Miscellaneous Flashcards
While taking a history from a person who is dyspneic, you ask if they are bringing up anything. What must you ask to explore that?
Phlegm: Volume!, Hard/easy to bring up, colour, Change from normal, how often
Haemoptysis: Any blood? Mixed in? Frank vs Dark
Always ask the onset, timeline and if this has happened before
While taking a history from a patient with COPD/Angina etc… What questions would you ask to help grade its severity?
How far?
Trouble speeding up?
Do you find trouble keeping up when walking with friends/family?
It is when walking or at rest?
Trouble going up stairs? Do you have trouble climbing stairs?
When exploring a wheeze, what questions will you ask?
When? Worse at night? Worse at any particular time of day/year? Any specific things you are doing when you notice it?
When someone has a history involving asbestos. What questions can u ask?
Actively working? e.g. cutting sheets
Were you wearing a mask?
Husband’s clothes when working with asbestos
When exploring orthopnoea in a history, what questions can you ask?
When did that come about?
How many pillows do you sleep on?
Is one side worse than the other?
When exploring orthopnoea in a history, what is the significance of asking if one side is worse than the other?
Lung function asymmetry
Also in severe cases, cor pulmonale => strain on the heart if on left side
You are prescribing a patient with COPD Azithromycin for antibiotic prophylaxis to take 3x per week (MWF)
What type of antibiotic is it?
What other pulmonary diseases is it commonly prescribed for?
What is the main side effect that should be monitored?
What microbe is out main concern in COPD and similar diseases?
When performing a sputum culture, you notice that the microbe is actually resistant to azithromycin. What is the last line drug used in this scenario and how is it administered?
Macrolide antibiotic
Also for CF and bronchiectasis
QT prolongation, request ECG + audiology (ototoxicity)
Pseudomonas aeruginosa
Colomycin administered either by IV or nebulized
Give 3 differentials for Asterixes on exam
Hepatic Encephalopathy
Respiratory failure (Hypoxia and CO2 retention)
Renal failure
Fun fact: In a non-diseased lung, chemoreceptors respond to hypercapnia however in patients with COPD, they become insensitive to that. The backup mechanism we have is increased respiratory rate in respond to hypoxia and that is the main mechanism in COPD patients
What is chemosis?
What are some causes?
How will you test for it on exam?
Chemosis is the swelling or oedema of the conjunctiva (white part)
Causes: Hayfever/allergy, Conjunctivitis (viral or bacterial), trauma/chemical exposure, Angioedema via ACE inhibitors, ! heart failure, !Renal failure, !raised ICP
Test by asking the patient to look up, down and to the sides to expose the white part where you will see oedema
What are you looking for when performing chest expansion as part of your respiratory examination?
Symmetry and >5cm expansion
When auscultating the chest for breath sounds…
The anterior chest is better for X lobes
The Posterior chest is better for Y lobes
X = Upper and middle lobes
Y = Lower lobes
When reporting your findings after chest ausultation, it is important to mention if it was vesicular or bronchial breath sounds
Define Vesicular breath sounds. When would you expect to hear these?
Define Bronchial breath sounds. When would you expect to hear these?
Vesicular breath sounds are normal, soft, low pitched sounds with a longer inspiratory phase than expiratory phase and no pause in between. This is the typical sound heard in most patients (incl. healthy) => longer inspiration > expiration
Bronchial breath sounds are abnormal, loud, high pitched sounds heard over the large airways (trachea and bronchi) with equal or longer expiratory phase compared to inspiratory. This is typically heard in pneumonia, COPD, bronchiectasis, CF, pulmonary oedema (HF) => Inspiration, pause, longer expiration
Side note: When reporting on a wheeze also make sure to define if it is inspiratory or expiratory and if it is local vs diffuse
Give 6 signs of CO2 retention
CO2 mainly affects the respiratory and neuro systems
Resp: Pounding pulse, tachypnoea
Neurological: Confusion/reduced GCS, Tremor/asterixes, papilloedema, Headache
