Thorax

Question 1

Red flags for Cough

Answer 1

• Duration > 3w
• Haemoptysis (v worrying symptom)
• SOB
• Chest pain
• Recurrent/persistent chest infection
• Hoarseness
• Dysphagia (Difficulty swallowing)
• Weight/appetite loss
• Fatigue (higher suspicion if age>40)
• Ask:
  
  • If ever smoked
  • Exposure to asbestos

Question 2

Red flags for Chest Pain/Palpitations

Answer 2

• Exertional chest pain
• Palpitations
• SOB
• Syncope
• FH heart problems/sudden death.
• Note: if palpitations present, ask whether exertional (more worrying) and if any syncope.

Question 3

Red flags for Shortness of Breath

Answer 3

• Is it respiratory? If so :-
  
  • Cough
  • Haemoptysis
  • Hoarseness
  • Dysphagia
  • Apetite/weight loss
  • Fatigue
  • FH thrombosis (re: PE?)
  • b. Ask about occupational history:
    
    • Dusts (mining & mills)
    • Asbestos (engineering & plumbing).
• If cardiac:-
  
  • Chest pains
  • Palpitations
  • Syncope
  • FH hearth problems/sudden death

Note: In HF, central fluid overload symptoms (exertional nature of SOB, orthopnoea and PND) are actually more significant than peripheral fluid overload symptoms like ankle oedema.