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OSCE revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Key symptoms to ask about during respiratory history?

A
  • dyspnoea
  • cough (productive v dry)
  • chest pain
  • wheeze
  • haemoptysis
  • calf tenderness/swelling
  • systemic Sx (fever, night sweats, weight loss, fatigue)
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2
Q

Which systemic symptoms to ask about during respiratory history?

A
  • fatigue (lung cancer, COPD)
  • fever (pneumonia)
  • night sweats (TB)
  • weight loss (lung cancer, end-stage COPD)
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3
Q

Name four medications which can cause respiratory s/e

A
  • ACEi: dry cough
  • oestrogen-containing medication: inc. risk of PE
  • immunosuppressants: eg methotrexate can cause pneumonitis
  • B-blockers: can cause broncho-constriction
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4
Q

Name some respiratory causes of dyspnoea

A
  • COPD
  • asthma
  • pneumonia
  • COVID-19
  • lung cancer
  • PE
  • pneumothorax
  • bronchitis
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5
Q

Five common symptoms of PE?

A
  • acute dyspnoea
  • pleuritic chest pain
  • cough, haemoptysis may also be present
  • syncope and dizziness
  • leg swelling, tenderness and redness
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6
Q

Name four causes of a productive cough

A
  • pneumonia
  • COPD
  • cystic fibrosis
  • bronchiectasis
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7
Q

Name five causes of a non-productive cough

A
  • ACE-i
  • asthma
  • GORD
  • COVID-19
  • pulmonary fibrosis
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8
Q

Name six causes of a wheeze

A
  • asthma
  • COPD
  • severe allergies
  • airway obstruction
  • pneumonia
  • bronchitis
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9
Q

Why may hobbies be relevant for a respiratory history?

A

Bird-keeping can increase risk of developing allergic extrinsic alveolitis, aka ‘bird-fancier’s lung’

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10
Q

What are some medications commonly prescribed to patients with respiratory disease?

A
  • short-acting beta-2-agonist inhalers
  • long-acting beta-2-agonist inhalers
  • inhaled corticosteroids
  • short-acting anti-muscarinic inhalers
  • long-acting anti-muscarinic inhalers
  • oral steroids
  • theophylline
  • antibiotics
  • anticoagulants
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11
Q

Why is travel relevant in a respiratory history?

A
  • if symptoms are suggestive of infective aetiology such as TB
  • to assess risk for PE (long-haul flights)
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12
Q

Which occupations might be relevant in a respiratory history?

A
  • exposure to allergic/asthma triggers eg animals, chemicals
  • coal mining - pneumoconiosis
  • farming - allergic extrinsic alveolitis
  • shipyards/construction (asbestos exposure) - mesothelioma
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13
Q

Risk factors for COPD

A
  • smoking
  • indoor air pollution - usually in developing world
  • alpha-1 antitrypsin deficiency
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14
Q

Most common examination findings for COPD

A
  • tachypnoea
  • wheeze on auscultation
  • pursed lips breathing
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15
Q

Differential diagnoses of COPD and how to differentiate

A

asthma

  • will have diurnal variation in symptoms and peak flow
  • history of atopy

bronchiectasis

  • expectorate larger volumes of sputum
  • more frequent LRTIs

congestive cardiac failure

  • orthopnoea and paroxysmal nocturnal dyspnoea
  • history of CVD

lung cancer

  • weight loss
  • haemoptysis

tuberculosis

  • drenching night sweats
  • weight loss
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16
Q

Main investigations for COPD

A 
Spirometry - <70%
Pulse oximetry - aim for 88-92%
Sputum cultures - for exacerbations 
ECG - cor pulmonale 
CXR - hyperinflation
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17
Q

Management for COPD

A

conservative:

  • smoking cessation
  • flu vaccine
  • management of RF

medical:
- inhalers: SABA/SAMA, LABA and LAMA, LABA and LAMA and ICS

18
Q

Typical clinical features for asthma

A
  • wheeze
  • cough
  • breathlessness
  • episodic/diurnal variation
19
Q

Important areas to cover in asthma history?

