Respiratory

Question 1

Describe how you can assess symptom progression

Answer 1

When did you last feel well?

What is normal for you?

Question 2

Summarise the Ddx of breathlessness

Answer 2

HEAD- ANXIETY

Metabolic- acidosis can cause hyperventilation (respiratory compensation)

Lungs- PE, Pneumothorax, COPD, Pneumonia, Asthma, Pulmonary Oedema, , ILD, Cancer, Pleural effusion

Heart- IHD, heart failure, valvular disease, arrhythmias,

Abdomen- Ascites, pregnancy

Muscles- GBS, Myasthenia, muscular dystrophy, MND

Body habits- obesity

Blood- Anaemia

Question 3

Summarise what to ask in a SOB history

Answer 3

Shortness of breath
‐ At rest/on exertion
‐ Exercise limitation (How far can you walk on the flat without stopping?)
‐ Orthopnoea
‐ Paroxysmal nocturnal dyspnoea
‐ Leg oedema

Question 4

Summarise what to ask in a cough history

Answer 4

‐ productive/non-productive
‐ quantity
‐ colour
‐ mucus plugs
‐ pattern (e.g. related to exposure or time of day)

Question 5

Summarise what to ask about chest pain

Answer 5

Chest pain

‐ Pleuritic?

Question 6

Summarise other systems to review in a respiratory history

Answer 6

Other systems review:
‐ Abdo – e.g. pain, swelling, PR bleeding/malaena
‐ CVS – e.g. palpitations
‐ Neuro – e.g. headache, mood, weakness, seizures
‐ GU – e.g. dysuria, haematuria
‐ Breast lumps
All of these could be important for specific diagnoses – e.g. cancers (bowel, breast, kidney, prostate causing lung metastases); heart failure – palpitations may be a cause and/or effect of cardiomyopathy; neurodegenerative disorders can cause respiratory muscle weakness although typically happens late.

Question 7

What should you ask in the PMH

Answer 7

Past Medical History Respiratory illnesses
Atopy
Childhood pneumonia TB

Question 8

What should you ask in the drug history

Answer 8

Drug history
Vaccination history
Specific medications can cause respiratory complaints (e.g. ACE inhibitors can cause cough)

Question 9

What should you ask in the family history

Answer 9

Family History Respiratory illness
Atopy
Cancer
TB (important if been in close proximity with patient)

Question 10

What should you ask in the social history

Answer 10

Social History
Occupational history
Pet history Smoking history Travel History