Cardiac & Resp History Taking Flashcards

1
Q

What are the cardinal symptoms for cardiac history?

A
Chest pain
Breathlessness
Paliptations
Syncope/presyncope
Oedema
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2
Q

Associated symptoms with chest pain

A
SOB
Autonomics (nausea, vomiting, sweating)
Palpitations
Syncope
Ankle/calf swelling
Haemoptysis
Sputum
Trauma
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3
Q

Exacerbating relieving factors with chest pain

A
Exercise
Food
Position
GTN
Analgesia
Pleuritic?
Pain on movement/pressing
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4
Q

Relevant PMH w/cardiac symptoms

A
MI
Previous cardiac procedures
Diabetes
Hypercholesterolaemia
Peripheral vascular disease
Stroke
Rheumatic fever
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5
Q

Risk factors for PE

A
Clinically suspected DVT
Alternative diagnosis less likely than PE
Tachycardia >100
Immobilisation/surgery in last 4 weeks
History of PE/DVT
Haemoptysis
Malignancy
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6
Q

Difference between unstable angina, NSTEMI and STEMI?

A

Unstable angina occurs with increasing frequency or at rest but lasts less than 20mins, troponin is normal
NSTEMI >20mins chest pain, ST depression/T wave changes and troponin is elevated
STEMI >20mins chest pain, ST elevation>2mm in chest leads, >1mm in limb leads and troponin significantly elevated

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7
Q

What would cause chest pain that is worse on lying down and gives a PR depression?

A

Pericarditis

May also be able to hear pericardial rub (fresh snow)

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8
Q

Classic history of pneumothorax?

A

Sudden onset SOB and pleuritic chest pain

young, tall, thin, cigarette smokers (marfan’s, COPD, asthmatics)

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9
Q

Classic history of PE?

A

SOB, pleuritic chest pain, haemoptysis, dizziness, syncope

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10
Q

Classic history of aortic dissection?

A

Sudden onset, tearing, excruciating chest pain radiating to the back
More common in hypertensives

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11
Q

What is relieved by GTN spray?

A

Angina/unstable angina/oesophageal spasm

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12
Q

Immediate treatment of ACS?

A
ROMANCE
Reassure
Oxygen (high-flow, non-rebreathing mask)
Morphine
Aspirin
GTN
Clopidogrel
Enoxaparin
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13
Q

Cardinal symptoms in respiratory history?

A
Chest pain
SOB
Stridor
Wheeze
Cough
Sputum
Haemoptysis
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14
Q

Breathlessness differential

A

Acute (asthma, pneumonia, pneumothorax, PE)
Intermediate (bronchial carcinoma, pleural effusion, TB)
Chronic (COPD, interstitial lung disease)

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15
Q

Describe classical respiratory chest pain

A

Unilateral
Aggravated by deep inspiration
Chest wall/shoulder tip if diaphragmatic

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16
Q

What is stridor?

A

High pitched musical sound heard on inspiration, aggravated by coughing

17
Q

What needs to be differentiated between with possible haemoptysis?

A

Blood stained sputum
Frothy pink sputum
Haematemesis
Nose bleeds

18
Q

How do you ask about volume of blood?

A

drop/teaspoon/tablespoon/cup/bucket

19
Q

Relevant PMH with respiratory symptoms

A
Childhood asthma/wheeze/bronchiolitis
Malignancy
Infections (TB, pneumonia)
Chest trauma/operations
Asthma/COPD
PE/DVT
20
Q

What social history is relevant with a cough?

A

Travel
Pets (pigeon racing)
Illicit drugs
Sexual (HIV/AIDS)

21
Q

Systemic enquiry Qs for respiratory history

A
Loss of appetite/malaise/weight loss
Night sweat/fevers/rigors
Nasal obstruction/bleeding/discharge
Stress incontinence when coughing
Cardiac?
Neuromuscular disease
22
Q

Further investigations in respiratory patient?

A
Blood tests (FBC, U&Es, LFTs, CRP)
ECG
Peak flow
ABGs
Chest Xray/CT
Sputum culture
Spirometry
Bronchoscopy
23
Q

What score is used to grade community acquired pneumonia?

A
CURB 65
Confusion
Urea (>7mmol/l)
Resp rate (>30)
BP (