A
  • triggers
  • occupation
  • exacerbation frequency
  • personal/family history of atopy
  • best expected/most recent PEFR
  • treatment adherence
  • smoking - active and passive
20
Q

Common examination findings for asthma

A
  • relevant medical equipment e.g. inhalers, spacer etc.
  • cyanosis
  • cough
  • audible wheeze
  • fine tremor
  • tachycardia
  • polyphonic expiratory wheeze
21
Q

Differential diagnoses of asthma

A

Resp: bronchiectasis, COPD, fibrosis, PE, infection, lung cancer
GI: gastro-oesophageal reflux
Cardio: HF
Misc: allergic rhinitis, foreign body inhalation

22
Q

Management of asthma

A

step-wise intervention:

  • all those w/ symptoms - SABA inhaler PRN
  • add low dose ICS
  • add LABA
  • inc. ICS or LTRA
23
Q

Risk factors for lung cancer

A
  • smoking - main RF
  • air pollution (both indoor and outdoor)
  • family history of cancer, esp. lung cancer
  • male sex
  • radon gas (normally affects miners)
24
Q

Typical history of lung cancer

A
  • unexplained cough for at least 3 weeks (w/ or w/o haemoptysis)
  • unintended weight loss
  • new-onset dyspnoea
  • pleuritic chest pain
  • bone pain due to metastases
  • fatigue
25
Q

Typical examination findings of lung cancer

A
  • cachexia (extreme weight loss and muscle wasting)
  • finger clubbing
  • dullness on percussion
  • cervical lymphadenopathy
  • wheeze on auscultation
26
Q

Differential diagnoses of lung cancer

A
  • TB
  • metastasis to lungs from other sites
  • sarcoidosis
  • granulomatosis with polyangiitis
  • non-Hodgkin’s lymphoma
27
Q

First-line investigation for suspected lung cancer

A

CXR - may show single or multiple opacities, pleural effusion and/or lung collapse

28
Q

Typical features of pleural effusion history

A
  • breathlessness
  • cough
  • pleuritic chest pain
29
Q

Typical features of pleural effusion on examination

A
  • possible reduced chest movement
  • palpation of trachea may reveal deviation away from affected side
  • reduced chest expansion on affected side
  • stony dullness on percussion of affected side
  • breath sounds and vocal resonance are reduced or absent on affected side
30
Q

Differential diagnoses for pleural effusion

A
  • infection e.g. TB or pneumonia
  • malignancy w/o effusion
  • PE
  • pneumothorax
31
Q

First-line investigation for pleural effusion

A
  • CXR - shows unilateral or bilateral effusion
32
Q

Treatments for pleural effusion

A
  • diuretics in HF
  • antibiotics in infection
  • pleural fluid aspiration of chest drain insertion
33
Q

Risk factors for PE

A
  • recent surgery
  • recent fractures
  • recent immobility
  • personal/family history of clotting disorder, PE or DVT
  • obesity
  • malignancy
  • infection
  • pregnancy
  • HRT or oral contraceptive pill
34
Q

Common examination findings for PE

A
  • tachypnoea
  • tachycardia
  • hypotension
  • evidence of DVT
  • pleural rub
  • cyanosis
35
Q

Investigations and procedures for PE

A
  • ABG - normally low PaO2 and normal/low PaCO2
  • CXR - often normal
  • Well’s score
36
Q

How is a definitive diagnosis of PE made?

A

Using a CT pulmonary angiogram

37
Q

What is the aetiology of TB?

A

Infection by M.tuberculosis (most common), M.bovis and M.africanum

Infection through droplet inhalation (coughing and sneezing)

After exposure, TB is engulfed by macrophages in lung - if infection is not cleared - TB develops

38
Q

Main risk factors for TB

A
  • close contact with infected individual
  • demographics - ethnic minorities, travel in high prevalence areas (India and sub-Saharan Africa), extremes of age and homelessness
  • medicines and conditions such as: alcohol/drug dependency, immunosuppression, malignancy, diabetes and long term steroid use
39
Q

Typical symptoms of TB

A
  • general: fever, lethargy, anorexia, weight loss, enlarged tender lymph nodes
  • resp: cough, sputum (dry, then purulent or blood-stained, breathlessness, pleuritic chest pain
  • other: urinary Sx, joint pain, headaches, reduced GCS, chest pain, abdominal pain and bloating, rash
40
Q

Most common cause for CAP?

A

Strep. Pneumoniae

41
Q

Pneumonia risk factors?

A
  • Age – under 16 and over 65
  • Co-morbidities
  • COPD
  • HIV
  • Diabetes mellitus
  • Cystic fibrosis
  • Congestive HF
  • Bronchiectasis
  • Nursing home residents
  • Smoking
  • Excess alcohol
  • IV drug use
  • Immunosuppressant therapy – prolonged corticosteroids
42
Q

Clinical signs of pneumonia?

A
  • Crackles ± wheeze
  • Pleural rub
  • Bronchial breath sounds
  • Increased vocal resonance
  • Dull to percussion
  • Consolidation

OSCE revision (9 decks)

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