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Clinical 3001 > Respiratory and Drug Taking History > Flashcards

Respiratory and Drug Taking History Flashcards

1
Q

What question must you ask specifically in a respiratory history taking? (7)

A
  • Chest pain
  • Dyspnoea
  • Cough
  • Sputum
  • Haemoptysis
  • Wheeze
  • Systemic upset
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2
Q

What does a sharp stabbing pain upon inspiration usually equate to?

A

Pleuritic pain

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3
Q

What diseases can cause central pain?

A
  • Tracheitis
  • Angina/MI
  • Aortic dissection
  • Massive PE
  • Oesophagitis
  • Lung tumour / metastases
  • Mediastinal tumour / mediastinitis
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4
Q

What diseases can non central chest pain indicate?

A
  • Shingles
  • Lung tumour
  • PE
  • Rib fracture
  • Pneumonia
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5
Q

What diseases can pleural chest pain indicate?

A
  • Pneumonia / Bronchiectasis / TB
  • Lung tumour / metastases / mesothelioma
  • PE
  • Pneumothorax
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6
Q

What can chest wall pain indicate?

A
  • Muscular / rib injury
  • Costochondritis
  • Lung tumour / bony metastases / mesothelioma
  • Shingles (herpes zoster)
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7
Q

What questions should you ask when someone has dyspnoea?

A
  • Is there anything that brings it on?
  • Does anything make it better or worse?
  • Are you always breathless? Is it when you walk/exercise?
  • Do you get breathless lying down?
  • How far can you walk normally? How far can you walk now? i.e exercise tolerance
  • How do you manage walking uphill / up stairs?
  • Is there anything it stops you from doing?
  • Have you noticed any other symptoms?
  • Consider - cough, sputum, chest pain, palpitations, wheeze, stridor
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8
Q

When does dyspnoea come on in a number of minutes?

A
  • PE
  • Pneumothorax
  • Acute LVF
  • Acute asthma
  • Inhaled foreign body
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9
Q

When does dyspnoea come on in a number of hours?

A
  • Pneumonia
  • Asthma
  • Exacerbation of COPD
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10
Q

When is the speed of onet of dyspnoea weeks to months?

A
  • Anaemia
  • Pleural effusion
  • Respiratory neuromuscular disorders
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11
Q

When is the speed of onet of dyspnoea from months to years?

A
  • COPD
  • Pulmonary fibrosis
  • Pulmonary TB
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12
Q

What are the respiratory causes of dyspnoea?

A
  • Airways e.g asthma, COPD, bronchiectasis, cystic fibrosis, laryngeal tumour, foreign body, lung tumour
  • Parenchyma e.g pneumonia, pulmonary fibrosis, sarcoidosis, TB
  • Pulmonary circulation e.g PE
  • Pleural e.g pneumothorax, pleural effusion
  • Chest wall e.g kyphoscoliosis, ankylosing spondylitis
  • Neuromuscular e.g myasthenia gravis, Guillain-Barre syndrome
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13
Q

What can the non cardio-respiratory causes of dyspnoea be?

A
  • Anaemia
  • Obesity
  • Hyperventilation
  • Anxiety
  • Metabolic acidosis
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14
Q

What questions should you ask when someone has a cough?

A
  • How long have you had it?
  • Is it a new problem?
  • When does it occur?
  • Is there anything that makes it better or worse?
  • Is it a dry cough Do you cough anything up?
  • Do you smoke
  • Has your medication changed recently?
  • Do you experience any other symptoms?
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15
Q

What are the likely causes of an acute cough?

A
  • Viral or bacterial infection
  • Pneumonia
  • Inhalation if foreign body
  • Irritants
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16
Q

What are the likely causes of chronic coughs?

A 
Common 
- Gastro-oesophageal reflux 
- Asthma 
- COPD 
- Smoking 
- Post-nasal drip 
- Occupationlor other irritants 
- Medication (ACEi)
Less common
- Lung tumour 
- Bronchiectasis
- Interstitial lung disease
17
Q

What are the ‘red flags’ when someone has a cough?

A
  • Haemoptysis
  • Breathlessness
  • Weight loss
  • Chest pain
  • Smoker
18
Q

What are the common causes of a productive cough?

A
  • Infection

- Bronchiectasis

19
Q

What are the common causes of a persistant ‘moist’ cough worst in morning?

A

COPD

20
Q

What are the common causes of a cough associated with a wheeze?

A

Asthma/COPD

21
Q

What usually the cause of a painful cough?

A

Tracheitis

22
Q

What is usually the cause of a harsh/barking cough?

A

Laryngitis / laryngeal tumour

23
Q

What is the commonest cause of a chronic, dry cough?

A

Interstitial lung disease

24
Q

What is the common cause of a persistant cough with haemoptysis?

A

Bronchial carcinoma

25
Q

What is the cause of a ‘bovine’ (non-explosive cough)?

A
  • Left recurrent laryngeal nerve invasion (secondary to malignancy)
  • Neuromuscular disorder
26
Q

What questions should you ask about sputum?

A
  • How often do you produce sputum when you cough?
  • How much sputum do you cough up? Has this changed?
  • What colour is it? Has the colour changed
  • Is there any blood?
  • Is it frothy or thick?
  • Is there any abnormal smell or taste?
  • Have you been experiencing any other symptoms? (e.g fever, dyspnoea, pain)
27
Q

What questions should you ask about haemoptysis?

A
  • When did you first notice blood in your sputum?
  • How many times has it happened?
  • How much blood is there?
  • Are there any other colours in the sputum apart from blood?
  • Have you noticed any bleeding or bruising anywhere else?
  • Are you taking any medication to thin the blood?
  • Have you noticed any other symptoms? (e.g breathlessness / chest pain / cough / weight loss
28
Q

What are important questions to ask with relation to systemic upset?

A
  • Change in appetite
  • Weight loss
  • Fever
  • Tiredness / lethargy
29
Q

Why should you ensure you have an accurate medication history?

A
  • Improves patient safety
  • Reduces medication errors / near misses
  • Reduces missed doses in hospital
  • Reduces delays to treatment
  • Savings to NHS from prevented errors
  • Improves therapeutic outcomes
30
Q

What is intentional non-adherence?

A

a definite decision to not take medicine(s)

31
Q

What can unintentional non-adherence be due to?

A
  • Physical dexterity e.g arthritis
  • Reduced vision
  • Cognitive impairment
  • Poor understanding
32
Q

What percentage of individuals with inhalers use their medication correctly?

A

31%

33
Q

Name some different inhaler device types?

A

Metered dose inhaler (mdi), accuhaler, autohaler, easibreathe, handihaler, via spacer / aerochamber

34
Q

What should you consider when taking a social hsitory?

A
  • Family members
  • Occupation / hobbies
  • Occupational asthma
  • Asbestos exposure
  • Coal worker’s pneumoconiosis
  • Extrinsic allergic alveolitis (hypersensitivity pneumonitis) e.g farmers lung / ‘bird-fanciers lung’
  • Pets
  • Housing
  • Pack years
  • Support / help required (ADLs)
35
Q

What questions should you perhaps ask in a systems enquiry?

A
  • CVS - palpitations, syncope
  • GI - change in bowels, abdominal pain
  • GU - urinary symptoms, LMP
  • Endocrine - lumps in neck, temp intolerence
  • MS - aches/stiffness joints/muscles/back
  • CNS - headaches, fits

Clinical 3001 (6 decks)

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