Thorax and Lungs

Question 1

What questions do we ask about a cough?

Answer 1

• When did it start
• Gradual or sudden
• How long have you had it
• How often do you cough, does it wake you at night

Question 2

What is the difference between acute and chronic coughs

Answer 2

• Acute: Lasts 2-3 weeks

- Chronic: more than 2 months

Question 3

What can the time that coughing occurs mean?

Answer 3

• Throughout day: acute illness
• Afternoon/evening: exposure to irritant at work
• Nigh: postnasal drip, sinusitis
• Early Morning: chronic brachial inflammation in smokers

Question 4

What would lead to diagnosis of bronchitis?

Answer 4

A history of productive cough for 3 months of the year, for 2 years in a row

Question 5

What can green phlegm mean?

Answer 5

Viral or bacterial infection

Question 6

What are 4 types of sputum and what do they mean?

Answer 6

White/Clear Mucoid: cold, bronchitis and viral infections
Yellow/Green” bacterial infections
Rust Coloured: TB, pneumococcal pneumonia
Pink/Frothy: pulmonary edema, sympathomimetic medications

Question 7

If a patient characterizes their cough as: hacking, dry, barking, hoarse, congested or bubbling, what does it mean

Answer 7

Hacking: mycoplasma pneumonia
Dry: Early heart failure
Barking: Croup
Congested: cold, bronchitis and pneumonia

Question 8

Why do we ask: What treatment have they tried (i.e. prescription or over the counter, position change, etc)

Answer 8

To assess effectiveness of coping strategies

Question 9

What is our goal when asking “ ever had shortness of breath? What brings it on? How severe and how long does it last”

Answer 9

To determine how much activity precipitates the shortness of breath specifically

Question 10

What is orthopnea?

Answer 10

Difficulty breathing in supine, state how many pillows needed

Question 11

What is paroxysmal nocturnal dyspnea?

Answer 11

Awakening from sleep with shortness of breath and needing to be upright to achieve comfort

Question 12

What condition causes night sweats?

Answer 12

Diaphoresis

Question 13

What is cyanosis?

Answer 13

Blueish colourish

Question 14

Why would you ask whether the coughing attacks seem to be related to food, pollen, animals, etc

Answer 14

Asthma attacks may be associated with a specific allergen, extreme cold or anxiety

Question 15

Why do we ask about chest pain and where it occurs?

Answer 15

Chest pain in thoracic origin occurs with muscle soreness from coughing or inflammation of pleura overlying pneumonia

Question 16

What do we need to be aware of when asking about chest pain?

Answer 16

Whether it is muscle soreness or if it cardiac origin or heartburn from stomach acid

Question 17

If patient answers yes to “past history of breathing trouble, bronchitis, emphysema, asthma or pneumonia”, what should we consider?

Answer 17

Sequelae: a condition that is a consequence of a previous disease or injury

Question 18

Why do we ask if patient has had any unusually frequent or severe colds

Answer 18

Because most people have had some colds, it is more effective to ask about number or severity

Question 19

Why would we ask if patient has family history of asthma, allergies or TB?

Answer 19

To assess for possible risk factors

Question 20

In regards to lungs/thorax, what do we ask about smoking?

Answer 20

• If they smoke cigarettes or cigars
• What age they started
• How many packs smoked per day
• How many years of smoking

Question 21

In regards to smoking, how should we address it to better the situation?

Answer 21

Instead of telling them that they should quit (like they already know), assess smoking behaviour, and ways to modify daily smoking activities, identify triggers and to manage withdrawl

Question 22

What environmental hazards can affect breathing?

Answer 22

Pollution exposure

Question 23

What is extrinisic allergic alveolitis

Answer 23

Farmers lung due to grain and pesticide inhalation

Question 24

What disease are coal miners at risk for? Stone cutters, miners and potters?

Answer 24

• pneumoconiosis

- silicosis

Question 25

Why would we assess self-care measures in regards to environmental factors?

Answer 25

To see how they protect their lungs (mask, ventilators, monitor exposure)

Question 26

What symptoms does carbon monoxide produce? Sulphur Dioxide?

Answer 26

• dizziness, headache and fatigue

- cough, congestion

Question 27

Why do we ask older adults if they experience any shortness of breath/fatigue with daily activities?

Answer 27

Older adults respiratory system is less efficient, giving them less tolerance for activity

Question 28

Why do we ask older adults to tell us about their usual amount of physical activity

Answer 28

They have reduced capacity to perform exercise because of pulmonary function deficits
Sedentary/bedridden people at risk for respiratory dysfunction

Question 29

Why do we ask older adults if they have chest pain with breathing?

Answer 29

Some feel pleuritic pain less intensely than younger adults

Question 30

What should we consider when older adults answer yes to chest pain after coughing

Answer 30

If precisely localized and sharp, consider fractured rib or muscle injury