Flashcards in Respiratory and Drug Taking History Deck (35)
What question must you ask specifically in a respiratory history taking? (7)
- Chest pain
- Systemic upset
What does a sharp stabbing pain upon inspiration usually equate to?
What diseases can cause central pain?
- Aortic dissection
- Massive PE
- Lung tumour / metastases
- Mediastinal tumour / mediastinitis
What diseases can non central chest pain indicate?
- Lung tumour
- Rib fracture
What diseases can pleural chest pain indicate?
- Pneumonia / Bronchiectasis / TB
- Lung tumour / metastases / mesothelioma
What can chest wall pain indicate?
- Muscular / rib injury
- Lung tumour / bony metastases / mesothelioma
- Shingles (herpes zoster)
What questions should you ask when someone has dyspnoea?
- 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?
- 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
When does dyspnoea come on in a number of minutes?
- Acute LVF
- Acute asthma
- Inhaled foreign body
When does dyspnoea come on in a number of hours?
- Exacerbation of COPD
When is the speed of onet of dyspnoea weeks to months?
- Pleural effusion
- Respiratory neuromuscular disorders
When is the speed of onet of dyspnoea from months to years?
- Pulmonary fibrosis
- Pulmonary TB
What are the respiratory causes of dyspnoea?
- 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
What can the non cardio-respiratory causes of dyspnoea be?
- Metabolic acidosis
What questions should you ask when someone has a cough?
- How long have you had it?
- 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?
What are the likely causes of an acute cough?
- Viral or bacterial infection
- Inhalation if foreign body
What are the likely causes of chronic coughs?
- Gastro-oesophageal reflux
- Post-nasal drip
- Occupationlor other irritants
- Medication (ACEi)
- Lung tumour
- Interstitial lung disease
What are the 'red flags' when someone has a cough?
- Weight loss
- Chest pain
What are the common causes of a productive cough?
What are the common causes of a persistant 'moist' cough worst in morning?
What are the common causes of a cough associated with a wheeze?
What usually the cause of a painful cough?
What is usually the cause of a harsh/barking cough?
Laryngitis / laryngeal tumour
What is the commonest cause of a chronic, dry cough?
Interstitial lung disease
What is the common cause of a persistant cough with haemoptysis?
What is the cause of a 'bovine' (non-explosive cough)?
- Left recurrent laryngeal nerve invasion (secondary to malignancy)
- Neuromuscular disorder
What questions should you ask about sputum?
- How often do you produce sputum when you cough?
- How much sputum do you cough up? Has this changed?
- What colour is it? Has the colour 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)
What questions should you ask about haemoptysis?
- 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 blood?
- Have you noticed any bleeding or bruising anywhere else?
- Are you taking any medication to thin the blood?
- Have you noticed any other symptoms? (e.g breathlessness / chest pain / cough / weight loss
What are important questions to ask with relation to systemic upset?
- Change in appetite
- Weight loss
- Tiredness / lethargy
Why should you ensure you have an accurate medication history?
- Improves patient safety
- Reduces medication errors / near misses
- Reduces missed doses in hospital
- Reduces delays to treatment
- Savings to NHS from prevented errors
- Improves therapeutic outcomes