Respiratory History Flashcards
Main respiratory disease types
Inflammatory
Neoplastic
Infective
Vascular
Main respiratory structures for disease categorisation
Breathing tubes (obstructive) Parenchyma (restrictive) Chest wall (restrictive) Pulmonary circulation Pleura
Questions to ask about the occupation
Were you ever exposed to industrial dusts or irritants?
Were you ever exposed to cigarette fumes?
History of child health
Premature? Whooping cough Pneumonia Bronchiectasis Asthma Exercised? Open air?
Breathlessness questions
Onset Duration Intermittent Relieving/exacerbating factors Diurnal variation Associated factors -chest pain, palpitations
Grade 1 MRC dyspnoea scale
Only SOB on severe exercise
Grade 2 MRC dyspnoea scale
Short of breath on slight hill or hurrying
Grade 3 MRC dyspnoea scale
Walks slower than most people. Stops after 15mins or 1 mile
Grade 4 MRC dyspnoea scale
Stops after 100 yards, or after a few minutes
Grade 5 MRC dyspnoea scale
Too breathlessness to leave house, or when undressing
Questions to ask about breathlessness progression
Stable?
Progressive?
Speed of progression?
Exacerbations?
Which childhood diseases can increase the chance of bronchiectasis
Whooping cough or pneumonia
Questions to ask about wheeze
SOCRATES
Inspiration/expiration
Diurnal variation
Questions to ask about cough
SOCRATES
Productive/dry?
Sputum? Nature? Volume?
Haemoptysis?
Questions to ask about chest pain
SOCRATES
breathless? cough?
‘0ther’ respiratory symptoms
Tiredness
Fever/night sweats
Weight loss
Collapses/falls
Components of PMH
Check with patient and GP letter
Other medical problems
Cured cancers?
What is wheeze
entirely expiratory noise
What causes inspiratory musical noises
extrathoracic obstruction
What is an inspiratory musical noise called
Stridor
What causes wheeze
Reduction in airways calibre
Questions for drug history
Ask patient Check -GP letter -repeat prescription list -integrated clinical portal anything herbal/traditional/otc
Drugs which cause unexplained breathlessness
Clopidogrel < ticagrelor
Drugs which cause asthma
Aspirin/NSAIDs
Drugs which cause cough
ACE inhibitors
Drugs which cause wheeze
Beta blockers
Drugs which cause pulmonary toxicity
Amiodarone
Drugs which cause pneumonitis and fibrosis
Methotrexate
What is a significant amount of sputum
A tea cup in a day
What is blood in sputum a sign of
young=PE
old/smokes= cancer
Drugs which cause pneumonitis
Nitrofurantoin
Drugs which increase the risk of opportunistic infection
Steroids/immunosupressants
Drugs which increase the risk of thromboembolism
Contraceptive pill
Drugs which increase the risk pulmonary hypertension
Anorectogens (slimming pills)
Localised, sharp, worse on inspiration pain
Pleural
Which disease is often seen with severe tiredness
Sarcoidosis
Rheumatological questions
Raynauds
Joint pain/swelling
Muscle aches/weakness
Dermatological questions
Rashes
Lumps and bumps
Unusual bruises
Opthalmological questions
Itchy eyes, dry eyes (mouth)
GI questions
Acid in back of throat, heartburn, dysphagia, bowels
Neurological questions
Fits
Faints and funny turns
Weakness
Urological questions
Polyuria
What is ticagrelor
P2Y12 inhibitor, antiplatelet
Questions for personal and social history
Smoker (pack years? just tobacco?) Drinker? Lives with? Carer? Pets Hobbies Foreign travel
Respiratory diseases where the family history is significant
Alpha 1 antitrypsin
Primary ciliary dyskinesia
Acid reflux is associated with which respiratory disease
Pulmonary fibrosis
What can budgies give you
EAA