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MD3001 > Respiratory and Drug History > Flashcards

Respiratory and Drug History Flashcards

1
Q

What is the importance of a medical history ?

A
  • Form a differential diagnosis
  • Identify risk factors for conditions
  • Identify red flags
  • Direct further clinical exams
  • Direct investigation and management
  • Develop a rapport between patient and health care worker
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2
Q

Identify the structure of history taking.

A
  • Presenting complaint (PC)
  • History of presenting complaint (HPC)
  • Past medical history (PMH)
  • Medication/ allergies(DH)
  • Family history (FH)
  • Social history (SH)
  • Systems enquiry/ review (SE)
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3
Q

Define presenting complaint.

A

Description of symptoms in patient’s own words

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4
Q

What are symptoms to ask about in a respiratory system enquiry ?

A
    1. Chest pain
    1. Dyspnoea
    1. Cough
    1. Sputum
    1. Haemoptysis
    1. Wheeze
    1. Systemic upset
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5
Q

What are the main indicators of pleuritic pain ?

A

Chest pain that is sharp on coughing and inspiration

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6
Q

What are possible sites of chest pain ?

A

Central, non central, pleural, chest wall

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7
Q

What are possible causes of central chest pain ?

A
  • Tracheitis
  • Angina/ MI
  • Aortic dissection
  • Massive PE
  • Oesophagitis
  • Lung tumour/ metastases
  • Mediastinal tumour/ mediastinitis
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8
Q

What are possible causes of non-central chest pain ?

A
  • Shingles
  • Lung tumour
  • PE
  • Rib fracture
  • Pneumonia
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9
Q

What are possible causes of pleural chest pain ?

A
  • Pneumonia / Bronchiectasis / TB
  • Lung tumour/ metastases/ mesothelioma
  • PE
  • Pneumothorax
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10
Q

What are possible causes of chest wall pain ?

A
  • Muscular / rib injury
  • Costochondritis
  • Lung tumour / bony metastases/ mesothelioma
  • Shingles (herpes zoster)
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11
Q

What are possible questions to ask about dyspnoea ?

A
  • Is there anything that brings it on?
  • Does anything make it better or worse?
  • Are you always breathless? Is it when you walk/ exercise?
  • Do you get breathless lying down?
    – Orthopnoea/ PND (cardiac causes)
  • How far can you walk normally? How far can you walk now? i.e. exercise tolerance
  • How do you manage walking uphill / up stairs?
  • Is there anything it stops you from doing?
  • Have you noticed any other symptoms?
    – Consider – cough, sputum, chest pain, palpitations, wheeze, stridor
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12
Q

What could dyspnoea with onset of minutes be due to ?

A
  • PE
  • Pneumothorax
  • Acute LVF
  • Acute asthma
  • Inhaled foreign body
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13
Q

What could dyspnoea with onset of hours to days be due to ?

A
  • Pneumonia
  • Asthma
  • Exacerbation of COPD
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14
Q

What could dyspnoea with onset of weeks to months be due to ?

A
  • Anaemia
  • Pleural effusion
  • Respiratory neuromuscular disorders
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15
Q

What could dyspnoea with onset of months to years be due to ?

A
  • COPD
  • Pulmonary fibrosis
  • Pulmonary TB
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16
Q

What are possible respiratory causes of dyspnoea ?

A

– Airways e.g. asthma, COPD, bronchiectasis, cystic fibrosis, laryngeal tumour, foreign body, lung tumour
– Parenchyma e.g. pneumonia, pulmonary fibrosis, sarcoidosis, TB – Pulmonary circulation e.g. PE
– Pleural e.g. pneumothorax , pleural effusion
– Chest wall e.g. kyphoscoliosis, ankylosing spondylitis
– Neuromuscular e.g. myasthenia gravis, Guillain-Barre syndrome

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17
Q

What are possible CV causes of dyspnoea ?

A
  • LVF

- Angina or MI

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18
Q

What are non-CV causes of dyspnoea ?

A
  • Anaemia
  • Obesity
  • Hyperventilation
  • Anxiety
  • Metabolic acidosis
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19
Q

What are questions to ask about the symptom of cough ?

A
  • How long have you had it? (i.e. is it a new problem?)
  • When does it occur?
  • Is there anything that makes it better or worse?
  • Is it a dry cough? Do you cough anything up?
  • Do you smoke?
  • Has your medication changed recently?
  • Do you experience any other symptoms?(consider dyspnoea, weight loss, stridor, pain, syncope, vomiting)
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20
Q

What are the most common causes of acute cough ?

