Respiratory (History and Examination)

Question 1

What PC are common in resp conditions?

Answer 1

• Dyspnoea
• Cough
• Wheeze
• Haemoptysis
• Chest pain
• Sputum

Question 2

How is dyspnoea evaluated?

Answer 2

• MRC dyspnoea score
• Onset
• Exercise tolerance - disance walked/ stairs climbed
• Relieving / worsening factors
• PND/ orthopnoea?
• Diurnal variation

Question 3

What are some of the causes of dyspnoea?

Answer 3

• Cardiac - LVF, IHD, mitral stenosis, aortic stenosis
• Respiratory - COPD, Asthma, PE, pneumothorax, interstitial lung disease, bronchiecstasis
• Others - respiratory acidosis with metabolic compensation, anaemia, shock

Question 4

What questions should be asked about a cough?

Answer 4

• Dry or productive
• Triggers/ relieving factors
• Diurnal variation
• Associated with eating/ dyspepsia
• Positional
• Nasal secretions
• Associated fever

Question 5

What questions should be asked about a sputum?

Answer 5

• How much has been produced over the last 24 hours
• Colour
• Consistency

Question 6

What questions should be asked about a haemoptysis?

Answer 6

• Quantify how much
• Fever
• Night sweats
• Appetite
• Weight loss -Think cancer

Question 7

What parts of the social history need to be asked?

Answer 7

• Smoking - pack years/ have they stopped/ are they still smoking
• Occupational history - asbestos
• Pets - cats/ dogs/ neighbours pets
• Foreign travel
• Immobility - flights/ long car or bus journey - DVT/PE
• Activities of daily living
• Performance status - cancer

Question 8

What part of PMH is relevant?

Answer 8

• Medical and Surgical History (PMH)
• All relevant
• Asthma (previous hospitalisation / ITU)
• COPD
• DVT / PE
• Nasal Polyps
• Previous lung infections, including TB
• Childhood lung infections
• Surgery
• Cardiovascular illness
• Cancer

Question 9

What questions can be asked about other respiratory symptoms in history taking?

Answer 9

Question 10

What is relevant in the drug history?

Answer 10

• Respiratory drugs (eg steroids, bronchodilators)?
• Any other drugs, especially with respiratory se (eg ace inhibitors, cytotoxics, β‎-blockers, amiodarone)?

Question 11

How do you report on an CXR?

Answer 11

• X ray: Name, age, gender pt
• Date taken
• Type: PA (normal); AP
• Quality: RIPE: Rotation, Inspiration, Penetration, Exposure
• Interpretation: ABDCE: Airways, breathing, circulation, diaphragm, everything else

Question 12

What must be covered under CXR quality (RIPE)?

Answer 12

• Rotation
  
  • Look at clavicular heads and spinous process
  • Film not rotated because equidistant from spinous processes
• Inspiration
  
  • Can you see 6 anterior + 6 posterior ribs
  • Barrel chest + 2 ribs
• Penetration
  
  • How well can you see the X rays penetrating the chest?
  • Can you see vertebral body behind the cardiac shadow?
• Exposure
  
  • ​Need to see the apices of the lungs, the costophrenic angle either side of the chest wall.

Question 13

When assessing an X ray, what does ABCDE stand for

Answer 13

Airway

Trachea deviated or in the midline

Is it in the middle following the spinous process

Carina divides at T4

Right - more vertical

Tension pneumothorax - x ray should never have been taken - 2ICSMCL

Breathing

Lung - zones

Lung markings all the way out to the pleural edge

Pneumonia - use cardiac margin to confirm lobe- As for lateral view

Pleural effusion - Loss of costophrenic angle, miniscus sign. opacity (white out), potential fluid in horizontal fissure

Circulation

PA only

1/5 size

Look for heart margins

Hilar vasculature - alveolar oedema bt wings, Kerley B lines

Diaphragm

Costophrenic angle - normal sharp and clear

Pneumoperitoneum - NOT gastric bubble

Everything else - lines, leads, tubes, rib fractures, NG tube