Respiratory History Flashcards
What are the 8 sections of a medical history?
- Presenting Complaint
- History of presenting complaint
- Past medical history/surgical history
- Medications/allergies
- Family history
- Social history
- Systems enquiry
- Closing questions (questions/concerns/ideas)
Respiratory system enquiry key points (8)
- Breathlessness/wheeze
- Cough
- Sputum
- Hemoptysis
- Dyspnea
- Hoarseness
- Chest pain
- Fever/night sweats
Direct questions related to a cough (6)
- Duration?
- Character (barking/hollow/dry)
- Nocturnal (= asthma, ask about other atopic symptoms i.e. eczema, hay fever)
- Exacerbating factors
- Sputum (colour, how much)
- hemoptysis?
Direct questions related to hemoptysis
- Always think about TB! (foreign travel?) and malignancy (weight loss?)
- Mixed with sputum? (blood w/out sputum = PE, trauma, bleeding into lung cavity)
- Melaena? (occurs if enough coughed up blood is swallowed)
Direct questions related to dyspnea
- Duration?
- Steps climbed/distance walked before onset?
- Diurnal variation (~asthma)
- Ask specifics about when dyspnea occurs (i.e. occupational allergen exposure)
Direct questions related to hoarseness
- Due to laryngitis, recurrent laryngeal nerve palsy, Singer’s nodules, or laryngeal tumour
Direct questions related to chest pain
- SOCRATES
- Usually pleuritic if respiratory (i.e. worse on inspiration)
What does a loud, brassy cough indicate?
Pressure on the trachea (i.e. by tumour)
What does a hollow, “bovine” cough suggest?
Recurrent laryngeal nerve palsy
What does a barking cough indicate?
Croup
What does a chronic cough indicate?
Pertussis, TB, foreign body, asthma
What does a dry, chronic cough indicate?
May occur following acid irritation of the lungs in esophageal reflux, and as a side effect of ACE inhibitors
Name 8 causes of hemoptysis?
- Infective
- Neoplastic
- Vascular
- Parenchymal
- Pulmonary hypertension
- Coagulopathies
- Trauma/foreign body
- Pseudo-hemoptysis
Name 4 causes of dyspnea
- Lung (i.e. airway + interstitial disease)
- Cardiac (i.e. IHD)
- Anatomical (i.e. ascites)
- Other (i.e. shock)
Explain what the different colours of sputum can show
Yellow/green = infection Pink/red/bloody = infection or cancer White = allergies, asthma, viral infection Clear/colourless = chronic bronchitis Grey/black = environmental (i.e. smoke/coal dust) Brown = chronic lung disease (bronchiectasis, cystic fibrosis)
