Shortness of breath – History
Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES
- Wash your hands
- Introduce yourself: give your name and your job (e.g. Dr. Loiuse Gooch, ward doctor)
- Identity: confirm you’re speaking to the correct patient (name and date of birth)
- Permission: confirm the reason for seeing the patient (“I’m going to ask you some questions about your cough, is that OK?”)
- Positioning: patient sitting in chair approximately a metre away from you. Ensure you are sitting at the same level as them and ideally not behind a desk
History of presenting complaint
- Onset and duration of shortness of breath
- If they are uncertain about the start of the shortness of breath, a good question is: “When were you last well?”
- Acute, chronic, constant, intermittent
- Exacerbating factors
- Effort, dust exposure
- Alleviating factors
- Rest, inhalers, GTN spray
- Relation to exertion, time of day (morning dips in asthma)
- Associated symptoms
- Wheeze or stridor?
- Cough: productive or dry, colour of sputum, change in colour of sputum?
- Hemoptysis: how much (teaspoonful, cupful), how frequently?
- Chest pain: pleuritic, cardiac-sounding, nausea, sweating?
- Constitutional symptoms: fever, weight loss (quantify how much), night sweats?
- Cardiac symptoms: palpitations, ankle swelling, PND, orthopnoea?
- Exercise tolerance
- Quantify how far the patient can walk before stopping due to shortness of breath (e.g. number of stairs, distance on the flat)
Past medical history
- Full medical history but ask specifically about:
- Frequency of attacks, admission to hospitals, admissions to ITU, need for non invasive ventilation (NIV)
- Frequency of exacerbations, admissions (as for asthma): home oxygen (number of hours and rate of flow), any home nebulizers.
- PE/DVT risk factors
- Long whole travel, malignancy, recent surgery, pregnancy, procoagulant stage
- Other resp
- Recurrent lower respiratory tract infractions (e.g. number in the last year, any antibiotics taken)
- Past history of ischemic heart disease, cardiac failure or structural heart disease.
- Arrhythmia (e.g. atrial fibrillation)
- Full drug history, especially:
- Home oxygen
- Cardiac medications, including: diuretics: ACE inhibitors, antianginals
- Asthma, eczema, hay fever
- Any recent contact?
- Smoking history (active and passive): quantify pack years
- Occupational exposure
- Coal, dust, asbestos, fumes, moulds (e.g. hay)
- Animal exposure
- Pets (especially birds), farming, any animals involved in hobbies
- Tuberculosis exposure
- Limitations of daily activities by shortness of breath
- e.g. any hobbies you can no longer perform due to your breathing?
Perfect revision for medical student exams, finals, OSCEs and MRCP PACES