Resp Session 9

Question 1

What are the characteristics of pleuritic chest pain?

Answer 1

Well localised
Sharp
Worse on inspiration and coughing

Question 2

What are the differentials for pleuritic chest pain?

Answer 2

Lobar pneumonia
PE
Infarction
Pneumothorax

Question 3

Why are respiratory S/S more concerning in children than adults?

Answer 3

Younger pts can compensate before S/S arise but this ability decreases with age

Question 4

What is dyspnoea?

Answer 4

An awareness that it is taking an abnormal amount of effort to breathe

Question 5

What are important questions to ask to help identify the cause of dyspnoea?

Answer 5

Onset
Exercise tolerance
PMHx
Smoking
Association with temperature or change

Question 6

What are the characteristic features of common causes of dyspnoea?

Answer 6

Asthma: onset over hours
PE: sudden onset
Infection: develops over days
Pleural effusion: hours to days
Unfit
Pneumothroax: sudden onset
COPD
Anaemia

Question 7

What Tx are important to consider when investigating dyspnoea and why?

Answer 7

Amiodarone –> fibrotic lung changes

Oestrogen predisposes to pulmonary embolism

Question 8

What different character coughs might pts present with?

Answer 8

Throat clearing
Barking
Painful
Productive
With blood

Question 9

How does the duration of a cough indicate it’s cause?

Answer 9

URTI/LRTI

>3 weeks –> virus/COPD/asthma/carcinoma of lung/medication e.g. ACEI

Question 10

What questions should be asked if a cough is productive?

Answer 10

Sputum clear or coloured
Streaked with blood and if so how much
Is it actually haematemisis following coughing fit

Question 11

What are the differentials indicated by haemoptysis?

Answer 11

Bronchitis
Bronchial carcinoma
Pneumonia
Pulmonary infarction
TB

Question 12

What is stridor?

Answer 12

Whistling noise from upper airway usually maximal on inspiration

Question 13

What causes stridor?

Answer 13

Aspiration of foreign body
Abscess in upper airway
Spasmodic croup

Question 14

What causes hoarseness?

Answer 14

Transient inflammation of vocal cords
Over use –> nodule formation on vocal cords
Vocal cord tumours
RLN palsy due to bronchial carcinoma

Question 15

What are the steps in the respiratory physical exam?

Answer 15

Introduction, gain consent and wash hands –> general inspection –> hands –> pulse and RR –> face –> chest inspection, palpation, expansion, percussion and auscultation –> vocal resonance –> completion with peak flow, sputum and temperature

Question 16

What causes small muscle atrophy in the hands which is relevant in a respiratory exam?

Answer 16

T1 nerve root compression by peripheral lung tumour

Question 17

Where is bronchial breathing heard normally and in pathology?

Answer 17

Normally over large airways

In pathology in periphery of lungs

Question 18

Why is chest auscultation carried out posteriorly?

Answer 18

Pathology is most likely in lower lobes of lungs due to gravity

Question 19

How does vocal resonance change in pathology?

Answer 19

Becomes clearer over consolidation

Question 20

How will fluid filled areas in the lungs sound on percussion?

Answer 20

Stony dull percussion

Question 21

What is barrel chest?

Answer 21

Increase in AP diameter

Question 22

What is pigeon chest?

Answer 22

Prominent sternum

Question 23

What is funnel chest?

Answer 23

Depression below sternum

Question 24

What general Hx should be considered when investigating a respiratory complaint?

Answer 24

PMHx: previous resp conditions, investigations, CVD
Drug Hx: ACEI, beta-blockers, oestrogens, amiodarone
FHx: first degree relative with early onset (!!)
Social Hx: smoking (how much and how long), IV drugs, occupation, home environment (need admitting despite clinical picture?)

Question 25

How does IV drug use lead to PE?

Answer 25

Damages endothelium

Question 26

What are common presenting complaints relating to the respiratory system?

Answer 26

Chest pain
SoB
Cough
Sputum
Haemoptysis 
Wheeze
Hoarseness