History Flashcards
4 cardinal symptoms
Chest pain
SOB
Cough
Wheeze
Chest pain - how to ask about?
SOCRATES
Ask about if it is worse breathing in or out
- Site – where is the pain
- Onset – when did it start? / sudden vs gradual?
- Character – sharp / dull ache / burning
- Radiation – does the pain move anywhere else?
- Associations – other symptoms associated with the pain
- Time course – worsening / improving / fluctuating / time of day dependent
- Exacerbating / Relieving factors – does anything make the pain worse or better?
- Severity – on a scale of 0-10, how severe is the pain?
SOB:
What 2 parameters need to be determined?
How can the severity of breathlessness be graded?:
- Grade 1 being the best and grade 5 being the worst
Now Baseline (good to know what they can do especially is they have a chronic disease)
(1) SOB on strenuous exercise
(2) SOB when hurrying on level or uphill
(3) Slower walker
(4) SOB after a few minutes on level ground tops for breath after walking about 100 yards or after a few minutes on level ground
(5) Too breathless to leave the house, or breathless when undressing
Cough:
What to ask first?
Q’s to ask about sputum?
Haemp[tysis
If it is dry or productive
Volume - teaspoon, tablespoon, egg cup, tea cup?
Colour
Consistency
Wheeze/stridor:
Q’s to ask?
Time of day / Triggers
What to ask for every cardinal symptom except chest pain?
Onset / Duration / Course / Severity / Precipitating factors / Relieving factors / Associated features / Previous episodes)
Systemic symptoms - 4
Weight loss - lung cancer, TB
Fever
Night sweats
Leg pain and dizziness - PE
PMH - what to ask? - 4
Respiratory conditions – asthma / pneumonia / COPD / PE / malignancy / TB
Other medical co-morbidities –CVD/ neuromuscular disease/malignancy
Surgical history
Acute hospital admissions / ITU admissions?
Drug Hx - what to ask? - 4
What should you never forget to ask about in a drug history?
Regular medications – often provide useful clues as to patients past medical history
- Inhalers – preventer/reliever
- Steroids
- Diuretics
Antibiotics
OTC/herbal remedies?
Home oxygen?
ALLERGIES !!!!!
Medications with respiratory side effects - what resp symptom do the following cause?
- Beta-Blockers / NSAIDs
- ACE inhibitors
- Cytotoxic agents
- Oestrogen – e.g. contraceptive pill / HRT
- Amiodarone / Methotrexate
Bronchoconstriction - COVID 19
Dry cough
Interstitial lung disease
Increased risk of PE - VTE
Pleural effusions / interstitial lung disease
Family Hx - what to ask?
Respiratory disease? – asthma / atopy / lung cancer / cystic fibrosis
Recent contact with others who were unwell? – viral infections / pneumonia / TB
Social Hx:
How to ask about smoking?
How to ask about alcohol?
Smoking – How many cigarettes a day? How long have they smoked for?
Alcohol – How many units a week? – be specific about type / volume / strength of alcohol
Recreational drug use – e.g. Cannabis (increased risk of lung cancer)
Social Hx:
Living situation - what to ask about?
Activities of daily living - what q’s do you ask to assess this?
Why is it important to ask about pets?
• House / Flat – stairs / adaptations / home oxygen
• Who lives with the patient? – important when considering discharge from hospital
• Any carer input? – what level of care do they receive?
———-
• Is the patient independent/able to fully care for themselves?
• Can they manage self-hygiene/housework/food shopping?
They may be ALLERGIC
Social Hx:
Occupation:
What is important to ask shipyard/construction/plumbers about in terms of exposure?
What resp illness could miners suffer from?
What resp illness could farmers suffer from?
Shipyard / Construction / Plumber – Asbestos
Pneumoconiosis - a disease of the lungs due to inhalation of dust, characterized by inflammation, coughing, and fibrosis.
Farmer – Allergic extrinsic alveolitis - ALLERGY
Social Hx:
Hobbies - what resp illness could bird fanciers suffer from?
Hobbies – Bird fancier – Allergic extrinsic alveolitis - ALLERGY
