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Respiratory Block: Clinical Examination > The Respiratory History > Flashcards

Flashcards in The Respiratory History Deck (125):
1

What is very important to find out about a cough?

The duration of the cough

2

A cough of recent origin, particularly if associated with fever and other symptoms of respiratory tract infection, may be due to:

Acute bronchitis
Or
Pneumonia

3

A chronic cough (>8 weeks duration) associated with wheezing may be due to:

Asthma
(Sometimes asthma can present with cough alone however)

4

A change in the character of a chronic cough may indicate:

The development of a new and serious underlying problem (e.g. Infection or lung cancer)

5

What is the single most common cause of chronic cough?

Upper airway cough syndrome

6

A cough associated with postnasal drip or sinus congestion or headaches may be due to:

Upper airway cough syndrome

7

What is peculiar about the cough of a patient with upper airway cough syndrome?

When asked to demonstrate their cough they do not cough, but clear their throat

8

An irritating, chronic, dry cough can result from:

Esophageal reflux and acid irritation of the lungs
Also:
- late interstitial lung disease
- or associated with the use of the angiotensin-converting enzyme inhibitor drugs

9

Cough that wakes a patient from sleep may be due to:

- a symptom of cardiac failure
- or reflux of acid from the esophagus into the lungs that can occur when a person lies down

10

A chronic cough that is productive of large volumes of purulent sputum may be due to:

Bronchiectasis

11

Cough related to viral croup is described as:

"Barking"

12

What cough would be loud and brassy?

A cough caused by tracheal compression due to a tumor

13

Cough associated with recurrent laryngeal nerve palsy has what sound and why?

A hollow sound because the vocal cords are unable to close completely - has been described as a bovine cough

14

A cough that is worse at night is suggestive of:

- asthma
- heart failure

15

Coughing that comes on immediately after eating or drinking may be due to:

- incoordinate swallowing
- esophageal reflux
- tracheo-esophageal fistula (rarely)

16

A large volume of purulent (yellow or green) sputum suggests the diagnosis of:

- bronchiectasis
- or lobar pneumonia

17

Foul smelling, dark colored sputum may indicate:

The presence of a lung abscess with anaerobic organisms

18

Pink frothy secretions from the trachea occur in:

Pulmonary edema (should not be confused with sputum)

19

Haemoptysis must be distinguished from:

- haematemesis
- nasopharyngeal bleeding

20

What does mild haemoptysis mean?

Usually <20mls blood / 24 hours
- appears as streaks of blood discoloring sputum

21

What does massive haemoptysis mean?

>250mls blood / 24 hours
= a medical emergency

22

What are the most common causes of massive haemoptysis?

- carcinoma
- CF
- bronchiectasis
- TB

23

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Nasopharynx / larynx
CHARACTER: Throat clearing, chronic
What are the likely causes?

- postnasal drip
- acid reflux

24

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Larynx
CHARACTER: Barking, painful, acute or persistent
What are the likely causes?

- laryngitis
- pertussis
- croup

25

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Trachea
CHARACTER: Acute, painful
What are the likely causes?

Tracheitis

26

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchi
CHARACTER: Intermittent, sometimes productive, worse at night
What are the likely causes?

Asthma

27

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchi
CHARACTER: Worse in the morning
What are the likely causes?

COPD

28

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Bronchial
CHARACTER: with blood
What are the likely causes?

Bronchial malignancy

29

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Dry, then productive
What are the likely causes?

Pneumonia

30

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Chronic, very productive
What are the likely causes?

Bronchiectasis

31

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Productive, with blood
What are the likely causes?

TB

32

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Irritating, dry and persistent
What are the likely causes?

Interstitial lung disease

33

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Lung parenchyma
CHARACTER: Worse lying down, sometimes with frothy sputum
What are the likely causes?

Pulmonary oedema

34

Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: ACE inhibitors
CHARACTER: Dry, scratchy, persistent
What are the likely causes?

Medication-induced

35

Differential Diagnosis of Cough based on its duration:
Acute Cough (<3 weeks)

1. URTI
- common cold
- sinusitis
2. LRTI
- pneumonia, bronchitis, exacerbation of COPD
- irritation: inhalation of bronchial irritant (e.g. smoke / fumes)

36

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- Smoking History indicates

COPD

37

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- wheeze, relief with bronchodilators indicates

Asthma

38

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- occurs when lying down, burning central chest pain indicates

Gastro-oesophageal reflux

39

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- history of rhinitis, postnasal drip, sinus headache and congestion indicates

Upper airway cough syndrome

40

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- chronic, very productive indicates

Bronchiectasis

41

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- drug history indicates

ACE inhibitor medication

42

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- smoking, haemoptysis indicates

Lung carcinoma

43

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- dyspnoea, PND indicates

Cardiac failure

44

Differential Diagnosis of Cough based on its duration:
Chronic cough differential and clues
- variable, prolonged symptoms, usually mild indicates

