the use of accessory muscles of respiration
cyanosis
anaemia 
ssigns of CO2 retention

Question 14

What are the signs of CO2 retention?

Answer 14

warm peripheries
bounding pulse
flapping tremor

Question 15

What are the potential signs for respiratory disease from outside of the chest?

Answer 15

raised jugular venous pressure (JVP)
peripheral oedema
lymph node enlargement
finger clubbing

Question 16

When does the jugular venous pressure become raised?

Answer 16

right heart failure (cor pulmonale)

SVC obstruction

Question 17

What is peripheral oedema caused by?

Answer 17

right heart failure

Question 18

What might lymph node enlargement be caused by?

Answer 18

carcinoma
TB
sarcoidosis

Question 19

What is cor pulmonale caused by?

Answer 19

pulmonary hypertension

Question 20

What conditions can cause clubbing of the fingers?

Answer 20

lung cancer
lung fibrosis
chronic infections in the lungs causing pus
cyanotic congenital heart disease
bacterial endocarditis
liver cirrhosis 
IBS

Question 21

How does percussion compare over the normal lung, over the heart and over the liver?

Answer 21

normal lung - resonant

heart & liver - dull

Question 22

What does percussion involve?

Answer 22

comparing the degree of resonance over the same sites on each side of the chest

Question 23

When are breath sounds decreased?

Answer 23

if there is fluid

if there is a collapsed lung

Question 24

When are breath sounds increased?

Answer 24

if there is consolidated lung between a bronchus and the chest wall

Question 25

What are the causes of dullness to percussion?

Answer 25

Lung consolidation
Lung collapse
Lung fibrosis
Pleural effusion

Question 26

How are breath sounds generated?

Answer 26

when turbulent air in the larynx is transmitted through the airways and lung tissue to the chest wall

Question 27

What are wheezes caused by?

Answer 27

by air passing through narrowed airways, usually expiratory

Question 28

What are crackles caused by?

Answer 28

popping open of blocked small airways, usually inspiratory

Question 29

What are pleural rubs caused by?

Answer 29

friction of inflamed pleural surfaces, may be inspiratory and expiratory

Question 30

What is reduced vocal resonance caused by?

Answer 30

pleural fluid

lung collapse

Question 31

What two words can you ask the patient to say to check for vocal sounds?

Answer 31

ninety nine

one, one, one