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Moslers > Respiratory history > Flashcards

Respiratory history Flashcards

1
Q

6 main questions?

A
  • cough
  • sputum
  • haemoptysis
  • chest pain
  • SOB
  • wheeze

(+/-
• fever
• weight loss
• apnoea)

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2
Q

Hx: patient presents with feeble non-explosive “bovine” cough, hoarseness, weight loss?

A

ΔΔ
• lung CA invading left recurrent laryngeal nerve (vocal cord paralysis)
• NMD

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3
Q

Hx: patient with harsh barking cough, pain upon coughing, and stridor?

A

ΔΔ
• laryngeal inflammation
• infection (epiglottitis)
• laryngeal tumour

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4
Q

Hx: patient presents with a chronic (>3 month) history of moist “smoker’s cough” first thing in the morning, coughing up sputum?

A

ΔΔ
• chronic bronchitis
• bronchiectasis

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5
Q

Hx: patient presents with nocturnal cough disrupting sleep?

A

• asthma

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6
Q

Hx: patient who works in a bakery notices that they have a chronic cough and SOB that lessens during weekends and holidays?

A

ΔΔ
• occupational asthma
• extrinsic allergic alveolitis

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7
Q

Hx: patient presents with daytime cough?

A
  • GORD

* chronic sinus disease + postnasal drip

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8
Q

Hx: hypertensive patient presents with a dry cough?

A

• ACEi

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9
Q

Hx: chronic dry cough?

A

• ILD/PF

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10
Q

Hx: centrally painful cough, dry, non-productive?

A
  • tracheitis

* pneumonia

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11
Q

RED FLAGS to ask with cough?

A
  • heamoptysis
  • fever
  • weight loss
  • chest pain
  • SOB
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12
Q

Qs to ask about sputum?

A 
• amount
- tsp or teacupful? 
• colour
• taste/smell
• solid material (in allergic aspergillosis secretions can accumulate and be coughed up as worm-like structures which are bronchial casts, also solid material in necrotic tumour and inhaled FB)
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13
Q

Hx: patient with wet cough, producing large volumes of purulent green sputum which varies with posture?

A

bronchiectasis

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14
Q

Hx: sudden production of large amounts of purulent green sputum on a single occasion?

A
  • ruptured lung abscess

* epmyema into bronchial tree

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15
Q

Hx: large volumes of serous, watery sputum with a pink tinge, acutely SOB?

if occurring over weeks (bronchorrhoea)?

A
  • pulmonary oedema

* alveolar cell cancer

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16
Q

Hx: purulent yellow sputum vs green?

A
  • yellow = acute LRTI (neutrophils), or asthma (eosinophils)

* green = longer-standing - dead neutrophils (pneumonia, bronchiectasis, CF, lung abscess, COPD)

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17
Q

Hx: patient coughing up rusty red sputum?

A

• pneumococcal pneumonia (lysis of rbcs)

18
Q

Hx: patient coughing up clear/white mucoid sputum, for over 3 months?

A
  • COPD (can be green in the morning)

* chronic bronchitis

19
Q

Hx: patient presents with vile-tasting , smelly sputum?

A

anaerobic bacterial infection:
• bronchiectasis
• lung abscess
• empyema

20
Q

Qs to ask about haemoptysis?

A
  • coughed up or V?
  • suddenly appeared in the mouth? (nasopharyngeal)
  • amount
  • appearance
21
Q

Hx: patient presents with daily coughing up of blood-streaked CLEAR sputum/blood clots in sputum, for >1 week?

A

• lung CA

also consider TB, and lung abscess

22
Q

Hx: patient presents with blood in purulent sputum?

A

infective cause

23
Q

Hx: patient presents with coughing up large volumes of pure blood?

A
  • lung CA
  • bronchiectasis
  • TB
rarely:
• lung abscess
• mycetoma
• CF
• aorto-bronchial fistula
• Wegener's granulomatosis
24
Q

Hx: patient has intermittent haemoptysis with respiratory tract infections over years?

