Respiratory Anatomy and Patient History Quiz
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Questions and Answers

Which of the following factors can worsen shortness of breath?

  • Sitting down
  • Sleeping
  • Exercise (correct)
  • Eating a large meal

    • A patient presents with wheezing. What would you ask to determine if the wheezing is related to allergies?

  • Do you have any family history of allergies? (correct)
  • Do you experience wheezing during exercise?
  • Do you wake up with wheezing?
  • Have you had a fever recently?

    • What is the main reason for asking a patient about their breathing at rest and overnight when taking a respiratory history?

  • To rule out any possible complications related to their respiratory condition.
  • To assess the severity of their condition and whether it is impacting their daily life. (correct)
  • To collect data for research purposes and analyze the effectiveness of different treatments.
  • To determine if they are a suitable candidate for a lung transplant.

    • What is the best way to clarify subjective symptoms, such as breathlessness, when taking a respiratory history?

    <p>Encourage the patient to describe their experience in detail. (A)</p> Signup and view all the answers

    What structure is most likely to be compromised in specific lung conditions, leading to difficulty breathing?

    <p>Brachial plexus (B)</p> Signup and view all the answers

    What is the primary anatomical feature that differentiates the right and left lung?

    <p>The number of lobes (A)</p> Signup and view all the answers

    Which of the following is NOT a factor that can influence the onset of shortness of breath?

    <p>Decreased blood pressure. (A)</p> Signup and view all the answers

    Which of these is the most likely cause of a 'bovine' cough?

    <p>Left recurrent laryngeal nerve damage (C)</p> Signup and view all the answers

    Which of these is NOT a component of the INSPECTION part of the PHYSICAL EXAMINATION, as described in the content?

    <p>Assessing chest expansion (A)</p> Signup and view all the answers

    What is the primary difference between inspiratory and expiratory stridor?

    <p>The location of the obstruction in the airway (D)</p> Signup and view all the answers

    A patient presents with a persistent cough, accompanied by a history of smoking. What additional clinical features would be most concerning for malignancy?

    <p>Hemoptysis and chest pain (B)</p> Signup and view all the answers

    In the context of hemoptysis, what volume of blood coughed up is considered significant and suggestive of a more serious underlying condition?

    <p>Greater than 20mL (A)</p> Signup and view all the answers

    Which of the following conditions is best characterized by sharp, knife-like chest pain that worsens with inspiration and coughing?

    <p>Pleuritic chest pain (C)</p> Signup and view all the answers

    Which of these is NOT a key aspect of the patient's history to be considered when evaluating a cough?

    <p>Presence of clubbing in the fingers (D)</p> Signup and view all the answers

    Which of these is NOT a clinical manifestation that can be observed during INSPECTION of the patient for respiratory symptoms?

    <p>Cardiac dullness on percussion (D)</p> Signup and view all the answers

    Which of these is a potential cause of tachypnoea (rapid and shallow breathing)?

    <p>Increased carbon dioxide (CO2) levels (D)</p> Signup and view all the answers

    What is the significance of noting the volume of sputum produced by a patient?

    <p>It provides insight into the severity of the underlying respiratory condition. (D)</p> Signup and view all the answers

    Which of these is NOT a clinical manifestation commonly associated with respiratory conditions?

    <p>Distal forearm tenderness (C)</p> Signup and view all the answers

    Which of the following breath sounds is most likely to be heard over areas of consolidation in the lungs, indicating a condition like pneumonia?

    <p>Bronchial (C)</p> Signup and view all the answers

    The presence of which of these on auscultation suggests inflammation of the pleura, as seen in conditions like pleurisy?

    <p>Pleural rub (C)</p> Signup and view all the answers

    Which of these is NOT a component of the patient's past medical history that is directly relevant when evaluating respiratory symptoms?

    <p>History of diabetes (D)</p> Signup and view all the answers

    What is the most likely cause of tracheal deviation?

    <p>Pneumothorax (B)</p> Signup and view all the answers

    Flashcards

    Surface anatomy of lungs

    Understanding the external features of the lungs and their nearby structures.

    Brachial plexus innervation

    Network of nerves supplying the upper limb, affected in lung conditions.

    Pleural markings

    Lines indicating the boundaries of the pleural space surrounding the lungs.

    Dyspnoea

    Difficulty in breathing, commonly referred to as breathlessness.

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    Wheeze

    High-pitched, whistling sound caused by turbulent airflow in small airways.

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    Exacerbating factors of breathlessness

    Conditions or activities that worsen the sensation of shortness of breath.

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    Oblique fissure

    The line that separates the lobes of the lungs, significant in lung examination.

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    Review of Systems

    An integral part of history-taking assessing various body systems' functionality.

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    Cough Reflex

    The action that dislodges material from the airways by opening the glottis and forcing air out.

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    Pleuritic Chest Pain

    Sharp, knife-like pain in the chest that worsens on inspiration or coughing.

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    Costochondritis

    Inflammation of costochondral cartilages leading to localized chest pain and tenderness.

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    Hemoptysis

    Coughing up blood from the respiratory tract with varying volumes.

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    Sputum Analysis

    Examining cough expectorations for neutrophils, mucus, and color for diagnosis.

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    Inspection in Physical Exam

    Visual observation during the examination for chest and respiratory abnormalities.

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    Percussion in Physical Exam

    Tapping on chest to distinguish between air and fluid presence.

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    Auscultation

    Listening to breath sounds using a stethoscope to assess lung health.

