Respiratory- PMH

Question 1

PMH relevant to respiratory disease

Answer 1

• eczema/hay fever: allergic tendency relevant to asthma
• childhood asthma: many adults with asthma had childhood wheeze
• whooping cough/meales/ inhaled foreign bodies: causes of bronchiectasis.
• Pneumonia: cause Bronchiectasis
• TB: reactivation if not treated properly
• connective tissue disorders (RA): respiratory manifestations (e.g. fibrosis, effusions, bronchiectasis), Tx for RA can cause fibrosis and increase risk of infection
• previous malignancy: Chemotherapy, metastatic disease, radiotherapy
• Ca, long travel, surgery, immobility: can cause PE
• LOC, surgery- increase risk of aspiration
• neuromuscular disorders: respiratory failure, aspiration

Question 2

Respiratory conditions caused by drugs- bronchoconstriction

Answer 2

• beta blockers
• opioids
• NSAIDs

Question 3

FHx

Answer 3

• Respiratory diseases with a known genetic cause are relatively rare.
• Patients with autosomal recessive conditions such as cysticforosis usually have unaffected carier parents but may have affected siblings.
• A family history of venous thromboembolism should prompt investigation of inherited thrombophilias such as Factor V Leiden or protein C or protein S deficiency.
• In rare cases, idiopathic pulmonary fibrosis and primary pulmonary hypertension may be familial.

Question 4

Respiratory conditions caused by drugs- cough, PE, respiratory depression and bronchiolitis

Answer 4

• cough= ACEI
• PE= oestrogens
• Respiratory depression= opioids and Bz
• bronchiolitis= penacillamine

Question 5

Respiratory conditions caused by drugs- diffuse parenchymal lung disease

Answer 5

• cytotoxics: bleomycin + MTX
• anti-inflammatory: sulfasalazine, penacillamine, gold salts, aspirin
• CV meds: amiodarone, hydralazine
• ABx: nitrofurantoin XP

Question 6

Respiratory conditions caused by drugs- pulmonary HTN and pleural effusion

Answer 6

• Pulmonary HTN: oestrogens, fenfluramine
• pleural effusion: amiodarone, nitrofurantoin, phenytoin, MTX, pergolide

Question 7

Respiratory conditions caused by drugs- TB

Answer 7

• concerned reactivation can be caused by
• glucocorticoids
• DMARDS
• biologics (immunomodulating such as for RA)

Question 8

SHX

Answer 8

• exposure to aggravating causes: pets,
• smoking
• living arrangements- multiple flights of stairs in reduced exercise tolerance

Question 9

Occupational history that can affect resp diseases

Answer 9

• asbestos: pleural disease, Ca, ILD,
• famers and bakers- asthma, infections,
• metal workers, miners, -

Question 10

Occupational history

Answer 10

• Ask the patient about their work history, starting with their first job documenting the employers’ names,the dates and duration of exposure, and whether any protective masks were offered or used.
• Occupational asthma should be considered if symptoms improve on days away from work.
• Inhalation of organic dusts may trigger hypersensitivity pneumonitis (birds, hay, metal working fluids)
• Inhalation of inorganic dusts such as asbestos, coal or silica cause ILD, with gradual onset of cough and breathlessness,often years after exposure.
• Certain occupations increase the risk of respiratory infection (sewage, abattoir, animals)

Question 11

All the history questions to be added

Answer 11

1) PC
2) HPC
3) PMH
4) DHx and allergies
5) FHx
6) SHx
7) Smoking
8) Occupational Hx