Respiratory history Flashcards
What questions should you ask in a breathlessness history?
How is this different to normal? How far can they normally walk?
Onset? Timing? Duration?
Variability? Diurnal variation?
Exacerbating/relieving factors?
Associated symptoms?
Severity? - at rest/on exertion/limiting AODL?
What questions should you ask in a cough history?
OATES
Productive/unproductive?
What questions should you ask in a sputum history?
OATES Variation? Colour? Consistency? Quantity? Odour?
What questions should you ask in a haemoptysis history?
Origin? OATES Quantity Colour Consistency Sputum Chest pain Recent trauma? Recent/recurrent DVT? Red flags? SOB? Bleeding/bruising elsewhere?
What PMH history should you ask about in a resp Hx?
Pneumonia - can lead to bronchiectasis or pulmonary fibrosis
TB - reactivation
Severe measles/whooping cough can lead to bronchiectasis
Asthma
Cardiac disease can lead to pulmonary oedema
Immunocompromised - infections
What surgery should you ask about in a resp Hx?
Dental surgery leading to aspiration of purulent material/fragments of tooth
Abdominal/pelvic/orthopaedic surgery are risk factors for DVT and PE
What cardiac history should you ask about?
Angina
Orthopnoea
Paroxysmal nocturnal dyspnoea
Previous MI
What medications should you ask about in the drug history?
Inhalers Steroids Antibiotics ACEi Amiodarone (pulmonary fibrosis) B-blockers NSAIDs Oxygen therapy
What should you ask about in a social history?
Occupation Smoking Pets Overseas travel Living conditions eg damp Alcohol Exercise, AODL, independence Been in contact with anyone with similar symptoms?
What family history should you ask about?
Asthma?
Alpha-1 antitrypsin deficiency?
What are the main steps of a respiratory examination?
Inspection
Palpation
Percussion
Auscultation
What should you inspect?
Hands Pulse Resp rate BP JVP Eyes Face Mouth Chest
What should you look for in the hands?
Clubbing Tar staining Wasting of intrinsic muscles (T1 nerve invasion by apical lung cancer) Tremor Flapping asterixis (resp failure)
What should you assess in the pulse?
Rate
Rhythm
Character
Pulsus paradoxus
What should you look for in the eyes?
Horner’s syndrome
Chemosis
What should you look for in the face and mouth?
Facial swelling
Dental caries
Central cyanosis
What should you look for in the chest?
Shape - barrel chest, severe kyphosis, severe pectus excavatum, pectus carinatum, Harrison's sulci Symmetry Scars Muscle wasting Chest vs diaphragmatic breathing Use of accessory muscles Recession
What should you palpate?
Trachea and apex beat for deviation
Chest expansion
Tactile vocal fremitus
What causes the trachea to deviate towards the side of pathology?
Pulmonary fibrosis
Pneumothorax
What causes the trachea to deviate away from the side of the pathology?
Tension pneumothorax
Massive effusion
What should you listen for when auscultating?
Vesicular (normal) breathing sounds Bronchial breathing Rhonchi (wheezes) Crackles/crepitations Pleural rub Assess for any change in sounds after coughing
What should you also do when auscultating?
Vocal resonance
If suspect consolidation - perform whispering pectoriloquy
What should you do after auscultation?
Repeat inspection, palpation, percussion and auscultation on back with patient sitting forwards
What special tests should you do in a resp examination?
Palpate cervical lymph nodes
Palpate ankles for oedema
Check sputum pot (volume, consistency, odour, colour, haemoptysis)
Assess peak flow
What should you look for in the hands?
Clubbing Tar staining Wasting of intrinsic muscles (T1 nerve invasion by apical lung cancer) Tremor Flapping asterixis (resp failure)
What should you assess in the pulse?
Rate
Rhythm
Character
Pulsus paradoxus
What should you look for in the eyes?
Horner’s syndrome
Chemosis
What should you look for in the face and mouth?
Facial swelling
Dental caries
Central cyanosis
What should you look for in the chest?
Shape - barrel chest, severe kyphosis, severe pectus excavatum, pectus carinatum, Harrison's sulci Symmetry Scars Muscle wasting Chest vs diaphragmatic breathing Use of accessory muscles Recession
What should you palpate?
Trachea and apex beat for deviation
Chest expansion
Tactile vocal fremitus
What causes the trachea to deviate towards the side of pathology?
Pulmonary fibrosis
Pneumothorax
What causes the trachea to deviate away from the side of the pathology?
Tension pneumothorax
Massive effusion
What should you listen for when auscultating?
Vesicular (normal) breathing sounds Bronchial breathing Rhonchi (wheezes) Crackles/crepitations Pleural rub Assess for any change in sounds after coughing
What should you also do when auscultating?
Vocal resonance
If suspect consolidation - perform whispering pectoriloquy
What should you do after auscultation?
Repeat inspection, palpation, percussion and auscultation on back with patient sitting forwards
What special tests should you do in a resp examination?
Palpate cervical lymph nodes
Palpate ankles for oedema
Check sputum pot (volume, consistency, odour, colour, haemoptysis)
Assess peak flow
