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Respiratory Block: Clinical Examination > The Respiratory History > Flashcards

The Respiratory History Flashcards

1
Q

What is very important to find out about a cough?

A

The duration of the cough

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2
Q

A cough of recent origin, particularly if associated with fever and other symptoms of respiratory tract infection, may be due to:

A

Acute bronchitis
Or
Pneumonia

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3
Q

A chronic cough (>8 weeks duration) associated with wheezing may be due to:

A

Asthma

Sometimes asthma can present with cough alone however

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4
Q

A change in the character of a chronic cough may indicate:

A

The development of a new and serious underlying problem (e.g. Infection or lung cancer)

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5
Q

What is the single most common cause of chronic cough?

A

Upper airway cough syndrome

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6
Q

A cough associated with postnasal drip or sinus congestion or headaches may be due to:

A

Upper airway cough syndrome

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7
Q

What is peculiar about the cough of a patient with upper airway cough syndrome?

A

When asked to demonstrate their cough they do not cough, but clear their throat

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8
Q

An irritating, chronic, dry cough can result from:

A

Esophageal reflux and acid irritation of the lungs
Also:
- late interstitial lung disease
- or associated with the use of the angiotensin-converting enzyme inhibitor drugs

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9
Q

Cough that wakes a patient from sleep may be due to:

A
  • a symptom of cardiac failure

- or reflux of acid from the esophagus into the lungs that can occur when a person lies down

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10
Q

A chronic cough that is productive of large volumes of purulent sputum may be due to:

A

Bronchiectasis

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11
Q

Cough related to viral croup is described as:

A

“Barking”

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12
Q

What cough would be loud and brassy?

A

A cough caused by tracheal compression due to a tumor

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13
Q

Cough associated with recurrent laryngeal nerve palsy has what sound and why?

A

A hollow sound because the vocal cords are unable to close completely - has been described as a bovine cough

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14
Q

A cough that is worse at night is suggestive of:

A
  • asthma

- heart failure

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15
Q

Coughing that comes on immediately after eating or drinking may be due to:

A
  • incoordinate swallowing
  • esophageal reflux
  • tracheo-esophageal fistula (rarely)
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16
Q

A large volume of purulent (yellow or green) sputum suggests the diagnosis of:

A
  • bronchiectasis

- or lobar pneumonia

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17
Q

Foul smelling, dark colored sputum may indicate:

A

The presence of a lung abscess with anaerobic organisms

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18
Q

Pink frothy secretions from the trachea occur in:

A

Pulmonary edema (should not be confused with sputum)

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19
Q

Haemoptysis must be distinguished from:

A
  • haematemesis

- nasopharyngeal bleeding

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20
Q

What does mild haemoptysis mean?

A

Usually <20mls blood / 24 hours

- appears as streaks of blood discoloring sputum

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21
Q

What does massive haemoptysis mean?

A

> 250mls blood / 24 hours

= a medical emergency

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22
Q

What are the most common causes of massive haemoptysis?

A
  • carcinoma
  • CF
  • bronchiectasis
  • TB
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23
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Nasopharynx / larynx
CHARACTER: Throat clearing, chronic
What are the likely causes?

A
  • postnasal drip

- acid reflux

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24
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Larynx
CHARACTER: Barking, painful, acute or persistent
What are the likely causes?

A
  • laryngitis
  • pertussis
  • croup
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25
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Trachea
CHARACTER: Acute, painful
What are the likely causes?

A

Tracheitis

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26
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchi
CHARACTER: Intermittent, sometimes productive, worse at night
What are the likely causes?

A

Asthma

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27
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchi
CHARACTER: Worse in the morning
What are the likely causes?

A

COPD

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28
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchial
CHARACTER: with blood
What are the likely causes?

A

Bronchial malignancy

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29
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Dry, then productive
What are the likely causes?

A

Pneumonia

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30
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Chronic, very productive
What are the likely causes?

A

Bronchiectasis

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31
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Productive, with blood
What are the likely causes?

A

TB

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32
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Irritating, dry and persistent
What are the likely causes?

