Symptoms in Respiratory Medicine (Week 1)

Question 1

What is a presenting complaint?

Answer 1

What the patient tells you is wrong with them, e.g
Sudden onset chest pain
Breathlessness on exertion
Haemoptysis for 3 weeks
12 hours of abdominal pain

Question 2

Is pneumonia a presenting complaint?

Answer 2

No. Pneumonia would PROMPT a presenting complaint of
Productive/unproductive cough
Fever
Pleuritic chest pain…

Question 3

What mnemonic is useful for getting a history of a presenting complaint?

Answer 3

SOCRATES

Question 4

Give two important characteristics of PLEURITIC chest pain.

Answer 4

1. Sharp

2. Worse on INSPIRATION

Question 5

Why is respiratory chest pain associated with the pleura rather than the lungs themselves?

Answer 5

The lungs have no pain receptors

Question 6

What is a symptom?

Answer 6

Something the patient experiences, found by taking a history

Question 7

What is a sign?

Answer 7

A physical variation from the norm, found by examining the patient

Question 8

Is breathlessness a symptom or a sign?

Answer 8

Symptom

Question 9

As breathlessness is a very subjective symptom, it is important to establish what is ____ for the patient.

Answer 9

normal

Question 10

Name a cause of acute breathlessness.

Answer 10

1. Pulmonary embolism
2. Pneumothorax
3. Pulmonary oedema (commonly triggered by heart failure)

Question 11

Name a cause of subacute breathlessness.

Answer 11

1. Pneumonia
2. Pulmonary oedema
3. Pleural effusion
4. Asthma
5. COPD

Question 12

Name a cause of chronic breathlessness.

Answer 12

1. COPD
2. Pulmonary fibrosis
3. Pulmonary embolism (less severe / accumulation of smaller ones)

Question 13

Name the three major categories of cough.

Answer 13

1. Dry cough
2. Productive cough
3. Haemoptysis

Question 14

An acute, dry cough is almost always caused by a ____.

Answer 14

virus

Question 15

Name a “sinister” cause of a chronic dry cough.

Answer 15

1. Lung cancer
2. Mesothelioma
3. Pulmonary metastases
4. Pulmonary fibrosis
5. Sarcoidosis
6. Hypersensitivity pneumonitis

Question 16

What is the name given to the substance brought up by a productive cough?

Answer 16

Sputum

Question 17

Name a couple of components of sputum.

Answer 17

1. Neutrophils
2. Eosinophils
3. Bacteria/fungi/viruses
4. Airway secretions

Question 18

What is haemoptysis?

Answer 18

Coughing up blood

Question 19

What is the definition of a massive haemoptysis?

Answer 19

> 500ml in 24 hours

Question 20

What is the definition of a non-massive haemoptysis?

Answer 20

<500ml in 24 hours

Question 21

Name the “Big Four” causes of haemoptysis.

Answer 21

1. Infection
2. Carcinoma
3. Pulmonary embolism
4. Bronchiectasis

Question 22

Apart from your major “red flag” signs/symptoms, what should you ask about when taking a history?

Answer 22

-Unexplained weight loss
-Fevers/sweats
(so far, more will crop up as you do each system).

Question 23

In a patient’s past medical history (PMX), what should be asked about (respiratory context)?

Answer 23

Childhood infection
Pulmonary embolism
Tuberculosis

Question 24

In the family history (FX), what should be asked about (respiratory context)?

Answer 24

Atopy

COPD

Question 25

In the social history (SX), what should be asked about (respiratory context)?

Answer 25

1. Occupation/hobbies (asbestos exposure, coal mining, farming, PETS!!!!)
2. Smoking
3. Other drugs
4. Foreign travel

Question 26

Where should you look for a good clerking layout?

Answer 26

THIS LECTURE