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Clinical skills/diagnosis > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Cardinal respiratory symptoms?

A 
Cough
Sputum
Haemoptysis
Breathlessness
Wheeze
Chest pain
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2
Q

Cough - explode

A
  1. Sound of the cough (harsh, barking, quiet)
  2. Timing (nocturnal/daytime/morning/evening/weekend sparing)
  3. Circumstances (after swallowing, in particular places)
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3
Q

Causes of cough (adult)?

A

Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD

Important to exclude: Tumour, LRTI, IFB/aspiration

Other causes:
Sinuses - Infection
Larynx-trachea-bronchi - Irritant dusts
Small airways - Post-viral reactivity, COPD, Bronchiectasis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts
Interstitium - ILD, sarcoidosis

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4
Q

Causes of cough (adult)?

A

Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD

Important to exclude: Tumour, LRTI, IFB/aspiration

Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli

Sinuses - Infection
Larynx-trachea-bronchi - Irritant dusts
Small airways - Post-viral reactivity, COPD, Bronchiectasis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts

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5
Q

Causes of cough (adult)?

A

Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD

Important to exclude: Tumour, infection, IFB/aspiration

Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli

Sinuses - Infection
Larynx-trachea-bronchi - GOR, Irritant dusts
Small airways - Asthma, post-viral reactivity, COPD, Bronchiectasis, Bronchiolitis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Alveolitis, LVF, Irritant dusts

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6
Q

Describe the different types of sputum and associated conditions

A

Serous/mucoid/purulent/rusty/black

Serous:
- Clear/watery/frothy/pink: Acute pulmonary oedema, alveolar cell cancer
Mucoid:
- Clear/grey: COPD
- White/viscid: Asthma
Purulent:
- Yellow/green: Bronchopulmonary infection (any cause)
- Green: Disease with associated white cell infiltrates (eg. asthma)
Rusty:
- Rusty/golden: Early pneumococcal pneumonia
Black:
- Rupture of necrotic areas of pulmonary fibrosis in pneumoconiosis

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7
Q

Causes of cough (adult)?

A

Commonest causes:
Acute - URTI
Chronic - Smoking, post-nasal drip, asthma, GORD

Other causes:
Sinuses/Larynx-trachea-bronchi/Small airways/Alveoli

Sinuses - Infection
Larynx-trachea-bronchi - Infection, tumour (benign/malignant/1ry/2ry), aspiration, GOR, FB, Irritant dusts
Small airways - Asthma, post-viral reactivity, COPD, Bronchiectasis, Bronchiolitis, Irritant dusts
Alveoli - Drugs (eg. ACE-I), Infection (pneumonia, TB), Alveolitis, LVF, Irritant dusts

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8
Q

Sputum - explode

A
  1. Normal/new (change?)
  2. Amount (teaspoons/day)
  3. Chronicity/Timing (how long for/regular/one-off)
  4. Colour (clear/green/yellow/rusty/black)
  5. Foul taste/smell
  6. Solid material (bronchial casts/necrotic tumour/IFB)
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9
Q

Describe the different types of sputum and associated conditions

A

Serous/mucoid/purulent/rusty/black

Serous:
- Clear/watery/frothy/pink: Acute pulmonary oedema, alveolar cell cancer

Mucoid:

  • Clear/grey: COPD
  • White/viscid: Asthma

Purulent:

  • Yellow/green: Bronchopulmonary infection (any cause)
  • Green: Disease with associated white cell infiltrates (eg. asthma)

Rusty:
- Rusty/golden: Early pneumococcal pneumonia

Black:
- Rupture of necrotic areas of pulmonary fibrosis in pneumoconiosis

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10
Q

Haemoptysis - explode

A
  1. Clarify origin (lung/UGI/nasopharyngeal)
  2. Amount (quantify)
  3. Appearance (pure blood/streaking/clots)
  4. Frequency/duration
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11
Q

Causes of haemoptysis?

A

Commonest cause: Infection (TB, bronchiectasis, abscess, pneumonia)

Important to exclude tumour (Ca Lung, mets, bronchial carcinoid)

Other causes:
(Rare)infection/Vascular/Vasculitis/Trauma/Cardiac/Haematological

Infection: Mycetoma, CF
Vascular: PE, AV malformation
Vasculitis: Wegener’s, Goodpasture’s
Trauma: IFB, penetrating chest trauma, iatrogenic (eg. biopsy)
Cardiac: Mitral valve disease, Acute LVF
Haematological: Blood dyscrasias, anticoagulation

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12
Q

Chest pain - explode

A
  1. Site (central/non-central)
  2. Onset (when?/sudden/gradual/activity at time)
  3. Time course (evolution/pattern/wake at night)
  4. Character (dull/sharp/gnawing)
  5. Severity
  6. Radiation (neck/jaw/shoulder/arm/back/abdomen)
  7. Exacerbating/relieving factors (position/respiration/movement)
  8. Associated Sx (resp+cardio Sx review/N&V/sweating/anxiety/fever)
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13
Q

Causes of chest pain?

