Respiratory and Drug History

Question 1

Respiratory Questions: HPC

Answer 1

• 1. Chest pain
• 2. Dyspnoea
• 3. Cough
• 4. Sputum
• 5. Haemoptysis
• 6. Wheeze
• 7. Systemic upset

Question 2

chest pain

Answer 2

SOCRATES

Pleuritic pain? = sharp on coughing and inspiration

Question 3

2. Dyspnoea–questions to ask

Answer 3

 Is there anything that brings it on?
 Does anything make it better or worse?
 Are you always breathless? Is it when you walk/ exercise?
 Do you get breathless lying down?
– Orthopnoea/ PND (cardiac causes)
 How far can you walk normally? How far can you walk now? i.e. exercise tolerance
 How do you manage walking uphill / up stairs?
 Is there anything it stops you from doing?
 Have you noticed any other symptoms?

Question 4

cardio causes of dyspnoea

Answer 4

cardiac failure (LVF), associated with angina or MI

Question 5

Non cardio-respiratory causes

Answer 5

anaemia, obesity, hyperventilation, anxiety, metabolic acidosis

Question 6

Cough- questions to ask

Answer 6

 How long have you had it?
 Is it a new problem?
 When does it occur?
 Is there anything that makes it better or worse?
 Is it a dry cough? Do you cough anything up?
 Do you smoke?
 Has your medication changed recently?
 Do you experience any other symptoms?

Question 7

 Acute cough

Answer 7

– Viral or bacterial infection / pneumonia / inhalation of foreign
body/ irritants

Question 8

 Chronic cough

Answer 8

– Common - gastro-oesophageal reflux / asthma/ COPD / smoking / post-nasal drip / occupational or other irritants / medication (ACEI)
– Less common – lung tumour / bronchiectasis / interstitial lung disease

Question 9

Sputum- questions to ask

Answer 9

 How often do you produce sputum when you cough?
 How much sputum do you cough up? Has this changed?
 What colour is it? Has the colour changed?
 Is there any blood?
 Is it frothy or thick?
 Is there any abnormal smell or taste?
 Have you been experiencing any other symptoms?

Question 10

Haemoptysis- questions to ask

Answer 10

 When did you first notice blood in your sputum?
 How many times has it happened?
 How much blood is there?
 Are there any other colours in the sputum apart from the blood?
 Have you noticed bleeding or bruising anywhere else?
 Are you taking any medication to thin the blood?
 Have you noticed any other symptoms?

Question 11

Wheeze - questions to ask

Answer 11

 When does it occur; timing and frequency
 Exacerbators / relievers
 Do they have an inhaler for wheeze – how often do they need to use it?
 Exercise tolerance
 Severity

Question 12

Systemic upset - questions to ask

Answer 12

 Change in appetite
 Weight loss
 Fever
 Tiredness / lethargy

Question 13

• Intentional non-adherence

Answer 13

definite decision to not take medicine(s)

Question 14

• Unintentional non-adherence

Answer 14

1. Physical dexterity
2. Reduced vision
3. Cognitive impairment
4. Poor understanding

Question 15

Blue inhaler

Answer 15

“reliever” e.g. salbutamol (short

acting beta 2 agonist)

Question 16

brown inhaler

Answer 16

“preventer”

e.g. beclomethasone (corticosteroid)