A
  • Viral or bacterial infection
  • Pneumonia
  • Inhalation of foreign body
  • Irritation
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21
Q

What are the most common causes of chronic cough ?

A

MORE COMMON

  • Gastro-oesophageal reflux
  • Asthma/ COPD / smoking
  • Post-nasal drip
  • Occupational or other irritants
  • Medication (ACEI)

LESS COMMON

  • Lung tumour
  • Bronchiectasis
  • Interstitial lung disease
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22
Q

What are red flags in a patient with coughing ?

A
  • Haemoptysis
  • Breathlessness / chest pain
  • Weight loss
  • Smoking
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23
Q

What are possible characteristics of cough ?

A
  • Productive
  • Persistent ‘moist’ cough worst in morning
  • Associated with wheeze
  • Painful
  • Harsh/ barking
  • Chronic, dry cough
  • Persistent with haemoptysis
  • ‘Bovine’ cough (non-explosive cough)
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24
Q

What are the most common causes of productive cough ?

A
  • Infection

- Bronchiectasis

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25
Q

What are the most common causes of persistent ‘moist’ cough worst in morning ?

A

-COPD

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26
Q

What are the most common causes of cough associated with wheeze ?

A
  • Asthma

- COPD

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27
Q

What are the most common causes of painful cough ?

A

-Tracheaitis

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28
Q

What are the most common causes of harsh/barking cough ?

A

-Laryngitis/laryngeal tumour

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29
Q

What are the most common causes of chronic, dry cough ?

A

-Interstitial lung disease

30
Q

What are the most common causes of persistent cough with haemoptysis ?

A

-Bronchial carcinoma

31
Q

What are the most common causes of bovine cough (non-explosive cough) ?

A
  • Left recurrent laryngeal nerve invasion (secondary to malignancy)
  • Neuromuscular disorders
32
Q

What are the questions to ask concerning sputum ?

A
  • How often do you produce sputum when you cough ?
  • How much sputum do you cough ? Has this changed ?
  • What color ? Has the color changed ?
  • Is there any blood ?
  • Is it frothy or thick ?
  • Is there any abnormal smell or taste
  • Have you been experiencing any other symptoms ? (e.g. fever, dyspnoea, pain)
33
Q

What are the main types of sputum ?

A

Serous, mucoid, purulent, rusty

34
Q

What is the appearance of serous sputum ?

A

Clear, watery

OR pink , frothy

35
Q

What is the appearance of mucoid sputum ?

A

Clear, grey

OR white, viscid

36
Q

What is the appearance of purulent sputum ?

A

Yellow, green, brown

37
Q

What is the appearance of rusty sputum ?

A

Rusty red

38
Q

What are the most common causes of serous sputum ?

A

Acute pulmonary oedema

39
Q

What are the most common causes of mucoid sputum ?

A

COPD/Asthma

40
Q

What are the most common causes of purulent sputum ?

A

Infection

41
Q

What are the most common causes of rusty sputum ?

A

Pneumococcal pneumonia

42
Q

What are questions to ask concerning haemoptysis ?

A
  • When did you first notice blood in your sputum?
  • How many times has it happened?
  • How much blood is there?
  • Are there any other colours in the sputum apart from the blood?
  • Have you noticed bleeding or bruising anywhere else?
  • Are you taking any medication to thin the blood?
  • Have you noticed any other symptoms?
    (consider breathlessness / chest pain / cough / weight loss (pleuritic chest pain and hemoptysis is a red flag))
43
Q

What are the different kinds of haemoptysis ?

A

Malignant, infective, vascular, cardiac, vasculitis

44
Q

What are common causes of malignant haemoptysis ?

A
  • Bronchial carcinoma

- Metastatic lung disease

45
Q

What are common causes of infective haemoptysis ?

A
  • Acute infection
  • Bronchiectasis
  • TB
46
Q

What are common causes of vascular haemoptysis ?

A
  • Pulmonary infarction

- Pulmonary embolus

47
Q

What are common causes of cardiac haemoptysis ?

A
  • Mitral valve disease

- LVF

48
Q

What are common causes of vasculitis haemoptysis ?