Psychogenic

45

Differential Diagnosis of haemoptysis (typical history):
Small amounts of blood with sputum

Bronchitis

46

Differential Diagnosis of haemoptysis (typical history):
Frank blood, history of smoking, hoarseness

Bronchial carcinoma

47

Differential Diagnosis of haemoptysis (typical history):
Large amounts of sputum with blood

Bronchiectasis

48

Differential Diagnosis of haemoptysis (typical history):
Fever, recurrent onset of symptoms, dyspnoea

Pneumonia

49

Differential Diagnosis of haemoptysis (typical history):
Pleuritic chest pain, dyspnoea

Pulmonary infarction

50

Differential Diagnosis of haemoptysis (typical history):
Recurrent infections

CF

51

Differential Diagnosis of haemoptysis (typical history):
Fever, purulent sputum

Lung abscess

52

Differential Diagnosis of haemoptysis (typical history):
HIV positive, previous TB, TB contact

TB

53

Differential Diagnosis of haemoptysis (typical history):
History of inhalation, cough, stridor

Foreign body

54

Differential Diagnosis of haemoptysis (typical history):
Pulmonary haemorrhage, glomerulonephritis, antibody to basement membrane antigens

Goodpasture's Syndrome

55

Differential Diagnosis of haemoptysis (typical history):
History of sinusitis, saddle-nose deformity

Wegener's granulomatosis

56

Differential Diagnosis of haemoptysis (typical history):
Pulmonary haemorrhage, multi-system involvement

SLE

57

Differential Diagnosis of haemoptysis (typical history):
History of severe cough preceding haemoptysis

Rupture of a mucosal blood vessel after vigorous coughing

58

Differential Diagnosis of haemoptysis (typical history):
Which are the 4 most common causes

1. Bronchitis
2. Bronchial carcinoma
3. Bronchiectasis
4. Pneumonia
(here probably also TB)

59

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors haemoptysis

- mixed with sputum
- occurs immediately after coughing

60

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors haematemesis

- follows nausea
- mixed with vomitus
- follows dry retching

61

Features distinguishing haemoptysis from haematemesis and nasopharyngeal bleeding:
Favors nasopharyngeal bleeding

Blood appears in mouth

62

Causes of dyspnoea

- respiratory or cardiac disease
- lack of physical fitness
- sometimes anxiety

63

New York Heart Association: Dyspnoea Grading Class I

Disease present, but no dyspnoea or dyspnoea only on heavy exertion

64

New York Heart Association: Dyspnoea Grading Class II

Dyspnoea on moderate exertion

65

New York Heart Association: Dyspnoea Grading Class III

Dyspnoea on minimal exertion

66

New York Heart Association: Dyspnoea Grading Class IV

Dyspnoea at rest

67

The association of dyspnoea with wheeze suggests

Airway disease:
- asthma
- COPD

68

Dyspnoea that worsens progressively over a period of weeks, months or years may be due to

Interstitial lung disease

69

Dyspnoea of more rapid onset may be due to

Acute respiratory infection
Or
Pneumonitis

70

Dyspnoea that varies from day to day or hour to hour indicates

Asthma

71

Dyspnoea associated with very rapid onset and sharp chest pain suggests

Pneumothorax

72

Dyspnoea described as inability to fill the lungs and associated with sighing indicates:

Anxiety

73

Dyspnoea that occurs on moderate exertion may be due to:

A combination of obesity and a lack of physical fitness (deconditioning)

74

Characteristics of wheeze

Maximal during expiration
&
Accompanied by a prolonged expiration

75

Characteristics of stridor

Loudest over the trachea
Occurs during inspiration

76

Characteristics of pleuritic pain

Sharp in nature
Made worse by deep inspiration and coughing
Typically localized to one area in the chest

77

3 conditions that cause sudden onset pleuritic chest pain:

1. Lobar pneumonia
2. Pulmonary embolism and infarction
3. Pneumothorax

78

Differential diagnosis of dyspnoea of sudden onset:
Presence of pleuritic chest pain favors

- pneumothorax
- pleurisy
- pneumonia
- pulmonary embolism
- trauma

79

Differential diagnosis of dyspnoea of sudden onset:
Absence of chest pain favors

- pulmonary oedema
- metabolic acidosis
- pulmonary embolism

80

Differential diagnosis of dyspnoea of sudden onset:
Presence of central chest pain favors

- MI / cardiac failure
- large pulmonary embolism

81

Differential diagnosis of dyspnoea of sudden onset:
Presence of cough and wheeze favors

- asthma
- bronchial irritant inhalation
- COPD

82

Prodronal symptoms that occur for a short period (hours) before pleuritic pain and dyspnoea begin

Bacterial pneumonia

83

Longer (days) prodronal symptoms before onset of pleuritic pain and dyspnoea

Viral pneumonia

84

What should be considered if patients present with fever at night?

