Respiratory

Question 1

What questions do you ask a patient presenting with breathlessness?

Answer 1

How is the patient normally? (is it acute/chronic/acute-on-chronic?)
Onset, timing, duration, variability, diurnal variation, any contact with illnesses?
Exacerbating factors - allergic triggers, exertion, cold air?
Relieving factors - rest, medication?
Associated symptoms - cough, sputum, haemoptysis, chest pain, wheeze, night sweats, weight loss, oedema, paroxysmal nocturnal dyspnoea, fever, palpitations, diziness?
Severity - at rest? on exertion? limiting ADLs?
Cancer screen/red flags

Question 2

What questions do you ask a patient presenting with a cough?

Answer 2

Onset, timing, duration (<2/12 = acute, >2/12 = chronic), variation (recent change to a chronic cough?), diurnal variation?
Productive/unproductive?
Resp symptoms - SOB, wheeze, chest pain + type
Cardiac symptoms - orthopnoea, ankle oedema
ENT symptoms - throat, rhinits
MSK symptoms - arthralgia, morning stiffness
Exacerbating/alleviating factors? (home/work/exercise/seasonal/posture)
Cancer screening/red flags

Question 3

What questions do you ask a patient presenting with a productive cough/sputum?

Answer 3

Onset, timing, duration, variation, diurnal variation?
Colour - ie rusty for pneumococcal pneumonia, frothy pink for pulmonary oedema
Consistency - viscous, mucous, purulent, frothy?
Quantity - teaspoon, cupful?
Odour - foul smelling suggests bronchiectasis or abscess

Question 4

What questions do you ask a patient presenting with haemoptysis?

Answer 4

Origin - definitely coughed up and not haematemesis
Onset, timing, duration, variation?
Quantity?
Colour - fresh red or dark?
Consistency - liquid, clots, mixed with sputum?
Sputum?
Chest pain?
Recent trauma or elsewhere? Recent/current DVT?
Weight loss, fever, night sweats?
Breathlessness?
Bleeding or bruising elsewhere?

Question 5

What questions should you ask about the patients PMH?

Answer 5

Previous respiratory problems - asthma, pneumonia, TB etc?
Recent surgery - dental surgery (aspiration of purulent material), other surgery (DVT/PE)
Cardiac disease (leading to pulmonary oedema) - angina, orthopnoea, paroxysmal nocturnal dyspnoea?
Immunocompromised - HIV, immunosuppression, post-transplant?
Childhood asthma/eczema/hayfever

Question 6

DH + A?

Answer 6

ALLERGIES! (what response)
Inhalers, steroids 
ABx 
ACEi's, Bblockers, amiodarone 
NSAIDs 
Oxygen therapy 
Vaccinations - BCG or flu

Question 7

What things would you ask about when taking social history?

Answer 7

Smoking - pack years (20 cigs/day/year)
Occupation/interests- asbestos, dusts?
Pets - zoonosis or hypersensitivity? 
Overseas travel?
Living conditions - damp? dusty? 
Alcohol?
Exercise, ADLs?

Question 8

What questions do you ask a patient about their FH?

Answer 8

Current infections in family members
Genetic predisposition to allergy ie asthma, eczema?
Alpha1-antitrypsin deficiency - emphysema?
Lung Ca or fibrosis