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Year 3 - Clinical Communication Skills > Respiratory History and Examination > Flashcards

Flashcards in Respiratory History and Examination Deck (51)
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1

What is taking a patients history

This is when you talk to the patient and obtain information from them

2

What is the aim of taking a patients history

- guides examination and investigations
- makes a differential diagnosis
- assesses the severity of the problem
- placing the problem in the patients own context
- initiates a management plan

3

why else do we take a history

Public health
- partner notification
- patterns of disease
- disease legal implications

research

identify and manage sources of anxiety

biomedical model
- make a diagnosis - differential diagnosis and assess clinical condition
- plan examination
- plan investigations
- plan Treatment

illness model
- understanding how the illness affects the patient
- understand how the patient affects the disease
- patients health beliefs

build a therapeutic relationship with the patient

preventative medicien
- screening
- risk factors
- primary prevention

4

what does
- PC
- HPC
- PMH
- DH
- SH
- FH
mean

- PC - presenting complaint
- HPC - history of presenting complaint
- PMH - past medical history
- DH - drug history - medications they take
- SH - social history
- FH - family history

5

What is the standard structure of a history

- PC – Presenting complaint
- HPC – History of Presenting Complaint
- PMH – Past Medical History
- DH + Allergies – Drug History - Medications they take – Not illicit drugs they use
- SH – Social History
- FH – Family History
- Systems Enquiry

(Clinical) Differential Diagnosis

6

why do we used a standard structure for history

Ensures nothing forgotten

Standardised documentation

Standard presentation/handover

7

in what section of the history does smoking history and chest pain come up in

In Lung Cancer or COPD clinic Smoking History comes in HPC

Chest pain in A&E Cardiac Risk Factors come in HPC

8

if a patient has multiple interlinked comorbidities what may you wish to start with

For a patient with multiple interlinked comorbidities you may wish to start with “Background” before PC

9

Name the types of questions that you ask in a history

- ask open questions - start with open questions to encourage the patient to tell their story in their own words
- then as the list narrows down start to ask closed questions

10

list some examples of open questions

Why did you come/are you here?

Can you describe the problem?

What is it that’s worrying you?

11

List some examples of closed questions

Does your pain come on on exercise?

Does rest make the pain go?

How many pillows do you sleep on?

Do your legs swell?

12

what is often the presenting compliant in respiratory (PC)

- pneumonia
- PE
- pneumothorax
- pulmonary oedema
- asthma
- pulmonary fibrosis

13

List the questions to ask

PC – Presenting complaint
- Why did you come here today?

HPC – History of Presenting Complaint
- when did it start
- did it come on suddenly or build up slowly


PMH – Past Medical History
- Has this happened before
- Do you have any other medical conditions

DH + Allergies – Drug History - Medications they take – Not illicit drugs they use
- Are you taking any medication?
- Have you taken any previous. medication for this?
do you have any allergies

SH – Social History


FH – Family History

Systems Enquiry

(Clinical) Differential Diagnosis

14

what presents at
- quick onset
- slower onset
- slowest onset
in respiratory cases

Quick onset
- PE
- pneumothorax
- asthma

slower onset
- pneumonia
- pulmonary oedema

slowest onset
- fibrosis

15

associated symptoms with
- Chest pain
- fever
- wheeze
- cough
- pulmonary oedema

Chest Pain
- PE
- Pneumothorax

Fever
- Pneumonia
- Asthma

Wheeze
- Asthma

Cough
- Pneumonia
- Asthma

Pulmonary Oedema
- Orthopnoea
- Paroxysmal Nocturnal Dyspnoea
- Swollen Ankles

16

What are the risk factors for PE

Immobility

Trauma/Surgery

Previous VTE

Abdominal mass

Malignancy

17

What are the risk factors for pneumothorax

PHx

Smoker

18

What are the risk factors for pulmonary oedema

Cardiac disease

19

What are the risk factors for asthma

Past History

Trigger

Atopic disease

family history

20

what are the risk factors for pulmonary fibrosis

Environmental Exposure

Connective Tissue Disease

21

What is the order of the respiratory examination

WIPER
- Wash hands
- introduction
- position the patient
- expose patient - chest exposed
- retreat to the end of bed

- Inspection
- hands
- arms
- face
- neck - cervical lymph nodes
- Chest - observe, palpitate, percuss, ausculate
- completing the examination

22

What does WIPER stand for

Wash your hands

Introduce yourself

Position the patient (45 degree angle)

Expose the patient (chest exposed)

Retreat to the End of the Bed

23

What are you looking for in the inspection

General inspection from the end of the bed
- oxygen masks
- nebulisers
- inhalers
- sputum pots
- medications
- stats monitor

24

What does general inspection involve

- Well/Unwell
- Breathing at rest – -Comfortable/Dyspnoea

Added Sounds:
- Cough
- Wheeze
- Stridor

Scars

Chest Shape

Chest Movements
- Asymmetrical Chest Expansion
- Accessory Muscle use
- Sub-Costal/Inter-Costal Recession

Peripheral Oedema

Peripheral Cyanosis

25

What is pectus excavatum

When the chest has pointed inwards

26

What is pectus carinatum

when the chest has a point bit outwards

27

What is barrel chest

rounded, bulging chest that resembles the shape of a barrel
- can be caused by COPD

28

what are you looking for in the hands

Peripheral Cyanosis

Tar Stains

Clubbing – (ABCDEF)

Resting tremor - caused by beta agonist use

CO2 retention flap

29

what are the causes of clubbing

Clubbing – (ABCDEF)
- Asbestosis/Abscess
- Bronchiectasis
- Bronchial Carcinoma
- Cystic Fibrosis
- Decreased O2 (hypoxia)
- Empyema
- Fibrosis

30

What do you palpate in the resp exam

Radial pulse
- Rate
- Rhythm
- Character = Bounding = CO2 Retention

Check Respiratory Rate at same time (whilst patient distracted by pulse check)
= Normal ≈ 12-20 bpm

Temperature change
(warm and well perfused?)