respiratory history

Question 1

what questions would you ask about dyspnoea?

Answer 1

MRC score, 
excercise tolerance, triggers, 
relieving factors, 
diurnal variation, orthopnoea, 
PND

Question 2

wha is the MRC dyspnoea score?

Answer 2

Grade of breathlessness related to activities

1 = not troubled by breathlessness except during strenuous exercise

2 = short of breath when hurrying or walking up a slight hill

3 = walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace

4 = stops for breath after walking about 100m or after a few minutes on level ground

5 = too breathless to leave the house, or breathless when dressing or undressing

Question 3

what questions would you ask about chest pain?

Answer 3

SQUITARS

ask about radiation

Question 4

what would you ask about a cough?

Answer 4

• dry/productive?
• triggers?
• relieving factors?
• diurnal variation?
• associated with eating or dyspepsia?
• positional?
• nasal secretions?
• fever?

Question 5

what would you ask about sputum?

Answer 5

• how much over 24hrs
• colour
• consistency

Question 6

what would you ask about haemoptysis?

Answer 6

• quality and frequency
• fever
• night swears
• appetite
• weight loss

Question 7

what would you specifically ask for in a family history?

Answer 7

• respiratory disease
• cardiac disease
• cancer
• thrombophilia if DVT/PE
• CF

Question 8

what questions would you ask in a social history?

Answer 8

• smoking
• occupational history
• pets
• recent travel
• immobility
• activities of daily living
• alcohol
  = WHO performance status

Question 9

what is the WHO performance status?

Answer 9

0 = fully active without restrictions

1 = restricted in physically strenuous activity but ambulatory and able to carry out light work

2 = ambulatory and capable of all self care but unable to carry out any work activities.

3 = capable of only limited self care, confined to bed or chair more than 50% of waking hours

4 = completely disabled. can’t self care.

5 = dead.

Question 10

what equation can be used to calculate Alveolar-arterial (A-a) gradient?

Answer 10

PAO2 = PIO2 - PaCO2/0.8

where

PAO2 = Alveolar partial pressure of oxygen

PIO2 = Room air (approx. 20 kPa)

PACO2 is virtually the same as arterial partial pressure of carbon dioxide (PaCO2)

A-a gradient in young healthy people should be less than 2kPa and in older people >4kPa implies pathology