Respiratory Medicine – a GP Perspective Flashcards
What are some of the common respiratory presentations seen in primary care?
Cough (acute, subacute, or chronic).
Shortness of breath (dyspnea), especially in chronic conditions like COPD or asthma.
Wheezing and chest tightness, commonly in asthma or bronchitis.
Sore throat and hoarseness, often in upper respiratory infections.
Sputum production (productive cough), seen in bronchitis or pneumonia.
Fatigue or general malaise, associated with viral or bacterial infections.
Chest pain, especially pleuritic pain in conditions like pneumonia or pleuritis.
How do cough and shortness of breath typically present in primary care?
Cough:
Acute: Lasting for a few days to weeks, often caused by viral infections like the common cold or influenza.
Chronic: Lasting more than 8 weeks, often associated with conditions like asthma, COPD, gastroesophageal reflux, or post-nasal drip.
Shortness of breath (dyspnea):
Often occurs with exertion in asthma, COPD, or heart failure.
Acute onset can suggest pneumonia, pulmonary embolism, or an exacerbation of asthma or COPD.
How do wheezing and chest tightness present in primary care?
Wheezing:
Often heard on expiration. Common in asthma, COPD, and bronchitis.
Associated symptoms: Cough, shortness of breath, and chest tightness.
Chest Tightness:
Common in asthma, COPD, or anxiety.
Often described as a sensation of pressure or heaviness in the chest.
How do sore throat and hoarseness typically present in primary care?
Sore Throat:
Often caused by viral infections (e.g., rhinovirus, adenovirus), but can also be caused by bacterial infections (e.g., Streptococcus pyogenes).
Associated with pain on swallowing, fever, and cough.
Hoarseness:
Often due to viral infections like laryngitis or upper respiratory tract infections.
Can also be caused by acid reflux or vocal cord strain.
How does sputum production present and what conditions can cause it?
Sputum: Typically yellow, green, or bloody.
Acute sputum production: Often due to acute bronchitis or pneumonia.
Chronic sputum production: Seen in conditions like chronic bronchitis (COPD), bronchiectasis, or cystic fibrosis.
How do fatigue and malaise present in respiratory conditions in primary care?
Fatigue: Common in viral respiratory infections (e.g., influenza, COVID-19), but also in chronic respiratory diseases like COPD and asthma.
Malaise: General feeling of discomfort or illness, often seen in the early stages of respiratory infections.
How does chest pain present in respiratory conditions in primary care?
Pleuritic chest pain: Sharp pain that worsens with deep breathing or coughing, often seen in pneumonia, pleuritis, or pulmonary embolism.
Non-pleuritic chest pain: Can be dull or constant, often due to COPD, asthma, or gastroesophageal reflux.
What is the role of primary care in managing common respiratory conditions?
Initial assessment and diagnosis: Recognizing symptoms, performing basic physical exams (e.g., auscultation, checking oxygen saturation), and making preliminary diagnoses.
Empiric treatment: Prescribing antibiotics for suspected bacterial infections (e.g., streptococcal pharyngitis), bronchodilators for asthma, or corticosteroids for COPD exacerbations.
Referral: Sending patients to secondary care when conditions like severe pneumonia, pulmonary embolism, or worsening chronic diseases are suspected.
Prevention: Offering vaccines (e.g., flu shots, pneumococcal vaccine), counseling on smoking cessation, and providing education on managing chronic conditions (e.g., COPD, asthma).
When should a primary care provider refer a patient to secondary care for respiratory conditions?
When there is severe or persistent symptoms despite initial treatment (e.g., pneumonia, COPD exacerbation).
Hypoxia or significant dyspnea requiring further investigation.
Uncertain diagnosis or suspected complex conditions (e.g., interstitial lung disease, pulmonary embolism, lung cancer).
Complicated cases of asthma, bronchiectasis, or COPD where advanced care is needed.
How does primary care manage chronic respiratory conditions like COPD and asthma?
Chronic Obstructive Pulmonary Disease (COPD):
Smoking cessation support, bronchodilators, inhaled corticosteroids, and pulmonary rehabilitation.
Vaccination (e.g., flu vaccine, pneumococcal vaccine).
Asthma:
Inhaled corticosteroids, bronchodilators (e.g., salbutamol), and long-acting bronchodilators.
Regular monitoring and education on managing attacks.
