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Phase 2B medicine > Respiratory history > Flashcards

Respiratory history Flashcards

1
Q

What questions should you ask in a breathlessness history?

A

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?

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2
Q

What questions should you ask in a cough history?

A

OATES

Productive/unproductive?

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3
Q

What questions should you ask in a sputum history?

A 
OATES
Variation?
Colour?
Consistency?
Quantity?
Odour?
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4
Q

What questions should you ask in a haemoptysis history?

A 
Origin?
OATES
Quantity
Colour
Consistency
Sputum
Chest pain
Recent trauma?
Recent/recurrent DVT?
Red flags?
SOB?
Bleeding/bruising elsewhere?
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5
Q

What PMH history should you ask about in a resp Hx?

A

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

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6
Q

What surgery should you ask about in a resp Hx?

A

Dental surgery leading to aspiration of purulent material/fragments of tooth
Abdominal/pelvic/orthopaedic surgery are risk factors for DVT and PE

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7
Q

What cardiac history should you ask about?

A

Angina
Orthopnoea
Paroxysmal nocturnal dyspnoea
Previous MI

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8
Q

What medications should you ask about in the drug history?

A 
Inhalers
Steroids
Antibiotics
ACEi
Amiodarone (pulmonary fibrosis)
B-blockers
NSAIDs
Oxygen therapy
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9
Q

What should you ask about in a social history?

A 
Occupation
Smoking
Pets
Overseas travel
Living conditions eg damp
Alcohol
Exercise, AODL, independence
Been in contact with anyone with similar symptoms?
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10
Q

What family history should you ask about?

A

Asthma?

Alpha-1 antitrypsin deficiency?

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11
Q

What are the main steps of a respiratory examination?

A

Inspection
Palpation
Percussion
Auscultation

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12
Q

What should you inspect?

A 
Hands
Pulse
Resp rate
BP
JVP
Eyes
Face 
Mouth
Chest
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13
Q

What should you look for in the hands?

A 
Clubbing
Tar staining
Wasting of intrinsic muscles (T1 nerve invasion by apical lung cancer)
Tremor 
Flapping asterixis (resp failure)
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14
Q

What should you assess in the pulse?

A

Rate
Rhythm
Character
Pulsus paradoxus

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15
Q

What should you look for in the eyes?

A

Horner’s syndrome

Chemosis

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16
Q

What should you look for in the face and mouth?

A

Facial swelling
Dental caries
Central cyanosis

17
Q

What should you look for in the chest?

A 
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
18
Q

What should you palpate?

A

Trachea and apex beat for deviation
Chest expansion
Tactile vocal fremitus

19
Q

What causes the trachea to deviate towards the side of pathology?

A

Pulmonary fibrosis

Pneumothorax

20
Q

What causes the trachea to deviate away from the side of the pathology?

A

Tension pneumothorax

Massive effusion

21
Q

What should you listen for when auscultating?

A 
Vesicular (normal) breathing sounds
Bronchial breathing
Rhonchi (wheezes)
Crackles/crepitations
Pleural rub
Assess for any change in sounds after coughing
22
Q

What should you also do when auscultating?

A

Vocal resonance

If suspect consolidation - perform whispering pectoriloquy

23
Q

What should you do after auscultation?

A

Repeat inspection, palpation, percussion and auscultation on back with patient sitting forwards

24
Q

What special tests should you do in a resp examination?

A

Palpate cervical lymph nodes
Palpate ankles for oedema
Check sputum pot (volume, consistency, odour, colour, haemoptysis)
Assess peak flow

25
Q

What should you look for in the hands?

A 
Clubbing
Tar staining
Wasting of intrinsic muscles (T1 nerve invasion by apical lung cancer)
Tremor 
Flapping asterixis (resp failure)
26
Q

What should you assess in the pulse?

A

Rate
Rhythm
Character
Pulsus paradoxus

27
Q

What should you look for in the eyes?

A

Horner’s syndrome

Chemosis

28
Q

What should you look for in the face and mouth?

A

Facial swelling
Dental caries
Central cyanosis

29
Q

What should you look for in the chest?

A 
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
30
Q

What should you palpate?

A

Trachea and apex beat for deviation
Chest expansion
Tactile vocal fremitus

31
Q

What causes the trachea to deviate towards the side of pathology?

A

Pulmonary fibrosis

Pneumothorax

32
Q

What causes the trachea to deviate away from the side of the pathology?

A

Tension pneumothorax

Massive effusion

33
Q

What should you listen for when auscultating?

A 
Vesicular (normal) breathing sounds
Bronchial breathing
Rhonchi (wheezes)
Crackles/crepitations
Pleural rub
Assess for any change in sounds after coughing
34
Q

What should you also do when auscultating?

A

Vocal resonance

If suspect consolidation - perform whispering pectoriloquy

35
Q

What should you do after auscultation?

A

Repeat inspection, palpation, percussion and auscultation on back with patient sitting forwards

36
Q

What special tests should you do in a resp examination?

A

Palpate cervical lymph nodes
Palpate ankles for oedema
Check sputum pot (volume, consistency, odour, colour, haemoptysis)
Assess peak flow

Phase 2B medicine (16 decks)

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