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    Tachypnoea

    Rapid and shallow breathing, often triggered by increased CO2 levels.

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    Recurrent Cough

    A cough that returns after an absence, could indicate underlying conditions.

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    Family History

    Information about diseases impacting family members which can influence medical history.

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    Drug History

    Record of patient medication use including prescription and over-the-counter drugs.

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    Symptoms of Weight Loss

    Unintended decrease in body weight that may indicate serious medical conditions.

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    Wheeze vs Crackles

    Wheeze is a whistling sound on exhale, crackles are popping sounds usually from secretions.

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    Clinical Examination Steps

    Stages of evaluating a patient's condition: inspection, palpation, percussion, auscultation.

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    Study Notes

    Respiratory History and Physical Examination

    • Understand the surface anatomy of the lungs and their relation to adjacent structures (diaphragm, ribs, liver, stomach, spleen, chest wall)
    • Correctly label the location of the right and left lung during inspiration and expiration
    • Know the innervation: brachial plexus and upper thoracic sympathetic outflow, and how these might be compromised by lung conditions
    • Detail the location of Pleural Markings, Lung markings, Cardiac notch, Oblique and horizontal fissures, and trachea.
    • Locate the upper lobes, middle lobe, lower lobes, and liver on a lateral view and upper lobes, lower lobes and middle lobe on a frontal view

    Respiratory History

    • Gather presenting complaint
    • Record history of presenting complaint
    • Assess past medical history
    • Document past surgical history
    • Note drug and allergy history
    • Obtain family and social history
    • Include review of systems

    History of Present Complaint (HPC)

    • Clarify symptoms (e.g., breathlessness, wheezing, cough, sputum/hemoptysis, chest pain, fever/rigors/night sweats, weight loss, sleepiness)
    • Evaluate breathlessness:
      • Define breathlessness (subjective experience—can't get enough air into my chest, psychological component)
      • Describe the mechanisms involved (stimulation of afferent nerves, mechanical loading of respiratory muscles, stimulation of chemoreceptors from hypoxia).
      • Use MRC breathlessness scale to grade severity.
      • Take a detailed history including onset, duration, how breathable it is at rest and overnight, exacerbating factors, and how far person can walk.

    Wheeze

    • Characterized by high pitched musical or whistling sounds
    • History:
      • Does pt worsen during exercise?
      • Does pt awaken with wheezing?
      • Any fever or allergies?
      • Presence of worse symptoms upon waking, or after clearing sputum?
      • Does pt smoke?
      • Note if sputum is green or yellow.

    Cough

    • Cough reflex - Dislodging foreign material and secretions
    • Characteristics of a cough (e.g., duration, triggers, frequency, intrusiveness, colour and consistency of sputum (e.g. volume, colour, consistency), symptoms and history).
    • Relevant lung pathology (e.g. asthma, chronic obstructive pulmonary disease (COPD), heart failure, pneumonia).
    • History (e.g. duration, present everyday, intrusive, triggers) and associated clinical features (e.g. wheeze, heartburn, altered voice), and relevant drug history (e.g. ACE inhibitors).
    • Consider possible relationships to malignancy.

    Chest Pain

    • Differentiate musculoskeletal, cardiac, and respiratory causes
    • Note history of site, severity, character, exacerbating and relieving factors, and associated symptoms.
    • Subcategories of chest pain, e.g. pleuritic (sharp, knife-like pain that worsens with inspiration/coughing), costochondritis, Tietze’s syndrome, and herpetic zoster.

    Additional Symptoms

    • Sputum (colour, consistency, volume):
      • Consider infections (accumulation of neutrophils, mucus, and proteinaceous secretions)
      • Note any volume or colour changes, particularly large volumes which may suggest lung cancer or bronchiectasis.
    • Hemoptysis: Coughing up blood from respiratory tract, confirm if blood is coughed up (volume consideration)
    • Stridor: Inspiratory vs expiratory difficulties (consider possible causes)
    • Presence of fevers, night sweats, rigors, weight loss, or sleepiness.
    • Consider sleep apnea.

    Other History

    • Drugs (e.g., inhalers, oxygen, NSAIDs, beta-blockers, ACE inhibitors, opioids)
    • Family history (e.g., asthma, cystic fibrosis)
    • Social history (e.g., smoking, occupation, home circumstances, normal baseline)
    • Previous medical diseases impacting respiratory health, with considerations that previous illness may be re-occurring or re-activated, or may be a new complication of the original illness.

    Occupational history

    • Occupational history, including potential exposure to toxic agents in jobs, and potential associated pulmonary diseases

    Physical Examination

    • Inspection (general, hands/arms, face and neck, neck, and thorax)
    • Palpation (apex beat, chest expansion, chest wall)
    • Percussion (air vs fluid, comparing sides, cardiac dullness location)
    • Auscultation (vital capacity, listen using diaphragm of stethoscope, normal sounds, bronchials sounds, collapse, pneumothorax, pleural effusion, breath sounds, added sounds)

    Additional Notes:

    • Include detailed descriptions of normal and abnormal findings for each procedure in the physical examination.
    • Emphasize the importance of comparing findings in one side of the body against the mirrored position on the other.

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    Description

    Test your knowledge on the respiratory system, including the anatomy of the lungs and their adjacent structures. This quiz covers the key aspects of respiratory history, such as gathering a patient's presenting complaint, assessing medical history, and identifying important lung markings. Perfect for medical students and healthcare professionals.

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