history taking
DESCRIPTION
clinical approach to a patient with chest painTRANSCRIPT
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CLINICAL APPROACH CLINICAL APPROACH TO A PATIENT WITH TO A PATIENT WITH COUGH… HISTORY COUGH… HISTORY TAKINGTAKING
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►Protective mechanismProtective mechanism►Seeks MEDICAL CARESeeks MEDICAL CARE
Discomfort from cough itselfDiscomfort from cough itself
Interference with normal Interference with normal lifestylelifestyle
Concern for cause of coughConcern for cause of cough
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HISTORYHISTORY
1.Onset & Duration1.Onset & Duration
Acute :- URTI; pneumonia; Acute :- URTI; pneumonia; aspiration; foreign aspiration; foreign
body; body; pulmonary emboli; CHFpulmonary emboli; CHF
Chronic :-COPD; bronchogenic CA; Chronic :-COPD; bronchogenic CA; post nasal drip; post nasal drip; asthma; asthma; GERD; TB; ILD; GERD; TB; ILD;
psychogenicpsychogenic
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2.Character and timing2.Character and timing
Short,dry irritating cough with Short,dry irritating cough with pain behind jaw or neck:- pain behind jaw or neck:-
PharyngealPharyngeal
Harsh,irritative and repetitive Harsh,irritative and repetitive with stridor and cyanosis:- with stridor and cyanosis:-
LaryngealLaryngeal
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Productive: amount; colour; Productive: amount; colour; consistency; smellconsistency; smell
Large amounts:-Large amounts:-
a)regular coughing up-a)regular coughing up-bronchiectasis bronchiectasis
b)Single occasion-lung abcess, b)Single occasion-lung abcess, empyemaempyema
c)Pink frothy-Pulm edemac)Pink frothy-Pulm edema
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Types of sputumTypes of sputum
TypesTypes AppearancAppearancee
CauseCause
SerousSerous Clear,watery Clear,watery frothy pinkfrothy pink
A/c pulm A/c pulm edemaedema
MucoidMucoid Clear grey- Clear grey- white viscidwhite viscid
C/c C/c bronchitis, bronchitis, COPD,AsthmCOPD,Asthmaa
PurulentPurulent Yellow/greenYellow/green BronchopulmBronchopulmonary onary infectioninfection
RustyRusty Rusty,golden Rusty,golden yellowyellow
PneumococcPneumococcal al pneumoniapneumonia
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FROTHY SPUTUMFROTHY SPUTUM
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PURULENT SPUTUMPURULENT SPUTUM
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RUSTY SPUTUMRUSTY SPUTUM
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Foul smelling sputum- Foul smelling sputum- bronchiectasis, bronchiectasis, lung lung abcess, empyemaabcess, empyema
Solid matter present in viscid Solid matter present in viscid secretions in asthma, allergic secretions in asthma, allergic brochopulmonary aspergillosis, brochopulmonary aspergillosis, necrotic tumour, foreign bodynecrotic tumour, foreign body
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Haemoptysis;- C/c bronchitis, Haemoptysis;- C/c bronchitis, Bronchiectasis, Bronchogenic Bronchiectasis, Bronchogenic carcinoma, Pulmonary emboli, carcinoma, Pulmonary emboli, Pulmonary edemaPulmonary edema
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3.Diurnal variation3.Diurnal variation
Cough which gets worse in Cough which gets worse in night and early morning :- night and early morning :- AsthmaAsthma
Persistent moist cough on Persistent moist cough on waking up in smokers :- C/c waking up in smokers :- C/c bronchitisbronchitis
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4.Seasonal variation4.Seasonal variation
Asthma, C/c bronchitisAsthma, C/c bronchitis
5.Postural variation5.Postural variation
Bronchiectasis, Lung abcess, Bronchiectasis, Lung abcess,
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6.Aggravating & Relieving 6.Aggravating & Relieving factorsfactors
Cold,smoke,dust,exertion:- Cold,smoke,dust,exertion:- asthma asthma
Swallowing of liquids:- NM d/s Swallowing of liquids:- NM d/s of oropharynxof oropharynx
Otogenic cough:- impacted wax or Otogenic cough:- impacted wax or
foreign body in ext auditory foreign body in ext auditory meatus:…..subsides with removal meatus:…..subsides with removal of cause of cause
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7.Associated symptoms7.Associated symptoms
Fever:- RTI; lung abcess; Fever:- RTI; lung abcess;
Chest pain:-Bronchitis, Chest pain:-Bronchitis, bronchogenic bronchogenic
carcinomacarcinoma
Pleuritic chest pain:-Pleurisy, Pleuritic chest pain:-Pleurisy, pleural effusion,bronchiectasispleural effusion,bronchiectasis
