History Taking Professor Tariq Waseem

Map of Holy Land: Mosaic work on the floor of an ancient church Madaba Jordan May 2013

Functions  Transfer of gases Absorption of Oxygen Excretion of CO 2  Protective function to heart by rib cage

 Dyspnea/Breathlessness  Onset Sudden : Anaphylaxis, Foreign body inhalation, Pulmonary Embolism, Pneumothorax, Acute Asthma. Progressive/Chronic : COPD, Post infective Fibrosis, Interstitial Lung disease.  Duration  Relation With Activity/Exertion  Associated Symptoms: Cough, Sputum, Hemoptysis  Time of occurrence : Early morning, at Work Place, Lying flat or on a side  Differentiation from cardiac dyspnea

 Respiratory  Cough prominent  Thick sputum  Hemoptysis  Morning dip in asthma  Fever often present  Occupational exposure important  H/O wheezing  Chest pain infrequent  Cardiac  Cough not prominent symptom  Thin frothy sputum  Often no hemoptysis  PND orthopnea  Fever generally absent  Generally not important  Wheezing generally absent  Chest pain frequently present

 A 50 year old male with 60 pack years of smoking history has been having progressive dyspnea for past 5 years which has progressed to an extent that he can’t go up a single flight of stairs without stopping in middle. He has been having cough all the year around but its worse in winters. He produces thick tenacious sputum which has become greenish over past 2 weeks and is blood stained as well. He has been running fever for past 1 week. He has lost 5 Kg weight over past 6 months.

 COPD/COAD with acute exacerbation?  Bronchogenic Carcinoma?

 A 45 years old diabetic and hypertensive with a smoking index of 60 and having slowly progressive dyspnea over past 5-7 years is brought to ER by Rescue 1122 with sudden onset breathlessness since 4 am. He woke up from sleep with a feeling of tightness in chest which worsened over 2 hours along with dyspnea. He has been spitting out pinkish frothy sputum. He is restless, unable to lie flat with noisy, rattling breathing audible from a distance.

 Acute Pulmonary edema/ LVF?  Acute Myocardial infarction?  Mitral Stenosis?  Atrial fibrillation?

Assa Moosa Replica Mont Neebo Jordan

 Onset  Duration Acute (days), Medium duration ( weeks), Chronic ( > 6 months).  Dry or with sputum  If sputum color, amount time of occurrence, relation with posture  Other associated respiratory symptoms  Time of occurrence

 Chronic Bronchitis  Acute Viral Bronchitis  Acute Bacterial Bronchitis  Pneumonia  Bronchiectasis  Lung Abscess

 Viral infection with slow recovery  COPD  Bronchogenic carcinoma  Tuberculosis  Interstitial Lung Disease  Angiotensin Converting Enzyme Inhibitors

Statue of wife of Loote (the Prophet) Jordan

 Wheeze  Stridor

 Amount  Time  Duration  Associated symptoms  Systemic complaints  Malignancy, cavity, vasculitis

 Acute viral or Bacterial Bronchitis  Pulmonary Infarction(h/o DVT, bed ridden pt)  CA Lung  Pulmonary Koch’s (TB).  URTI ( Nasal polyps, Laryngeal/Pharyngeal CA  Lung Abscess  Bronchiectasis  Wegener’s Granulomatosis  Good Pasture’s syndrome  Pulmonary arteriovenous malformation  Bleeding disorders

 Pleuritis  Pulmonary Infarction  Pulmonary HTN  Trauma  Musculoskeletal

 Smoking history  Other addictions  Occupation  Treatment history  Seasonal variation  Aggravating and relieving factors

 Fever  Arthritis, skin rashes  Connective tissue disorders  Vasculitis  Hematuria  Weight Loss  GI Symptoms /GERD  Altered Sensorium  Snoring & Sleep Disturbance

 Tuberculosis.  Bronchiectasis.  Cystic fibrosis.  CA lung

 Smoking  Pets  Limitation of activities & job requirements.  Exposure to dusts, moulds, hay.