Respiratory History Taking Flashcards
What are the seven symptoms that you must explore in history of presenting complaint?
- Chest Pain,
- Dysponea,
- Cough,
- Sputum
- Haemoptysis,
- wheeze,
- systemic upset
Explain SOCRATES
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbators/relievers
- Severity
What are the causes of central chest pain?
- Tracheitis
- Angina/MI,
- Aortic dissection
- Large PE,
- Oesophagitis,
- Lung tumour,
- Mediastinal tumour.
What are some causes on non central chest pain?
- Shingles,
- Rib fracture,
- Lung tumour,
- Pneumonia,
- PE.
What are some of the causes of pleural chest pain?
- Pneumonia/TB,
- Lung tumour/metastases/mesothelioma,
- PE,
- Pneumothorax.
What are some causes of chest wall chest pain?
- Muscular/Rib injury.
- Costochondritis,
- Lung tumour,
- Shingles
What questions to ask when patient complains of dysponea?
- Anything that brings it on? makes it better? worse?
- Can you exercise?
- Breathlessness lying down?
- Can you walk upstairs? How far can you walk?
- Any other symptoms?
Describe the different speeds of onset of dyspnoea and their causes.
Mins - PE, pneumothorax, acute LVF, acute asthma, aspiration.
Hours to days - Pneumonia, asthma, COPD.
Weeks to months - Anaemia, plural effusion.
Months to years - COPD, pulmonary fibrosis, pulmonary TB.
What questions should you ask if patient complains of cough?
- How long?
- Is it a new problem?
- When does it occur?
- Anything make it worse/better?
- Is it dry? Do you cough anything up?
- Smoker?
- Medications
- Any other symptoms?
What are some causes of an acute cough?
Viral/bacterial infection, pneumonia, inhalation of foreign body or irritants.
What are some causes of chronic coughs?
Gastro-oesophageal reflux, asthma, COPD, smoking, post nasal drip, ACE inhibitors. Less common = Lung tumour, bronchiectasis or interstitial lung disease
What are some red flags for coughing?
Haemoptysis, breathlessness, weight loss, chest pain or smoker.
What questions should you ask about when they complain about sputum?
- How often do you produce sputum?
- How much?
- Any blood?
- Is it frothy or thick?
- Abnormal smell or test?
- Any other symptoms?
What is the appearance and cause of serous sputum?
A - Clear, watery, frothy and pink.
C - Acute pulmonary oedema?
What is the appearance and cause of mucoid sputum?
A - Clear, grey, whist and viscid.
C - COPD/asthma.
What is the appearance and cause of purulent sputum?
A - Yellow, green or brown.
C - Infection
What is the appearance and cause of rusty sputum?
A - Rusty red,
C - Pneumococcal pneumonia.
What questions do you ask if patient complains of haemoptysis?
- When did you first notice the blood?
- How many times?
- How much blood?
- Any other colours
- Bleeding or bruising anywhere else?
- Any blood thinners?
What are some malignant cause of haemoptysis?
Bronchial carcinoma, metastatic lung cancer.
What are some infective causes of heamoptysis?
Acute infections, bronchiectasis and TB
What are some cardiac causes of haemoptysis?
Mitral valve disease, acute LVF
What are some of the causes of vasculitis haemoptysis?
Wegener’s granulomatosis and good pasture’s syndrome.
What are some other causes of haemoptysis?
Trauma, anticoagulation, clotting disorders
What are questions to ask patients who complain about wheeze?
- When does it occur and how long does it last for?
- Exacerbators? relievers?
- Inhaler use?
- Exercise tolerance?
What are some questions to ask about systemic upset?
- Changes in appetite?
- Weight loss?
- Fever?
- Tiredness?
How do you take a medication history?
For each drug ask about:
- Name of medicine, what it is for, dose/strength? route? number of tablets/puffs a day? Type? how often? changes to dose? side effects?
- Ask about over counters, alternative or recreational drugs.
- Ask about allergies to medicine
- Ask about concordance
What is intentional and unintentional non-adherences?
Intentional - definite decision to NOT take meds.
Unintentional can be due to: Physical dexterity, reduced vision, cognitive impairment and poor understanding.
Describe the process of questions for systems enquiry?
CVS - Palpitations? Syncope?
GI - Changes in bowels, abdo pain?
GU - Urinary symptoms? Last period?
Endocrine - Lumps in neck? Temperature intolerance?
MS - Aches? stiff joints, muscles or back?
CNS - headaches or fits?
