History Taking: The Respiratory System Flashcards
What is the history taking structure?
Presenting complaint (PC) History of presenting complaint (HPC) Past medical history (PMH) Medication/allergies (DH) Family history (FH) Social history (SH) Systems enquiry/review (SE)
What symptoms should you ask the patient about/ whether they have had any of the said symptoms?
- Chest pain - Dyspnoea - Cough
- Sputum
- Haemoptysis
- Wheeze
- Systemic upset
If yes to chest pain, what ‘clarifying’ questions need to be asked?
SOCRATES Site Onset Character Radiation Associated symptoms Timing Exacerbators / relievers Severity (1-10 rating scale)
If central chest pain, what can be potential causes?
Tracheitis Angina/ MI Aortic dissection Massive PE Oesophagitis Lung tumour / metastases Mediastinal tumour/ mediastinitis
If pleural chest pain, what can be potential causes?
Pneumonia / Bronchiectasis / TB
Lung tumour/ metastases/ mesothelioma
PE
Pneumothorax
If chest wall chest pain, what can be potential causes?
Muscular / rib injury
Costochondritis
Lung tumour / bony metastases/ mesothelioma
Shingles (herpes zoster)
What questions should be asked if patient is experiencing dyspnoea?
Is there anything that brings it on?
Does anything make it better or worse?
Are you always breathless? Is it when you walk/ exercise?
Do you get breathless lying down?
– Orthopnoea/ PND (cardiac causes)
How far can you walk normally? How far can you walk now? i.e. exercise tolerance
How do you manage walking uphill / up stairs?
Is there anything it stops you from doing?
Have you noticed any other symptoms?
– Consider – cough, sputum, chest pain, palpitations, wheeze, stridor
If dyspnoea onset is in minutes, what could be potential diagnoses?
PE Pneumothorax Acute LVF Acute asthma Inhaled foreign body
If dyspnoea onset is in hours to days, what could be potential diagnoses?
Pneumonia
Asthma
Exacerbation of COPD
If dyspnoea onset is in weeks to months, what could be potential diagnoses?
Anaemia
Pleural effusion
Respiratory neuromuscular disorders
If dyspnoea onset is in months to years, what could be potential diagnoses?
COPD
Pulmonary fibrosis
Pulmonary TB
What questions should be asked of a patient suffering with a cough?
How long have you had it?
Is it a new problem?
When does it occur?
Is there anything that makes it better or worse?
Is it a dry cough? Do you cough anything up?
Do you smoke?
Has your medication changed recently?
Do you experience any other symptoms?
– Consider - dyspnoea, weight loss, stridor, pain, syncope, vomiting
If the cough is productive, what could be potential diagnoses?
Infection
Bronchiectasis
If the patient is presented with a persistent ‘moist’ cough worst in morning, what could be potential diagnoses?
COPD
If the cough is associated with wheeze, what could be potential diagnoses?
Asthma / COPD
If the cough is painful, what could be potential diagnoses?
Tracheitis
If the cough is harsh or barking, what could be potential diagnoses?
Laryngitis/ laryngeal tumour
If the cough is chronic and dry, what could be potential diagnoses?
Interstitial lung disease
If the cough is Bovine (non-explosive), what could be potential diagnoses?
Left recurrent laryngeal nerve invasion (secondary to malignancy) Neuromuscular disorders
If the cough is persistent with haemoptysis, what could be potential diagnoses?
Bronchial carcinoma
If the patient has been producing sputum, what questions do you need to ask?
How often do you produce sputum when you cough?
How much sputum do you cough up? Has this changed?
What colour is it? Has the colour changed?
Is there any blood?
Is it frothy or thick?
Is there any abnormal smell or taste?
Have you been experiencing any other symptoms?
E.g. fever, dyspnoea, pain
If serous sputum is produced, what could be some potential diagnoses?
Acute pulmonary oedema
If mucoid sputum is produced, what could be some potential diagnoses?
COPD/ asthma
If purulent sputum is produced, what could be some potential diagnoses?
Infection
If rusty sputum is produced, what could be some potential diagnoses?
Pneumococcal pneumonia
If the patient is presented with haemoptysis (coughing up blood), what questions do you need to ask?
When did you first notice blood in your sputum?
How many times has it happened?
How much blood is there?
Are there any other colours in the sputum apart from the blood?
Have you noticed bleeding or bruising anywhere else?
Are you taking any medication to thin the blood?
Have you noticed any other symptoms?
– E.g. breathlessness / chest pain / cough / weight loss (pleuritic chest pain and hemoptysis is a red flag)
If the cause of haemoptysis is malignant, what potential diagnosises can be reached?
Bronchial carcinoma Metastatic lung disease
If the cause of haemoptysis is infective, what potential diagnosises can be reached?
Acute infection
Bronchiectasis
TB
If the cause of haemoptysis is vascular, what potential diagnosises can be reached?
Pulmonary infarction or pulmonary embolus
If the cause of haemoptysis is cardiac, what potential diagnosises can be reached?
Mitral valve disease
Acute LVF
If the cause of haemoptysis is vasculitis, what potential diagnosises can be reached?
Wegener’s granulomatosis
Good pasture’s syndrome
If the cause of haemoptysis is of other origin, what potential diagnosises can be reached?
Trauma
Anticoagulation (consider warfarin)
Clotting disorder
What are some other question that should be asked in a taking a pulmonary system history?
Change in appetite
Weight loss
Fever
Tiredness / lethargy