- TB
- Pmeumonia
- Lymphoma

85

Hoarseness of dysphonia may be seen in:

- transient inflammation of the vocal cords (laryngitis)
- vocal cord tumor
- recurrent laryngeal nerve palsy

86

Sleep apnoea

An abnormal increase in the periodic cessation of breathing during sleep

87

Obstructive sleep apnoea

Airflow stops during sleep for a period of at least 10 seconds and sometimes more than 2 minutes, despite persistent respiratory efforts

88

Patient presents with: daytime somnolence, chronic fatigue, morning headaches, personality disturbances and very loud snoring

Obstructive sleep apnoea

89

Patients with obstructive sleep apnoea are often:

Obese and hypertensive

90

Patient presents with daytime somnolence but does not snore excessively

Central sleep apnoea

91

Central sleep apnoea

Cessation of inspiratory muscle activity

92

What is the result of hyperventilation?

Increased carbon dioxide excretion
= development of alkalosis
May complain of variable dyspnoea: more difficulty breathing in than out

93

What are the symptoms of alkalosis?

- paresthesias of the fingers and around the mouth
- light-headedness
- chest pain
- feeling of impending collapse

94

What are bronchodilators and steroids prescribed for?

Asthma
&
COPD

95

Increased use of bronchodilators indicates:

Poor control of asthma and the need for review of treatment

96

Oral steroid use may predispose to:

TB & Pneumocystis Pneumonia

97

Cessation of airflow for more than 10 seconds more than 10 times a night during sleep is called:

Sleep apnoea

98

Periods of apnoea (associated with reduced level of consciousness) alternate with periods of hyperpnoea (lasts 30s on average, associated with agitation) indicates

Cheyne-Stokes Breathing
- due to a delay in the medullary chemoreceptor response to blood gas changes

99

Deep, rapid respiration due to stimulation of the respiratory center indicates:

Kussmaul's Breathing (air hunger)

100

Irregular breathing in timing and depth indicates

Ataxic (Biot) Breathing

101

Alkalosis and tetany and peri-oral paresthesia is due to:

Hyperventilation

102

Post-inspiratory pause in breathing is called:

Apneustic breathing

103

The abdomen sucks inward during inspiration - this phenomenon is called:

Paradoxical respiration

104

Causes of sleep apnoea

Obstructive (e.g. Obesity with upper airway narrowing, enlarged tonsils, pharyngeal soft tissue changes in acromegaly or hypothyroidism)

105

Causes of Cheyne-Stokes Breathing

- Left Ventricular Failure
- Brain damage (trauma, cerebral haemorrhage etc.)
- High altitude

106

Causes of Kussmaul's Breathing

Metabolic acidosis (DM, chronic renal failure)

107

Causes of hyperventilation:

Anxiety

108

Causes of Ataxic (Biot) Breathing

Brainstem damage

109

Causes of Apneustic Breathing

Brain (pontine) damage

110

Cause of paradoxical respiration

Diaphragmatic paralysis

111

Within a few hours, patients develop flu-like symptoms: fever, headache, muscle pain, dyspnoea WITHOUT wheeze and dry cough
What is the most likely condition?

Allergic alveolitis:
Exposure to organic dusts that cause a local immune response resulting in allergic alveolitis

112

Allergic Alveolitis: source in Bird Fancier's Lung Disorder

Bird feathers and excreta

113

Allergic Alveolitis: source in Farmer's Lung Disorder

Moldy hay or straw (Aspergillus Fumigatus)

114

Allergic Alveolitis: source in Byssinosis Disorder

Cotton or hemp dust

115

Allergic Alveolitis: source in Cheese Worker's Lung Disorder

Moldy cheese (Aspergillus Clavatus)

116

Allergic Alveolitis: source in Humidifier Fever

Air conditioning (Thermophilic Actinomycetes)

117

Lung Toxicity due to Drugs: OCP produces

Pulmonary embolism

118

Lung Toxicity due to Drugs: Cytotoxic Agents (Methotrexate, Bleomycin, Cyclophophamide etc) produce

Interstitial lung disease

119

Lung Toxicity due to Drugs: Beta-blockers and NSAIDs cause

Bronchospasm

120

Lung Toxicity due to Drugs: ACE Inhibitors cause

Cough

121

Smoking increases the risk of:

1. Major cause of COPD and lung cancer
2. Increases the risk of: spontaneous pneumothorax and Goodpasture's Syndrome

122

What can drinking large amounts of alcohol in binges causes?

Can sometimes result in aspiration pneumonia

123

Alcoholics are more likely to develop what infection?

Pneumococcal or Klebsiella Pneumonia

124

What are IV drug users at risk of?

Lung abscesses and drug related pulmonary oedema

125

Alpha(1)-Antitrypsin Deficiency predisposes to

Extremely susceptible to the development of emphysema