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14 Cards in this Set
- Front
- Back
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cough history
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-duration
-fever (URTI) -wheeze (asthma -wet -irritating dry (GERD, late interstitial pulmonary fibrosis, ACEi) -wakes from sleep (GERD, HF) -sputum (large volumes bronchiectasis, worse at night (asthma, HF) -immediately after eating or drinking (GERD, tracheo-oesophageal reflux) -purulent (yellow green) sputum (bronchiectasis, lobar pneumonia) -foul smelling dark sputum (lung abscess with anaerobes) -pink frothy sputum (pulmonary oedema) -coughing blood (inflammatory, infarction, infection, degenerative (CF), mechanical, HF, bleeding) |
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SOB history
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-timing of onset
-severity -pattern (ie with exercise (NYHA class) -distance walked or number of stairs climbed -duration and variability (worsening over mths to yrs lung fibrosis, acute onset--> acute resp infection, pneumonitis, varies from day to day or hr to hr--> asthma), very rapid onset with chest pain--> pneumothorax or PE) -with moderate exersion (obesity, or low fitness level) -is there a wheeze (airway disease) causes: 1.airway disease (inflammation, COPD, tumor, mechanical) 2. lung parenchyma (inflammatory, infection, degenerative, tumor, trauma) 3. circulation (infarction, HTN, inflammation) 4. cardiac (HF, pericardial) 5. anaemia 6. psychogenic or acidosis, hypothalamic |
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Wheeze Hx
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-wheeze (asthma or COPD, airway obstruction (foreign or tumor)
-maximal during expiration, (ass with prolonged expiration) |
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Chest pain Hx
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if pleural: sharp and made worse by deep inspiration and coughing (lung or pericarditis)
-onset sudden (PE, lobar pneumonia, infarction, pneumothorax) -SOB associated (could be all of the above) -nature (pressure or choking--> heart ischemia, tearing--> dissecting aneurysm, sharp (chest wall or pleural/pericardial) -severe chest pain (MI, dissecting aneurysm) -location (middle of chest--> heart, comes from back toward front of chest--> cervical thoracic spine dysfxn, sharp localized to small area in front of cehst wall assoc with moving shoulders or resp--> chest wall pain) -sudden onset (MI, pulmonary, dissecting aneurysm) -pain comes on at rest, more severe and lasts longer (MI, more than 30 min) -radation (to neck or left arm--> heart ischemia) -pain lasts for days (unlikely heart) -features (occurs with exertion--> stable angina), associated with respiration (pulmonary) not associated (heart) -associated Sx (dyspneoa, sweating, anxiety, nausea, faintness (MI), dyspnoea, cyanosis, collapse (PE), severe dyspnoea (tension pneumo) -aggravating (exertion (lung or heart) eating or drinking hot or cold fluids and relieved by nitrates (oesophageal spasm) |
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fever malaise myalgia before pleuritic chest pain and dyspnoea
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if hrs before (bacterial pneumonia) if days before (viral)
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fever at night
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pneumonia (drenching)
mesotheleoma TB |
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hoarseness
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laryngeal nerve palsy (ie tumor in mediastinum, recurrent larygneal nerve palsy--> dissecting aneurysm)
-laryngeal tumor -larygitis (transient inflammation of vocal cords) |
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daytime solomnesence, chronic fatigue,
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morning headaches, personality disturbances, snoring, stop breathing for >10sec >10 times during sleep (obstructive sleep apnoea)
-no snoring (central sleep apnoea) |
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types of abnormal patterns of breathing
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-sleep apnoea
-cheyne stokes -kussmaul's -ataxic (biot) -hyperventilation -apneustic -paradoxical |
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treatment hx
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Hx previous and current meds
-bronchodilators, inhales steroids, oral steroids (COPD, asthma, bronchiectasis) -increased use of bronchodilators (poor asthma control) -oral steroids predispose to TB (asthma, sarcoidosis, hypersensitivity pneumonia) -drugs: beta blockers/NSAIDs for bronchospasm, cough (ACEi), PE (oral contraceptive), interstitial lung disease from cytotoxics, cocaine, morphine, tryptophan, glaucoma eye drops timolol (beta block), |
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past MHx
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pneumonia, TB, chronic bronchitis, abnormal CXR, lung tests/Ix, AIDS (pneumocystis carinii pnemonia, TB, etc)
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occupational Hx
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present and previous occupations
-exposures through mining or factors work to (asbestos, berrylium, coal, iron oxide, silica, tin oxide, cotton, titanium oxide, silver, nitrogen dioxide, anhydrides), -work or household exposures to animals (Q fever psittacosis) -mouldy hay, humidifiers, air conditioners (allergic alveolitis) -insulating wire or boards (asbestos) up to 25 years ago -handling work clothes of those working with asbestos -find out: what do at work, exposure duration, protection equiptment use, other workers ill -Sx improve over weekend (spray paints, plastic or soldering fumes) |
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social Hx
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-smoking (incr risk of LC, COPD, spontaneous pneumo, Goodpastures,
-pack years (20 pack cigarettes per day) -second hand exposure -ADL, housing conditions (exercise intolerance or infectious disease), -use of oxygen at home -ability to work -alcohol consumption (Klebsiella and pneumococcal) -IV drug use (lung abscess, drug related pulmonary oedema, IE) |
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FHx
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asthma
CF emphysema (alpha1-antitrypsin def) TB |