A

bronchiectasis

25
Q

Hx: patient presents with a single episode of coughing up blood, with pleuritic chest pain and breathlessness?

A

PE and infarction

Ix!!!

26
Q

Hx: pt presents with sharp, stabbing chest pain, intensified by coughing or breathing in?

A 
ΔΔ
• PE
• pneumonia
• pneumothorax
• #ribs

rarely:
• infection - bronchiectasis, TB
• CA - mesothelioma, mets
• connective tissue disease (RA, SLE)

27
Q

where does pain refer to from the pleura overlying the central diaphragm?

A
  • innervated by the phrenic nerve

* referred to neck or shoulder tip

28
Q

Hx: pt presents with chest wall pain in a dermatomal distribution?

A
  • prevesicular herpes zoster

* intercostal nerve root compression

29
Q

Hx: pt describes dull, aching/gnawing pain in the chest wall, unrelated to respiration, progressively worsening and disrupting sleep?

A

• CA invading the chest wall

  • lung CA
  • mesothelioma
  • rib mets
30
Q

Hx: patient presents with weight loss, new cough, and pain spreading down the medial side of the arm?

A

Pancoast tumour of the lung apex

erodes the first rib and brachial plexus, causing referred pain

31
Q

Hx: patient presents with central, retrosternal pain?

A

ΔΔ mediastinal pain:
• irritants/dust/infection of tracheobronchial tree (raw, burning retrosternal pain worse on coughing)
• CA invading mediastinal lymph nodes (dull, aching retrosternal pain that is disturbing sleep and unrelated to cough)
• massive PE
• MI

32
Q

Qs to ask about SOB?

A

• onset
- mins? = PE, asthma, pneumothorax, inhaled FB, LVF
- hours/days? = pneumonia, COPD exac
- weeks? = anaemia, pleural effusion, NMD
- months? = COPD, PF, TB
• aggravating/relieving factors
- lying flat (orthopnoea) = LVF/resp muscle weakness
- wakes from sleep (paroxysmal ND) = LVF
- wakes 3-5am with wheeze = asthma
- worst in morning = COPD
• severity
- MRC classification; how far can they walk?
• associated Sx

33
Q

Hx: patient complains of SOB that occurs suddenly whilst at rest or whilst talking, feeling of light-headedness, dizziness, tingling in fingers and around mouth, with a tight chest?

A

• psychogenic SOB (anxiety, etc)

34
Q

MRC classification of SOB? (1-3)

A

1) hurrying on level ground
2) when walking with people own age on level
3) has to stop whilst walking alone on level ground

35
Q

Qs to ask if suspect asthma?

A
  • exercise induced? worsens 5-10 mins after stopping
  • occupational?
  • allergens
  • cold
  • perfumes
  • fumes
  • drugs
  • NSAIDS
36
Q

Hx: acute SOB + NO pain?

A
  • PE
  • pneumothorax
  • metabolic acidosis
  • hypovolaeamic shock
  • acute LVF
37
Q

Hx: acute SOB + pleuritic chest pain?

A
  • PE
  • pneumonia
  • pneumothorax
  • rib fracture
38
Q

Hx: acute SOB + central chest pain?

A
  • MI with LVF

* massive PE

39
Q

Hx: acute SOB + cough + wheeze?

A
  • asthma

* COPD

40
Q

what other than the PC to ask about in a resp Hx?

A 
• PMHX
- atopy (asthma)
- whooping cough, measles, CAP (bronchiectasis)
- previous TB, RA, CA, surgery, NMD
• DHx
- chemo (PF)
• FHx
- atopy, CF
• SHx
- travel (PE)
- smoking
- asbestos etc
- pets (birds - alveolitis) (parrots/parakeets - psittacosis pneumonia)

Moslers (3 decks)

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