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Question 1

Hx OF PC

What symptoms would you ask about in Hx of PC?

Answer 1

• Dyspnoea.
• Cough.
• Sputum.
• Haemoptysis.
• Chest pain.
• SYSTEMIC.

Question 2

Hx OF PC

What would you ask about in dyspnoea?

Answer 2

• How the pt is normally (acute/chronic).
• What triggers it (rest, sleep, positional, exertional).
• Diurnal variation (asthma worse in morning).
• PND? Orthopnoea?
• Associated symptoms (cough, calf swelling).

Question 3

Hx OF PC

What would you ask about in cough?

Answer 3

• Onset/timing/duration (≥2months = chronic).
• Variation (nocturnal cough in asthma).
• Productive/unproductive.

Question 4

Hx OF PC

What would you ask about in sputum?

Answer 4

• Onset/timing/variation.
• Colour.
• Consistency (viscous, mucous, purulent, frothy).
• Quantity.
• Odour.
• Blood?

Question 5

Hx OF PC

What can sputum colour/odour tell you about pathology?

Answer 5

• Rusty sputum = ?pneumococcal pneumonia.
• Frothy prink = ?pulmonary oedema.
• Haemoptysis = ?TB/cancer.
• Thick, green, smelly = ?bronchiectasis.

Question 6

Hx OF PC

What would you ask about in haemoptysis?

Answer 6

• Systemic questions (weight loss, fever, night sweats = ?TB).
• Any pain during it?
• Consistency (fresh red, any clots?)
• Recent trauma? DVT?

Question 7

Hx OF PC

What systemic questions would you ask about?

Answer 7

• Fever.
• Weight loss.
• Change in appetite.
• Night sweats.
• Hoarse voice, shoulder pain.
• Cardiac disease (angina, etc).

Question 8

PMH

What would you ask about in PMH?

Answer 8

• Infections in past, TB, asthma.
• Recent surgery (DVT/PE), VTE risk factors.
• Immunocompromised pts are predisposed to atypical infections.
• If relevant, risk factors for CVS disease.

Question 9

DH

What would you ask about in DH?

Answer 9

• Inhalers, steroids (bad control).
• ACEi/BB (cough/wheeze, SOB).
• Amiodarone (fibrosis).
• Oxygen therapy.
• Vaccinations.

Question 10

SH

What would you ask about in social history?

Answer 10

• Smoking, alcohol.
• Occupation (industrial, does it get better/worse at work? Potential asbestos exposure?)
• Pets (hypersensitivity).
• Overseas travel (Spain/Portugal/AC = legionella pneumonia w/ dry cough), any infectious contacts.
• Living conditions (damp).
• Exercise/ADLs.

Question 11

FH

What would you ask about in FH?

Answer 11

• Infections can be transmitted amongst family members, care home (anyone around you ill?)
• Predisposition to allergic conditions (eczema, hayfever).
• alpha-1-antitrypsin deficiency = emphysema.