A

Interstitial lung disease

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33
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Worse lying down, sometimes with frothy sputum
What are the likely causes?

A

Pulmonary oedema

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34
Q

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: ACE inhibitors
CHARACTER: Dry, scratchy, persistent
What are the likely causes?

A

Medication-induced

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35
Q 
Differential Diagnosis of Cough based on its duration: 
Acute Cough (<3 weeks)
A
  1. URTI
    - common cold
    - sinusitis
  2. LRTI
    - pneumonia, bronchitis, exacerbation of COPD
    - irritation: inhalation of bronchial irritant (e.g. smoke / fumes)
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36
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- Smoking History indicates

A

COPD

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37
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- wheeze, relief with bronchodilators indicates

A

Asthma

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38
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- occurs when lying down, burning central chest pain indicates

A

Gastro-oesophageal reflux

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39
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- history of rhinitis, postnasal drip, sinus headache and congestion indicates

A

Upper airway cough syndrome

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40
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- chronic, very productive indicates

A

Bronchiectasis

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41
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- drug history indicates

A

ACE inhibitor medication

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42
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- smoking, haemoptysis indicates

A

Lung carcinoma

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43
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- dyspnoea, PND indicates

A

Cardiac failure

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44
Q

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- variable, prolonged symptoms, usually mild indicates

A

Psychogenic

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45
Q

Differential Diagnosis of haemoptysis (typical history):

Small amounts of blood with sputum

A

Bronchitis

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46
Q

Differential Diagnosis of haemoptysis (typical history):

Frank blood, history of smoking, hoarseness

A

Bronchial carcinoma

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47
Q

Differential Diagnosis of haemoptysis (typical history):

Large amounts of sputum with blood

A

Bronchiectasis

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48
Q

Differential Diagnosis of haemoptysis (typical history):

Fever, recurrent onset of symptoms, dyspnoea

A

Pneumonia

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49
Q

Differential Diagnosis of haemoptysis (typical history):

Pleuritic chest pain, dyspnoea

A

Pulmonary infarction

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50
Q

Differential Diagnosis of haemoptysis (typical history):

Recurrent infections

A

CF

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51
Q

Differential Diagnosis of haemoptysis (typical history):

Fever, purulent sputum

A

Lung abscess

52
Q

Differential Diagnosis of haemoptysis (typical history):

HIV positive, previous TB, TB contact

53
Q

Differential Diagnosis of haemoptysis (typical history):

History of inhalation, cough, stridor

A

Foreign body

54
Q

Differential Diagnosis of haemoptysis (typical history):

Pulmonary haemorrhage, glomerulonephritis, antibody to basement membrane antigens

A

Goodpasture’s Syndrome

55
Q

Differential Diagnosis of haemoptysis (typical history):

History of sinusitis, saddle-nose deformity

A

Wegener’s granulomatosis

56
Q

Differential Diagnosis of haemoptysis (typical history):

Pulmonary haemorrhage, multi-system involvement

57
Q

Differential Diagnosis of haemoptysis (typical history):

History of severe cough preceding haemoptysis

A

Rupture of a mucosal blood vessel after vigorous coughing

58
Q

Differential Diagnosis of haemoptysis (typical history):

Which are the 4 most common causes

A
  1. Bronchitis
  2. Bronchial carcinoma
  3. Bronchiectasis
  4. Pneumonia
    (here probably also TB)
59
Q

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors haemoptysis

A
  • mixed with sputum

- occurs immediately after coughing

60
Q

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors haematemesis

A
  • follows nausea
  • mixed with vomitus
  • follows dry retching
61
Q

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors nasopharyngeal bleeding

A

Blood appears in mouth

62
Q

Causes of dyspnoea

A
  • respiratory or cardiac disease
  • lack of physical fitness
  • sometimes anxiety
63
Q

