Respiratory and Drug History Taking Flashcards
What is the structure for taking a history?
- presenting complaint
- history of presenting complaint
- past medical history
- medication/allergies
- family history
- social history
- systems enquiry
What are some key respiratory questions to ask in the history of the presenting complaint?
- chest pain?
- dyspnoea?
- cough?
- sputum?
- haemoptysis?
- wheeze?
- systemic upset?
explore symptoms
Causes of central chest pain?
- tracheitis
- angina/MI
- massive PE
Causes of pleural chest pain?
- pneumonia
- lung tumour
- pneumothorax
What are questions to ask about dyspnoea?
- anything that brings it on?
- is it always or when you exercise?
- lying down?
- how far can you walk/can you walk uphill?
Things that cause dyspnoea?
- minutes: PE, pneumothorax
- hours/days: pneumonia, asthma
- weeks/months: anaemia, pleural effusion
- months/years: COPD, pulmonary fibrosis
Questions to ask about coughs?
- how long?
- when does it occur?
- anything making it better or worse?
- is it dry? do you cough anything up?
- smoking/change in medication
What are the red flags for coughs?
- haemoptysis
- breathlessness
- weight loss
- chest pain
- smoker
Questions to ask about sputum?
- how often?
- how much?
- what colour? has it changed?
- any blood?
- frothy or thick?
- abnormal taste or smell?
- other symptoms
What illness produces clear/watery/frothy/pink sputum?
acute pulmonary oedema
What illness produces clear/grey/white/viscid sputum?
COPD/asthma
What illness produces yellow/green/brown sputum?
Infection
What illness produces rusty red sputum?
pneumococcal pneumonia
Questions to ask about haemoptysis?
- when did you first notice blood in your sputum?
- how many times?
- how much blood?
- any other colours?
- do you have bruising or bleeding anywhere else?
- are you taking any blood thinners?
- other symptoms
Questions to ask about wheezing?
- when does it occur?
- frequency
- exacerbators/relievers
- do they have an inhaler? how often do they need to use it?
- exercise tolerance
- severity
Questions to ask about systemic upset?
- change in appetite
- weight loss
- fever
- tiredness
What are the golden rules of medication history taking?
- be structured
- engage with patient but find out if anyone knows more about the patients meds
- use more than one source of information
- be alert to high risk medicines
- contraception
- clinical trials
Describe the systems enquiry
- CVS: palpitations/syncope
- GI: change in bowels/abdo pain
- GU: urinary symptoms, last period
- endocrine: lumps in neck, temperature intolerance
- MSK: aches/stiffness in joints/muscles
- CNS: headaches/fits
