Resp Session 9 Flashcards
What are the characteristics of pleuritic chest pain?
Well localised
Sharp
Worse on inspiration and coughing
What are the differentials for pleuritic chest pain?
Lobar pneumonia
PE
Infarction
Pneumothorax
Why are respiratory S/S more concerning in children than adults?
Younger pts can compensate before S/S arise but this ability decreases with age
What is dyspnoea?
An awareness that it is taking an abnormal amount of effort to breathe
What are important questions to ask to help identify the cause of dyspnoea?
Onset Exercise tolerance PMHx Smoking Association with temperature or change
What are the characteristic features of common causes of dyspnoea?
Asthma: onset over hours PE: sudden onset Infection: develops over days Pleural effusion: hours to days Unfit Pneumothroax: sudden onset COPD Anaemia
What Tx are important to consider when investigating dyspnoea and why?
Amiodarone –> fibrotic lung changes
Oestrogen predisposes to pulmonary embolism
What different character coughs might pts present with?
Throat clearing Barking Painful Productive With blood
How does the duration of a cough indicate it’s cause?
URTI/LRTI
>3 weeks –> virus/COPD/asthma/carcinoma of lung/medication e.g. ACEI
What questions should be asked if a cough is productive?
Sputum clear or coloured
Streaked with blood and if so how much
Is it actually haematemisis following coughing fit
What are the differentials indicated by haemoptysis?
Bronchitis Bronchial carcinoma Pneumonia Pulmonary infarction TB
What is stridor?
Whistling noise from upper airway usually maximal on inspiration
What causes stridor?
Aspiration of foreign body
Abscess in upper airway
Spasmodic croup
What causes hoarseness?
Transient inflammation of vocal cords
Over use –> nodule formation on vocal cords
Vocal cord tumours
RLN palsy due to bronchial carcinoma
What are the steps in the respiratory physical exam?
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
What causes small muscle atrophy in the hands which is relevant in a respiratory exam?
T1 nerve root compression by peripheral lung tumour
Where is bronchial breathing heard normally and in pathology?
Normally over large airways
In pathology in periphery of lungs
Why is chest auscultation carried out posteriorly?
Pathology is most likely in lower lobes of lungs due to gravity
How does vocal resonance change in pathology?
Becomes clearer over consolidation
How will fluid filled areas in the lungs sound on percussion?
Stony dull percussion
What is barrel chest?
Increase in AP diameter
What is pigeon chest?
Prominent sternum
What is funnel chest?
Depression below sternum
What general Hx should be considered when investigating a respiratory complaint?
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?)