New York Heart Association: Dyspnoea Grading Class I

A

Disease present, but no dyspnoea or dyspnoea only on heavy exertion

64
Q

New York Heart Association: Dyspnoea Grading Class II

A

Dyspnoea on moderate exertion

65
Q

New York Heart Association: Dyspnoea Grading Class III

A

Dyspnoea on minimal exertion

66
Q

New York Heart Association: Dyspnoea Grading Class IV

A

Dyspnoea at rest

67
Q

The association of dyspnoea with wheeze suggests

A

Airway disease:

  • asthma
  • COPD
68
Q

Dyspnoea that worsens progressively over a period of weeks, months or years may be due to

A

Interstitial lung disease

69
Q

Dyspnoea of more rapid onset may be due to

A

Acute respiratory infection
Or
Pneumonitis

70
Q

Dyspnoea that varies from day to day or hour to hour indicates

71
Q

Dyspnoea associated with very rapid onset and sharp chest pain suggests

A

Pneumothorax

72
Q

Dyspnoea described as inability to fill the lungs and associated with sighing indicates:

73
Q

Dyspnoea that occurs on moderate exertion may be due to:

A

A combination of obesity and a lack of physical fitness (deconditioning)

74
Q

Characteristics of wheeze

A

Maximal during expiration
&
Accompanied by a prolonged expiration

75
Q

Characteristics of stridor

A

Loudest over the trachea

Occurs during inspiration

76
Q

Characteristics of pleuritic pain

A

Sharp in nature
Made worse by deep inspiration and coughing
Typically localized to one area in the chest

77
Q

3 conditions that cause sudden onset pleuritic chest pain:

A
  1. Lobar pneumonia
  2. Pulmonary embolism and infarction
  3. Pneumothorax
78
Q

Differential diagnosis of dyspnoea of sudden onset:

Presence of pleuritic chest pain favors

A
  • pneumothorax
  • pleurisy
  • pneumonia
  • pulmonary embolism
  • trauma
79
Q

Differential diagnosis of dyspnoea of sudden onset:

Absence of chest pain favors

A
  • pulmonary oedema
  • metabolic acidosis
  • pulmonary embolism
80
Q

Differential diagnosis of dyspnoea of sudden onset:

Presence of central chest pain favors

A
  • MI / cardiac failure

- large pulmonary embolism

81
Q

Differential diagnosis of dyspnoea of sudden onset:

Presence of cough and wheeze favors

A
  • asthma
  • bronchial irritant inhalation
  • COPD
82
Q

Prodronal symptoms that occur for a short period (hours) before pleuritic pain and dyspnoea begin

A

Bacterial pneumonia

83
Q

Longer (days) prodronal symptoms before onset of pleuritic pain and dyspnoea

A

Viral pneumonia

84
Q

What should be considered if patients present with fever at night?

A
  • TB
  • Pmeumonia
  • Lymphoma
85
Q

Hoarseness of dysphonia may be seen in:

A
  • transient inflammation of the vocal cords (laryngitis)
  • vocal cord tumor
  • recurrent laryngeal nerve palsy
86
Q

Sleep apnoea

A

An abnormal increase in the periodic cessation of breathing during sleep

87
Q

Obstructive sleep apnoea

A

Airflow stops during sleep for a period of at least 10 seconds and sometimes more than 2 minutes, despite persistent respiratory efforts

88
Q

Patient presents with: daytime somnolence, chronic fatigue, morning headaches, personality disturbances and very loud snoring

A

Obstructive sleep apnoea

89
Q

Patients with obstructive sleep apnoea are often:

A

Obese and hypertensive

90
Q

Patient presents with daytime somnolence but does not snore excessively

A

Central sleep apnoea

91
Q

Central sleep apnoea

A

Cessation of inspiratory muscle activity

92
Q

What is the result of hyperventilation?

A

Increased carbon dioxide excretion
= development of alkalosis
May complain of variable dyspnoea: more difficulty breathing in than out

93
Q

What are the symptoms of alkalosis?

A
  • paresthesias of the fingers and around the mouth
  • light-headedness
  • chest pain
  • feeling of impending collapse
94
Q

What are bronchodilators and steroids prescribed for?