A 
Common causes (age dependent) include:
Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis), oesophageal (GORD, hiatus hernia), anxiety

Important to exclude: Pneumothorax, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis

Other causes include:
Central

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14
Q

Causes of chest pain?

A 
Common causes (age dependent) include:
Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety

Important to exclude: Pneumothorax, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis

Other causes include:
Central - Tumour, lymphadenopathy
Pleural - Infection, tumour, connective tissue disease
Chest wall - Tumour, Coxsackie B infection, shingles

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15
Q

Causes of central chest pain?

A

Cadiac/oesophageal/tracheal/aortic/mediastinal

Common causes (age dependent) include:
ACS/angina, oesophagitis, anxiety

Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour

Other causes include:
Oesophageal

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16
Q

Causes of chest pain?

A 
Common causes (age dependent) include:
Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety

Important to exclude: Pneumothorax, tumour, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis

Other causes include:
Central - Lymphadenopathy
Pleural - Suppurative lung disease, TB, CTD
Chest wall - Tumour, Coxsackie B infection, shingles

17
Q

Causes of central chest pain?

A

Cadiac/oesophageal/tracheal/aortic/mediastinal/psychological

Common causes (age dependent) include:
ACS/angina, oesophagitis, anxiety

Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour

Other causes include:
Tracheal infection, irritant inhalation, lymphadenopathy

18
Q

Causes of pleuritic chest pain?

A

Infection/malignancy/pneumothorax/PE/CTD

Common causes (age dependent) include:
PE/pneumonia, malignancy
19
Q

Causes of central chest pain?

A 
Common causes (age dependent) include:
ACS/angina, oesophagitis, anxiety

Important to exclude: Massive PE, oesophageal rupture, aortic dissection, tumour

Other causes include:
Tracheal - infection, irritant inhalation
Mediastinal - lymphadenopathy

20
Q

Causes of pleuritic chest pain?

A 
Common causes (age dependent) include:
Musculoskeletal (from chest wall), LRTI, PE, pneumothorax

Important to exclude: Pneumonia/abscess, malignancy

Other causes include:
Other infective causes - Bronchiectasis, TB
Connective tissue disease - RhA, SLE

21
Q

Causes of chest wall pain?

A

Common causes include:

Costochondritis, rib pain, muscle sprain/tear

22
Q

Causes of chest pain?

A 
Common causes (age dependent) include:
Cardiac (ACS, angina), pulmonary (PE, pneumonia), musculoskeletal (muscle strain, costochondritis, trauma), oesophageal (GORD, hiatus hernia), anxiety

Important to exclude: Pneumothorax, tumour, aortic dissection/aneurysm, oesophageal perforation, cholecystitis, pancreatitis

Other causes include:
Central - Lymphadenopathy
Pleural - Suppurative lung disease, TB, CTD
Chest wall - Coxsackie B infection, shingles

23
Q

Causes of chest wall pain?

A

Common causes include:
Costochondritis, rib pain/#, muscle sprain/tear, fibromyalgia, RhA

Important to exclude: Malignancy

Other causes include:
Infection - Coxsackie B virus, herpes zoster
Autoimmune - Ank Spond, SLE, PsA
Intercostal nerve compression

24
Q

Causes of chest wall pain?

A

Common causes include:
Costochondritis, rib pain/#, muscle sprain/tear, fibromyalgia, RhA

Important to exclude: Malignancy

Other causes include:
Infection - Coxsackie B virus, herpes zoster
Autoimmune - Ank Spond, SLE, PsA
Intercostal nerve compression

25
Q

Breathlessness - explode

A
  1. Onset (rapid/gradual/activity at time)
  2. Time course (duration/progression)
  3. Variation (nocturnal/morning/week(end)/location)
  4. Exacerbating/relieving factors (position/activity/exercise/animals/perfumes/smoke/drugs)
  5. Severity (exercise tolerance/effect on ADLs/hobbies)
  6. Associated Sx (resp/cardio Sx review, dizziness, light-headedness, anxiety, tingling, syncope)
26
Q

Causes of breathlessness?

A

Acute causes:
Respiratory - AECOPD, asthma, pneumonia, pneumothorax, PE, IFB, anaphylaxis, epiglottitis
Cardiac - Severe pulmonary oedema, MI, arrhythmia, pericarditis, pericardial effusion
Other - Pain, DKA, drugs (eg. aspirin OD), airway trauma, panic, hyperventilation, thyrotoxicosis, altitude sickness

Chronic causes:
Respiratory - Asthma, COPD, pulmonary fibrosis, pleural effusion, Ca lung, bronchiectasis, sarcoidosis
Cardiac - LVF, mitral/aortic valvulopathy, arrhythmia, pericarditis
Other - Obesity, anaemia, anxiety, neuromuscular (Guillain-Barré, MG), thyroid disease

Clinical skills/diagnosis (2 decks)

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