A
  • Wegener’s granulomatosis

- Good pasture’s syndrome

49
Q

What are common causes of other haemoptysis ?

A
  • Trauma
  • Anticoagulation (consider warfarin)
  • Clotting disorder
50
Q

What are questions to ask about wheezing ?

A
  • When does it occur; timing and frequency
  • Exacerbators / relievers
  • Do they have an inhaler for wheeze – how often do they need to use it?
  • Exercise tolerance
  • Severity
51
Q

What are questions to ask about systemic effect ?

A
  • Change in appetite
  • Weight loss
  • Fever
  • Tiredness / lethargy
52
Q

Why is it important to take an accurate medication history ?

A

GENERAL

  • Improves patient safety
  • Savings to NHS from prevented errors

SPECIFIC

  • Reduces medication errors/near misses
  • Reduces missed doses in hospital
  • Reduces delays to treatment
  • Improves therapeutic outcomes
53
Q

Identify the golden rules of medication history taking.

A
  • Use more than one source of info to confirm patient’s medication history (e.g. carer)
  • Be alert to use of high risk medicines (e.g. warfarin, insulin, methotrexate) as accuracy critical in these cases.
  • Women of child bearing age – ask about prescribed contraception
  • Taking part in any clinical trials ?
54
Q

Identify examples of sources of information about a patient’s medicines.

A
  • Patient or family/friends/carers
  • Patient’s own medicines
  • Repeat prescription slips/other lists
  • GP surgery staff / letter/ printout
  • Substance misuse services – e.g. for methadone doses
55
Q

What are specific questions to ask about each drug listed by the patient ?

A
  • Name of medicine?
  • Do you know what it is for?
  • What is the dose/strength?
  • What is the route?
  • Number of tablets or puffs or dose units taken?
  • Type/Form – device type?
  • How often do you take this?
  • Any recent changes to dose / frequency?
  • Do you think you have any side effects with any of these medications?
56
Q

What are questions to ask about non-prescribed medication ?

A
  • Over the counter medicines ?
  • Complementary and alternative medicines ?
  • Smoking ?
  • Recreational drug use ?
57
Q

What are possible questions to ask about allergies to medication ?

A
  • Are you allergic to any medicines ?
  • What happened when you had these medicines ?
  • Have any medicines caused a rash or difficulty breathing in the past?
58
Q

What are different questions to ask to find out whether a patient has ever developed an adverse reaction to a medication ?

A
  • Have any medicines recently been stopped and if so why?
  • Have you ever had a medicine stopped because the Dr thought it was making you worse?
  • Have you ever stopped a medicine because you felt unwell?
59
Q

Define concordance.

A

A negotiated, shared agreement between clinician and patient concerning treatment regimen(s), outcomes, and behavior

60
Q

Define adherence.

A

Is patient taking their medicines?

61
Q

What are the main types of non-adherence ?

A

Intentional non-adherence (definite decision to not take medicine(s))
Unintentional non-adherence

62
Q

What are possible reasons for unintentional non-adherence ?

A
  1. Physical dexterity
  2. Reduced vision
  3. Cognitive impairment
  4. Poor understanding
63
Q

How can occupations/hobbies be relevant to respiratory history ?

A 
Because 
– Occupational asthma
– Asbestos exposure
– Coal worker's pneumoconiosis
– Extrinsic allergic alveolitis aka hypersensitivity pneumonitis (e.g. ‘farmer’s lung’ / ‘bird- fanciers lung’)
64
Q

Define ADLs.

A

(=Activities of daily living) Activities that are necessary for daily care of oneself and independent community living.

65
Q

Give examples of ADLs.

A

Using the toilet and grooming, dressing, and feeding oneself

66
Q

What are things to ask about in a GI system enquiry ?

A

Change in bowels, abdominal pain

67
Q

What are things to ask about in a GU system enquiry ?

A

Urinary symptoms, LMP

68
Q

What are things to ask about in an endocrine system enquiry ?

A

Lumps in neck, temp intolerance

69
Q

What are things to ask about in an MS system enquiry ?

A

Aches/stiffness joints/muscles/back

70
Q

What are things to ask about in a CNS system enquiry ?

A

Headaches, fits

71
Q

What are aspects of social history to ask about in a respiratory systems enquiry ?

A
  • Occupation/Hobbies
  • Pets
  • Housing
  • Smoking
  • Support / help required (ADLs)

MD3001 (75 decks)

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