Respiratory History and Examination Flashcards
What is taking a patients history
This is when you talk to the patient and obtain information from them
What is the aim of taking a patients history
- guides examination and investigations
- makes a differential diagnosis
- assesses the severity of the problem
- placing the problem in the patients own context
- initiates a management plan
why else do we take a history
Public health
- partner notification
- patterns of disease
- disease legal implications
research
identify and manage sources of anxiety
biomedical model
- make a diagnosis - differential diagnosis and assess clinical condition
- plan examination
- plan investigations
- plan Treatment
illness model
- understanding how the illness affects the patient
- understand how the patient affects the disease
- patients health beliefs
build a therapeutic relationship with the patient
preventative medicien
- screening
- risk factors
- primary prevention
what does - PC - HPC - PMH - DH - SH - FH mean
- PC - presenting complaint
- HPC - history of presenting complaint
- PMH - past medical history
- DH - drug history - medications they take
- SH - social history
- FH - family history
What is the standard structure of a history
- PC – Presenting complaint
- HPC – History of Presenting Complaint
- PMH – Past Medical History
- DH + Allergies – Drug History - Medications they take – Not illicit drugs they use
- SH – Social History
- FH – Family History
- Systems Enquiry
(Clinical) Differential Diagnosis
why do we used a standard structure for history
Ensures nothing forgotten
Standardised documentation
Standard presentation/handover
in what section of the history does smoking history and chest pain come up in
In Lung Cancer or COPD clinic Smoking History comes in HPC
Chest pain in A&E Cardiac Risk Factors come in HPC
if a patient has multiple interlinked comorbidities what may you wish to start with
For a patient with multiple interlinked comorbidities you may wish to start with “Background” before PC
Name the types of questions that you ask in a history
- ask open questions - start with open questions to encourage the patient to tell their story in their own words
- then as the list narrows down start to ask closed questions
list some examples of open questions
Why did you come/are you here?
Can you describe the problem?
What is it that’s worrying you?
List some examples of closed questions
Does your pain come on on exercise?
Does rest make the pain go?
How many pillows do you sleep on?
Do your legs swell?
what is often the presenting compliant in respiratory (PC)
- pneumonia
- PE
- pneumothorax
- pulmonary oedema
- asthma
- pulmonary fibrosis
List the questions to ask
PC – Presenting complaint
- Why did you come here today?
HPC – History of Presenting Complaint
- when did it start
- did it come on suddenly or build up slowly
PMH – Past Medical History
- Has this happened before
- Do you have any other medical conditions
DH + Allergies – Drug History - Medications they take – Not illicit drugs they use
- Are you taking any medication?
- Have you taken any previous. medication for this?
do you have any allergies
SH – Social History
FH – Family History
Systems Enquiry
(Clinical) Differential Diagnosis
what presents at - quick onset - slower onset - slowest onset in respiratory cases
Quick onset
- PE
- pneumothorax
- asthma
slower onset
- pneumonia
- pulmonary oedema
slowest onset
- fibrosis
associated symptoms with
- Chest pain
- fever
- wheeze
- cough
- pulmonary oedema
Chest Pain
- PE
- Pneumothorax
Fever
- Pneumonia
- Asthma
Wheeze
- Asthma
Cough
- Pneumonia
- Asthma
Pulmonary Oedema
- Orthopnoea
- Paroxysmal Nocturnal Dyspnoea
- Swollen Ankles
What are the risk factors for PE
Immobility
Trauma/Surgery
Previous VTE
Abdominal mass
Malignancy
What are the risk factors for pneumothorax
PHx
Smoker
What are the risk factors for pulmonary oedema
Cardiac disease
What are the risk factors for asthma
Past History
Trigger
Atopic disease
family history
what are the risk factors for pulmonary fibrosis
Environmental Exposure
Connective Tissue Disease
