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Respiratory (LECTURE NOTES) > History Taking and Examination > Flashcards

Flashcards in History Taking and Examination Deck (56):
1

What symptoms should you ask about when taking a respiratory history?

Dyspnoea
Wheeze
Cough
Sputum
Haemoptysis
Chest pain

2

What is dyspnoea?

Sensation of being unable to breathe easily (breathlessness)

3

What questions should be asked regarding dyspnoea

Speed of onset
Prgression
Periodicity
Precipitating and relieving factors
Severity (according to exercise tolerance)

4

What is the term for dyspnoea when lying flat which is relieved on sitting up?

Orthopnoea

5

What is orthopnoea a feature of

Pulmonary oedema or diaphragm paralysis

6

What is the term used for a patient who wakes up breathless at night

Paroxysmal nocturnal dyspnoea (PND)

7

What is PND most commonly associated with?

Pulmonary oedema

8

What is wheeze?

A whistling or sighing noise that is characteristic of air passing through a narrow tube

9

What is wheeze a characteristic feature of

Airways obstruction cause by asthma or COPD

10

When is wheeze worse in asthma?

On wakening in the morning and may be precipitated by exercise or cold air

11

What happens in occupational asthma

Wheeze improves on the eekends or on holiday away from work. It deteriorates when returning to work

12

What is an inspiratory wheeze called

Stridor

13

What is stridor a feature of

Disease of the central airways - usually caused by an obstruction of the trachea by a carcinoma or a foreign object in children

14

Why do we cough

It is a protective reflex that removes secretions or inhaled solid material

15

What 2 types of cough can we get

Dry
Productive

16

What is purulent sputum a sign of?

A respiratory tract infection

17

What is chronic bronchitis

A cough productive of sputum on most days for a least 3 months of 2 consecutive years

18

What is bronchiectasis

The production of copious amounts of purulent sputum

19

What can violent coughing result in?

A cough fracture of a rib

20

What is bronchorrhoea
Who would often have bronchorhoea

the excessive discharge of watery mucus from the air passages of the lung. Patients with alveolar cell carcinoma

21

What is the name of black sputum

Melanoptysis

22

Who is most likely to present with melanoptysis

Patients with coalworker's pneumoconiosis

23

What is haemoptysis

Coughing up blood

24

What is haemoptysis a red flag for?

Bronchial carcinoma

25

What should all patients presenting with haemoptysis have?

A chest Xray, bronchoscopy, CT, sputum cytology

26

What else can cause haemoptysis

Bronchial carcinoma
TB
Bronchitis
Pulmonary infarction
Pulmonary oedema
Pulmonary vasculitis
Bronchiectasis

27

What is pleuritic chest pain

Pain that is aggravated by inspiration or coughing

28

What can cause irritation of the pleura

Inflammation of the pleura
Infection
Infarction
Tumour

29

What are 2 symptoms of carcinoma or lung abscess

Weight loss and anorexia

30

What are 2 symptoms of infection

Pyrexia and sweating

31

What are 3 other symptoms of hypoxaemia

Lethargy
Confusion
Malaise

32

What is headaches in the morning a symptom of?

Hypercapnia

33

What might oedema indicate

Cor pulmonale

34

What is cor pulmonale

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

35

What are indications of sleep apnoea

Snoring and daytime somnolence

36

What can hoarseness be a sign of

Damage to the recurrent laryngeal nerve by a tumour

37

What should you ask for in the past medical history

Major illness in childhood
Ever been admitted with a chest disease

38

What should you ask for in family history

Previous history of lung disease

39

What should you ask for in social history

Smoking status
Passive smoking
Pets
Participation in any sports or hobbies
Occupation over the years
Asbestos exposure

40

What should you look for in general examination of a respiratory patient?

Character of breathing - use of accessory muscles
Shape of the chest
Hoarseness of the voice
Stridor or wheeze
Respiratory rate

41

What should you look for in the hands of a respiratory patient

Finger clubbing
tar staining
features of rheumatoid arthritis
Carbon Dioxide retention
Asterexis (tremmor)
Pulse

42

What should you look for in the head and neck of a respiratory patient

Cyanosis
Anaemia
JVP
Lympadenopathy

43

What can finger clubbing signify?

Bronchial carcinoma
Fibrotic lung disease
Idiopathic pulmonary fibrosis
Asbestosis
Mesothelioma
Bronchiectasis
Cystic fibrosis
Chronic empyema
Lung abscess
Fibrosis
Bacterial endocarditis

44

What can cyanosis be an indication of

Hypoxamia

45

Where is the JVP most easily seen

Along the surface of the sternocleidomastoid muscles

46

When would the JVP be elevated?

In right heart failure as a result of pulmonary embolism
cor pulmonale in COPD

47

What should you look for during the chest inspection

Shape
Asymmetry
Scars
Skeletal abnormality
Movement of the chest as the patient breaths in and out
Abdominal paradox

48

What should you palpate during the chest palpation?

Expansion - equal either side (symmetrical
Trachea - any deviation
Apex beat

49

What should you percuss for in a chest examination?

Should be resonant over air filled lungs
Percussion over organs should sound dull
Abnormal dullness is dfound over areas of lung consolidatin
Hyper-resonance may be present over an area of collapsed lung

50

What should you get the patient to do when going to examine the back

Cross their arms to bring the scapula out of the way

51

What should you be listening for during auscultation?

Intensity and character of the breath sounds
Added sounds (wheeze, crackles, pleural rub)

52

What does wheeze on one side or area of the lung indicate

Obstruction of a bronchus by a carcinoma or a foreign body

53

What do crackles indicate

Pulmonary oedema
Lung fibrosis
Bronchiectasis

54

What do pleural rubs sound like?

Creaking they indicate roughening of the normally slippery pleural surfaces

55

What is the pitch of consolidated lungs during vocal resonance

Higher than normal

56

What is bronchial breathing

The harsher breath sounds normally heard over the trachea and main bronchi
It can be heart over consolidated lung areas also