History Taking: The Respiratory System Flashcards Preview

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Flashcards in History Taking: The Respiratory System Deck (33)
1

What is the history taking structure?

Presenting complaint (PC)
History of presenting complaint (HPC)
Past medical history (PMH)
Medication/allergies (DH)
Family history (FH)
Social history (SH)
Systems enquiry/review (SE)

2

What symptoms should you ask the patient about/ whether they have had any of the said symptoms?

- Chest pain - Dyspnoea - Cough
- Sputum
- Haemoptysis
- Wheeze
- Systemic upset

3

If yes to chest pain, what 'clarifying' questions need to be asked?

SOCRATES
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbators / relievers
Severity (1-10 rating scale)

4

If central chest pain, what can be potential causes?

Tracheitis
Angina/ MI
Aortic dissection
Massive PE
Oesophagitis
Lung tumour / metastases
Mediastinal tumour/ mediastinitis

5

If pleural chest pain, what can be potential causes?

Pneumonia / Bronchiectasis / TB
Lung tumour/ metastases/ mesothelioma
PE
Pneumothorax

6

If chest wall chest pain, what can be potential causes?

Muscular / rib injury
Costochondritis
Lung tumour / bony metastases/ mesothelioma
Shingles (herpes zoster)

7

What questions should be asked if patient is experiencing dyspnoea?

 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?
– Consider – cough, sputum, chest pain, palpitations, wheeze, stridor

8

If dyspnoea onset is in minutes, what could be potential diagnoses?

PE
Pneumothorax
Acute LVF
Acute asthma
Inhaled foreign body

9

If dyspnoea onset is in hours to days, what could be potential diagnoses?

Pneumonia
Asthma
Exacerbation of COPD

10

If dyspnoea onset is in weeks to months, what could be potential diagnoses?

Anaemia
Pleural effusion
Respiratory neuromuscular disorders

11

If dyspnoea onset is in months to years, what could be potential diagnoses?

COPD
Pulmonary fibrosis
Pulmonary TB

12

What questions should be asked of a patient suffering with a cough?

 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?
– Consider - dyspnoea, weight loss, stridor, pain, syncope, vomiting

13

If the cough is productive, what could be potential diagnoses?

Infection
Bronchiectasis

14

If the patient is presented with a persistent ‘moist’ cough worst in morning, what could be potential diagnoses?

COPD

15

If the cough is associated with wheeze, what could be potential diagnoses?

Asthma / COPD

16

If the cough is painful, what could be potential diagnoses?

Tracheitis

17

If the cough is harsh or barking, what could be potential diagnoses?

Laryngitis/ laryngeal tumour

18

If the cough is chronic and dry, what could be potential diagnoses?

Interstitial lung disease

19

If the cough is Bovine (non-explosive), what could be potential diagnoses?

Left recurrent laryngeal nerve invasion (secondary to malignancy) Neuromuscular disorders

20

If the cough is persistent with haemoptysis, what could be potential diagnoses?

Bronchial carcinoma

21

If the patient has been producing sputum, what questions do you need to ask?

 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?
E.g. fever, dyspnoea, pain

22

If serous sputum is produced, what could be some potential diagnoses?

Acute pulmonary oedema

23

If mucoid sputum is produced, what could be some potential diagnoses?

COPD/ asthma

24

If purulent sputum is produced, what could be some potential diagnoses?

Infection

25

If rusty sputum is produced, what could be some potential diagnoses?

Pneumococcal pneumonia

26

If the patient is presented with haemoptysis (coughing up blood), what questions do you need to ask?

 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?
– E.g. breathlessness / chest pain / cough / weight loss (pleuritic chest pain and hemoptysis is a red flag)

27

If the cause of haemoptysis is malignant, what potential diagnosises can be reached?

Bronchial carcinoma Metastatic lung disease

28

If the cause of haemoptysis is infective, what potential diagnosises can be reached?

Acute infection
Bronchiectasis
TB

29

If the cause of haemoptysis is vascular, what potential diagnosises can be reached?

Pulmonary infarction or pulmonary embolus

30

If the cause of haemoptysis is cardiac, what potential diagnosises can be reached?

Mitral valve disease
Acute LVF

31

If the cause of haemoptysis is vasculitis, what potential diagnosises can be reached?

Wegener’s granulomatosis
Good pasture’s syndrome

32

If the cause of haemoptysis is of other origin, what potential diagnosises can be reached?

Trauma
Anticoagulation (consider warfarin)
Clotting disorder

33

What are some other question that should be asked in a taking a pulmonary system history?

Change in appetite
Weight loss
Fever
Tiredness / lethargy

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