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ICP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Taking history of presenting complaint

A

Focus on in why the patient has come to see you

Let them speak, language they can understand, prompt but no leading

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2
Q

6 symptoms of respiratory disease

A
  • Cough
  • Sputum production
  • Haemoptysis
  • Shortness of breath (dyspnoea)
  • Unusual breathing (wheeze)
  • Chest pain
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3
Q

Describe cough

A
  • Rhinitis, colds
  • Patients are consistent in the way they describe coughs
  • Persistent or recurrent (disruptive at night, in front of others= distressing)
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4
Q

Common respiratory disorders that present as cough

A
  • Asthma
  • Chronic bronchitis
  • Bronchial carcinoma
  • Bronchiectasis (less common)
  • Gaud
  • Gastro-oesophageal reflux disease
  • Drugs (ACE inhibitors)
  • Chronic sinusitis= post nasal drip of secretions that cough up
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5
Q

Features of asthma cough

A
  • Asthma= dry, irritating cough, can be productive of small sputum, at worst in small hours of morning= inadequately controlled- occupational? Environmental?
  • Intermittent
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6
Q

Features of chronic bronchitis cough

A
  • Chronic bronchitis (spectrum of COPD)= mucus hypersecretion and inflammation, increased risk of bacterial infection.
  • Sputum production most days of the week for 3 consecutive months in 2 successive years
  • More persistent than asthma, productive, not disturbed at night
  • Do you usually bring up flehm in the winter months?
  • Does this go on for a period of several months each year
  • Do you have repeated chest infections during the year/ winter?
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7
Q

Features of lung cancer cough

A
  • Difficult to notice as already may have COPD
  • Persistent, blood stained if encroaching airway, haemoptysis= slight to significant
  • Central tumours in left lung invade left recurrent laryngeal nerve that hooks around the left main bronchus= bovine sounding cough, hoarseness of voice
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8
Q

Describe sputum

A
  • Amount, character, colour, viscosity, smells, taste

- Large amounts= bronchiectasis

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9
Q

What does mucopurulent mean?

A

Mucus that is infected

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10
Q

Colour of sputum

A

clear, whitish/grey (smokers), yellow, green (invasion of neutrophils or eosinophils infiltrating airway), red/ brown sputum= pneumococcal pneumonia

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11
Q

Thickness of sputum

A

watery (acute pulmonary oedema, bronchio-alveolar cell carcinoma= rare), mucoid (chronic bronchitis, chronic asthma), thick

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12
Q

Taste and smell of sputum

A

-Taste and smell= anaerobic infections of lung

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13
Q

Describe haemoptysis

A

Coughing up blood
Malignancy- tumour within airways/ chest infection that doesn’t go away
Pulmonary infarction and embolism- tissue destruction, bright red blood initially then darkens, severe pleuritic chest pain, breathlessness and hypoxia
-Infections= cavitation (TB, fungal like aspergillosis, chronic bronchiectasis)

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14
Q

Sudden shortness of breath

A

Duration- hyper acute to gradual
-Sudden shortness= pneumothorax (puncture in lung surface leading to deflation), pulmonary embolism (pleuritic pain), PND (Paroxysmal nocturnal dyspnoea, acute left ventricular failure), acute myocardial infarction?

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15
Q

Shortness of breath- hours

A

Pneumonia, acute asthma, acute left ventricular failure, COPD (can be acute deterioration with infection), acute alveolitis environmental exposure

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16
Q

Shortness of breath- days to weeks

A

Pleural effusion (weeks to occupy hemithorax), carcinoma (collapse of major lobe), sub acute alveolitis, heart failure, congestive cardiac failure, anaemia as gradual onset shortness

17
Q

Shortness of breath- chronic

A

COPD, parenchymal lung diseases (fibrotic), congestive heart failure (ankle swelling), anaemia, anxiety and panic attacks

18
Q

How to talk about breathlessness

A

MRC dyspnoea scale- Grade 1 (normal) to Grade 5 (breathless on minimal exertion)

19
Q

Describe chest pain

A
  • Inflamed pleura (pleuritic chest pain)
  • Bony structure= crush, fractures, tumour invasion of vertebral bodies, chronic and persistent pain
  • Inflammation of the costochondral joints Tietze’s syndrome (benign)
  • Neuralgic pain in thorax= intercostal nerve compression by vertebral collapse, herpes zoster
  • Oesophagus and heart= chest pain
20
Q

Describe wheeze

A
  • Musical sound produced by the passage of air through narrowed airways
  • Expiration over inspiration
  • Pitch reflection of diameter of airway
  • Asthma and bronchitis= polyphonic wheeze
  • Monophonic wheeze, loud in one area= fixed lesion (tumour/ inhaled foreign body)
21
Q

What is stridor?

A

Sound worse on inspiration, caused by partial obstruction of a major airway such as the trachea/ one of two main bronchi
Often tumour, foreign body
Audible over trachea

22
Q

Other history taking in adults

A

-Airways disease- *asthma as child/ atopic diseases (eczema, hay fever) = common clinical trajectory to recur in middle age
=Asthma more clinically responsive than COPD
-Chronic bronchiectasis, COPD= childhood infections (pneumonia, measles, TB, whooping cough)
-Pulmonary embolism= extensive foreign travel, surgery

23
Q

What is involved in a systematic enquiry?

A

Underlying tumour/ COPD= appetite, weight loss

  • Morning headaches= respiratory failure, CO2 retention
  • Nasal polyps in asthma
  • Post nasal drip in chronic cough
  • Ankle swelling- cor pulmonale, right sided failure of chronic lung disease
  • Anorexia and weight loss
  • Recurrent pneumonia, aspiration of stomach and oesophageal content
24
Q

Family and social history

A
  • Smoking= person themselves, passive smoking, occupational and environmental exposure
  • How old when started smoking
  • Still smoking? Given up? When?
  • How many cigarettes a day at peak and how long that continued for
  • Quantify in pack years, 1 pack year= 20 cigarettes a day for a year
  • COPD= 10 pack year smoking history or more (not including passive smoke or occupational exposure)
  • Family history of asthma= can happen later on in life
  • Pets- dogs and cats
  • Hobbies- soldiering and paint
  • Pigeon fanciers
  • Abroad= TB, legionella (bacterial pneumonia)
  • Social circumstances= quality of living, bungalow/ flat, stairs, bathroom same floor as bedroom, living alone, support network, nursing services

ICP (7 decks)

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