The Respiratory History Flashcards
(125 cards)
1
Q
What is very important to find out about a cough?
A
The duration of the cough
2
Q
A cough of recent origin, particularly if associated with fever and other symptoms of respiratory tract infection, may be due to:
A
Acute bronchitis
Or
Pneumonia
3
Q
A chronic cough (>8 weeks duration) associated with wheezing may be due to:
A
Asthma
Sometimes asthma can present with cough alone however
4
Q
A change in the character of a chronic cough may indicate:
A
The development of a new and serious underlying problem (e.g. Infection or lung cancer)
5
Q
What is the single most common cause of chronic cough?
A
Upper airway cough syndrome
6
Q
A cough associated with postnasal drip or sinus congestion or headaches may be due to:
A
Upper airway cough syndrome
7
Q
What is peculiar about the cough of a patient with upper airway cough syndrome?
A
When asked to demonstrate their cough they do not cough, but clear their throat
8
Q
An irritating, chronic, dry cough can result from:
A
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
Q
Cough that wakes a patient from sleep may be due to:
A
- a symptom of cardiac failure
- or reflux of acid from the esophagus into the lungs that can occur when a person lies down
10
Q
A chronic cough that is productive of large volumes of purulent sputum may be due to:
A
Bronchiectasis
11
Q
Cough related to viral croup is described as:
A
“Barking”
12
Q
What cough would be loud and brassy?
A
A cough caused by tracheal compression due to a tumor
13
Q
Cough associated with recurrent laryngeal nerve palsy has what sound and why?
A
A hollow sound because the vocal cords are unable to close completely - has been described as a bovine cough
14
Q
A cough that is worse at night is suggestive of:
A
- asthma
- heart failure
15
Q
Coughing that comes on immediately after eating or drinking may be due to:
A
- incoordinate swallowing
- esophageal reflux
- tracheo-esophageal fistula (rarely)
16
Q
A large volume of purulent (yellow or green) sputum suggests the diagnosis of:
A
- bronchiectasis
- or lobar pneumonia
17
Q
Foul smelling, dark colored sputum may indicate:
A
The presence of a lung abscess with anaerobic organisms
18
Q
Pink frothy secretions from the trachea occur in:
A
Pulmonary edema (should not be confused with sputum)
19
Q
Haemoptysis must be distinguished from:
A
- haematemesis
- nasopharyngeal bleeding
20
Q
What does mild haemoptysis mean?
A
Usually <20mls blood / 24 hours
- appears as streaks of blood discoloring sputum
21
Q
What does massive haemoptysis mean?
A
> 250mls blood / 24 hours
= a medical emergency
22
Q
What are the most common causes of massive haemoptysis?
A
- carcinoma
- CF
- bronchiectasis
- TB
23
Q
Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Nasopharynx / larynx
CHARACTER: Throat clearing, chronic
What are the likely causes?
A
- postnasal drip
- acid reflux
24
Q
Differential Diagnosis of Cough Based on CHARACTER:
ORIGIN: Larynx
CHARACTER: Barking, painful, acute or persistent
What are the likely causes?
A
- 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
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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
