Respiratory and Drug Taking History Flashcards
What question must you ask specifically in a respiratory history taking? (7)
- Chest pain
- Dyspnoea
- Cough
- Sputum
- Haemoptysis
- Wheeze
- Systemic upset
What does a sharp stabbing pain upon inspiration usually equate to?
Pleuritic pain
What diseases can cause central pain?
- Tracheitis
- Angina/MI
- Aortic dissection
- Massive PE
- Oesophagitis
- Lung tumour / metastases
- Mediastinal tumour / mediastinitis
What diseases can non central chest pain indicate?
- Shingles
- Lung tumour
- PE
- Rib fracture
- Pneumonia
What diseases can pleural chest pain indicate?
- Pneumonia / Bronchiectasis / TB
- Lung tumour / metastases / mesothelioma
- PE
- Pneumothorax
What can chest wall pain indicate?
- Muscular / rib injury
- Costochondritis
- Lung tumour / bony metastases / mesothelioma
- Shingles (herpes zoster)
What questions should you ask when someone has dyspnoea?
- 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
When does dyspnoea come on in a number of minutes?
- PE
- Pneumothorax
- Acute LVF
- Acute asthma
- Inhaled foreign body
When does dyspnoea come on in a number of hours?
- Pneumonia
- Asthma
- Exacerbation of COPD
When is the speed of onet of dyspnoea weeks to months?
- Anaemia
- Pleural effusion
- Respiratory neuromuscular disorders
When is the speed of onet of dyspnoea from months to years?
- COPD
- Pulmonary fibrosis
- Pulmonary TB
What are the respiratory causes of dyspnoea?
- 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
What can the non cardio-respiratory causes of dyspnoea be?
- Anaemia
- Obesity
- Hyperventilation
- Anxiety
- Metabolic acidosis
What questions should you ask when someone has a cough?
- 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?
What are the likely causes of an acute cough?
- Viral or bacterial infection
- Pneumonia
- Inhalation if foreign body
- Irritants
What are the likely causes of chronic coughs?
Common - Gastro-oesophageal reflux - Asthma - COPD - Smoking - Post-nasal drip - Occupationlor other irritants - Medication (ACEi) Less common - Lung tumour - Bronchiectasis - Interstitial lung disease
What are the ‘red flags’ when someone has a cough?
- Haemoptysis
- Breathlessness
- Weight loss
- Chest pain
- Smoker
What are the common causes of a productive cough?
- Infection
- Bronchiectasis
What are the common causes of a persistant ‘moist’ cough worst in morning?
COPD
What are the common causes of a cough associated with a wheeze?
Asthma/COPD
What usually the cause of a painful cough?
Tracheitis
What is usually the cause of a harsh/barking cough?
Laryngitis / laryngeal tumour
What is the commonest cause of a chronic, dry cough?
Interstitial lung disease
What is the common cause of a persistant cough with haemoptysis?
Bronchial carcinoma
What is the cause of a ‘bovine’ (non-explosive cough)?
- Left recurrent laryngeal nerve invasion (secondary to malignancy)
- Neuromuscular disorder
What questions should you ask about sputum?
- 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)
What questions should you ask about haemoptysis?
- 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
What are important questions to ask with relation to systemic upset?
- Change in appetite
- Weight loss
- Fever
- Tiredness / lethargy
Why should you ensure you have an accurate medication history?
- 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
What is intentional non-adherence?
a definite decision to not take medicine(s)
What can unintentional non-adherence be due to?
- Physical dexterity e.g arthritis
- Reduced vision
- Cognitive impairment
- Poor understanding
What percentage of individuals with inhalers use their medication correctly?
31%
Name some different inhaler device types?
Metered dose inhaler (mdi), accuhaler, autohaler, easibreathe, handihaler, via spacer / aerochamber
What should you consider when taking a social hsitory?
- 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)
What questions should you perhaps ask in a systems enquiry?
- 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