A

Asthma
&
COPD

95
Q

Increased use of bronchodilators indicates:

A

Poor control of asthma and the need for review of treatment

96
Q

Oral steroid use may predispose to:

A

TB & Pneumocystis Pneumonia

97
Q

Cessation of airflow for more than 10 seconds more than 10 times a night during sleep is called:

A

Sleep apnoea

98
Q

Periods of apnoea (associated with reduced level of consciousness) alternate with periods of hyperpnoea (lasts 30s on average, associated with agitation) indicates

A

Cheyne-Stokes Breathing

- due to a delay in the medullary chemoreceptor response to blood gas changes

99
Q

Deep, rapid respiration due to stimulation of the respiratory center indicates:

A

Kussmaul’s Breathing (air hunger)

100
Q

Irregular breathing in timing and depth indicates

A

Ataxic (Biot) Breathing

101
Q

Alkalosis and tetany and peri-oral paresthesia is due to:

A

Hyperventilation

102
Q

Post-inspiratory pause in breathing is called:

A

Apneustic breathing

103
Q

The abdomen sucks inward during inspiration - this phenomenon is called:

A

Paradoxical respiration

104
Q

Causes of sleep apnoea

A

Obstructive (e.g. Obesity with upper airway narrowing, enlarged tonsils, pharyngeal soft tissue changes in acromegaly or hypothyroidism)

105
Q

Causes of Cheyne-Stokes Breathing

A
  • Left Ventricular Failure
  • Brain damage (trauma, cerebral haemorrhage etc.)
  • High altitude
106
Q

Causes of Kussmaul’s Breathing

A

Metabolic acidosis (DM, chronic renal failure)

107
Q

Causes of hyperventilation:

108
Q

Causes of Ataxic (Biot) Breathing

A

Brainstem damage

109
Q

Causes of Apneustic Breathing

A

Brain (pontine) damage

110
Q

Cause of paradoxical respiration

A

Diaphragmatic paralysis

111
Q

Within a few hours, patients develop flu-like symptoms: fever, headache, muscle pain, dyspnoea WITHOUT wheeze and dry cough
What is the most likely condition?

A

Allergic alveolitis:

Exposure to organic dusts that cause a local immune response resulting in allergic alveolitis

112
Q

Allergic Alveolitis: source in Bird Fancier’s Lung Disorder

A

Bird feathers and excreta

113
Q

Allergic Alveolitis: source in Farmer’s Lung Disorder

A

Moldy hay or straw (Aspergillus Fumigatus)

114
Q

Allergic Alveolitis: source in Byssinosis Disorder

A

Cotton or hemp dust

115
Q

Allergic Alveolitis: source in Cheese Worker’s Lung Disorder

A

Moldy cheese (Aspergillus Clavatus)

116
Q

Allergic Alveolitis: source in Humidifier Fever

A

Air conditioning (Thermophilic Actinomycetes)

117
Q

Lung Toxicity due to Drugs: OCP produces

A

Pulmonary embolism

118
Q

Lung Toxicity due to Drugs: Cytotoxic Agents (Methotrexate, Bleomycin, Cyclophophamide etc) produce

A

Interstitial lung disease

119
Q

Lung Toxicity due to Drugs: Beta-blockers and NSAIDs cause

A

Bronchospasm

120
Q

Lung Toxicity due to Drugs: ACE Inhibitors cause

121
Q

Smoking increases the risk of:

A
  1. Major cause of COPD and lung cancer

2. Increases the risk of: spontaneous pneumothorax and Goodpasture’s Syndrome

122
Q

What can drinking large amounts of alcohol in binges causes?

A

Can sometimes result in aspiration pneumonia

123
Q

Alcoholics are more likely to develop what infection?

A

Pneumococcal or Klebsiella Pneumonia

124
Q

What are IV drug users at risk of?

A

Lung abscesses and drug related pulmonary oedema

125
Q

Alpha(1)-Antitrypsin Deficiency predisposes to

A

Extremely susceptible to the development of emphysema

Respiratory Block: Clinical Examination (2 decks)

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