Shortness of Breathe - History Taking

Question 1

What are the acute causes of SOB?

Answer 1

Pulmonary Embolism 
Pneumothorax
Inhalation of foreign body
Anaphylaxis
Acute asthma attack 
Laryngeal oedema secondary to burns
Tension pneumothorax

Question 2

What position is heart failure SOB worse in?

Answer 2

Lying flat

Question 3

Questions to ask regarding Asthma?

Answer 3

Any particular times during the day?
Certain times of the year?
Certain locations?
Pets?

Question 4

Which drugs can cause pulmonary fibrosis?

Answer 4

Amiodarone, methotrexate, cyclophosphamide, bleomycin, hydralazine, busulphan

Question 5

How do you calculate pack year?

Answer 5

N. per day/20 x years

Question 6

Cough questions

Answer 6

Productive?
Colour of sputum?
Blood/haemopytsis? 
When does the cough occur?
Volume?
Sound- wheeze?

Question 7

Cause of acute persistent productive cough?

Answer 7

Pneumonia

Question 8

Cause of chronic productive cough?

Answer 8

Chronic bronchitis

Question 9

What are the cause of a dry cough?

Answer 9

Cancer
Asthma
Left ventricular failure
Atypical pneumonia

Question 10

Causes of haemoptysis?

Answer 10

Pulmonary embolism
Lung cancer - FLAWs
TB
Cavitating pneumonia

Question 11

What can cause a bovine cough?

Answer 11

Lung cancer - compression - recurrent laryngeal nerve palsy

Question 12

Causes of pleuritic chest pain?

Answer 12

PE,
Pneumothorax,
Pericarditis,
Pleural effusion

Question 13

Causes of muscle weakness and fatigue

Answer 13

Neuromuscular disease-GBS
Myasthenia gravis
Lambert-eaton syndrome 
Polymyositis
Motor neurone disease

Question 14

Red flag signs for lung cancer

Answer 14

Weight loss
Night sweats
Loss of appetite
Lethargy/fatigue

Question 15

Causes of chronic SOB?

Answer 15

COPD
Chronic asthma
Heart failure
Pulmonary fibrosis
Anaemia
Bronchiectasis

Question 16

What is the presentation of chronic COPD?

Answer 16

Cough productive of sputum

Irreversible shortness of breath

Question 17

What are causes of COPD?

Answer 17

− Smoking (usually more than 20 pack years)
− Occupational exposure to lung irritants, e.g. in coal miners, tunnel workers
− α1-Antitrypsin defi ciency (liver failure, family history).

Question 18

What are the signs of COPD?

Answer 18

Hyperexpanded chest
− Breathing through pursed lips
− Reduced air entry/chest expansion
− Hyper-resonant percussion note (particularly resonance over the heart
and liver).

Question 19

Presentation of chronic asthma?

Answer 19

History of transient, reversible cough, wheeze and shortness of breath –
often worse at night, during exercise, or when exposed to allergens or cold
− Presence of associated atopic conditions personally or in family members
(eczema, hayfever, allergies, nasal polyps)
− Symptoms may be exacerbated by drugs such as non-steroidal antiinfl
ammatory drugs (NSAIDs), aspirin, β-blockers (including those in eye
drops used for glaucoma)
− Wheeze on auscultation of the lungs.

Question 20

Signs of pulmonary fibrosis?

Answer 20

Clubbing
Reduced air entry/chest expansion
End-inspiratory bibasal crepitatins

Question 21

What are the risk factors for pulmonary fibrosis?

Answer 21

History of exposure to asbestos, silica, or coal (pneumoconioses causing
fi brosis), exposure to drugs (e.g. methotrexate)

Question 22

What are the signs of heart failure?

Answer 22

Displaced apex beat
− Th ird and fourth heart sounds
− Crackles in both lung bases
− Raised jugular venous pressure (JVP), hepatomegaly, peripheral oedema
(ankles, sacrum).