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Dyspnoea:- COPD, Asthma, ILD, Dyspnoea:- COPD, Asthma, ILD, Pneumonia, Bronchogenic Pneumonia, Bronchogenic carcinoma, Sarcoidosis, CHF carcinoma, Sarcoidosis, CHF ( orthopnoea & PND)( orthopnoea & PND)
Wheeze:- asthmaWheeze:- asthma
“ “cough variant asthma”cough variant asthma”
Nasal discharge, tickling Nasal discharge, tickling sensation in throat:- Postnasal sensation in throat:- Postnasal dripdrip
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Loss of weight:- bronchogenic Loss of weight:- bronchogenic carcinomacarcinoma
Stridor:-FB,Laryngeal nerve Stridor:-FB,Laryngeal nerve involvmentinvolvment
Hoarseness of voice:-Lary.N Hoarseness of voice:-Lary.N invlvmtinvlvmt
Heart burn, regurgitation:- GERDHeart burn, regurgitation:- GERD
Erythema nodosum:-SarcoidosisErythema nodosum:-Sarcoidosis
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HISTORY OF PAST ILLNESS
COPD, Asthma, Postnasal drip, COPD, Asthma, Postnasal drip, GERDGERD
R/c or complicated Pneumonia, R/c or complicated Pneumonia, tuberculosis.whooping cough:- tuberculosis.whooping cough:- BronchiectasisBronchiectasis
ImmunosuppressionImmunosuppression
Surgery ;bed restSurgery ;bed rest
BCG vaccinationBCG vaccination
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Personal historyPersonal history
Loss of appetite, sleepLoss of appetite, sleep
SmokingSmoking
Occupational exposureOccupational exposure
Allergy or atopyAllergy or atopy
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FAMILY HISTORYFAMILY HISTORY
Chronic bronchitis with Chronic bronchitis with emphysema, Respiratory emphysema, Respiratory allergy, Asthma, Cystic allergy, Asthma, Cystic fibrosisfibrosis
TBTB
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TREATMENT HISTORYTREATMENT HISTORY
Angiotensin Converting Angiotensin Converting
Enzyme InhibitorsEnzyme Inhibitors
Past treatment of d/s like Past treatment of d/s like allergies,asthma,pneumonia,Tallergies,asthma,pneumonia,TB,BronchitisB,Bronchitis
ImmunosuppressantsImmunosuppressants
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……DDsDDs1.Pneumonia:-fever, cough,dyspnoea, 1.Pneumonia:-fever, cough,dyspnoea,
rigor,night sweatsrigor,night sweats
2.Asthma:-episodic wheeze,dyspnea, 2.Asthma:-episodic wheeze,dyspnea, c/c dry or productive cough worst at c/c dry or productive cough worst at night,chest tightnessnight,chest tightness
3.COPD:-persistent cough,large 3.COPD:-persistent cough,large amount sputum,shortness of breathamount sputum,shortness of breath
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4.Bronchiectasis:-c/c 4.Bronchiectasis:-c/c cough,copious amount of foul cough,copious amount of foul smelling sputum, smelling sputum, hemoptysis,pleuritic chest pain, hemoptysis,pleuritic chest pain, dyspnoea,loss of weight,anemiadyspnoea,loss of weight,anemia
5.Bronchogenic carcinoma:-new 5.Bronchogenic carcinoma:-new cough/change in cough,dyspnoea, cough/change in cough,dyspnoea, hemoptysis,anorexia,loss of hemoptysis,anorexia,loss of weight, chest painweight, chest pain
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6.Tuberculosis:-cough 6.Tuberculosis:-cough
(dry…purulent(dry…purulent
… …blood streaks in blood streaks in
sputum),sputum),
anorexia,LOW,anorexia,LOW,
night sweats,night sweats,
evening rise of evening rise of
temperaturetemperature
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7.ILD:-insidous onset exertional 7.ILD:-insidous onset exertional dyspnoea,cough dyspnoea,cough
8.CHF:-exertional dyspnoea,cough, 8.CHF:-exertional dyspnoea,cough, fatigue,orthopnea.PND,edemafatigue,orthopnea.PND,edema
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9.Sarcoidosis:-9.Sarcoidosis:-cough,dyspnoea,erythema cough,dyspnoea,erythema nodosum, eye nodosum, eye inflammation,fatigue,feverinflammation,fatigue,fever
10.Cystic fibrosis:-c/c or r/c cough 10.Cystic fibrosis:-c/c or r/c cough with sputum,dyspnoea,wheeze, with sputum,dyspnoea,wheeze, hemoptysis..young adult hemoptysis..young adult
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11.Post nasal drip;-nasal 11.Post nasal drip;-nasal discharge… mucoid or discharge… mucoid or mucopurulent,tickle in throatmucopurulent,tickle in throat
12.GERD:-cough,heart burns, 12.GERD:-cough,heart burns, regurgitationregurgitation
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13.Laryngeal inflammation:-cough, 13.Laryngeal inflammation:-cough, hoarseness of voice,stridorhoarseness of voice,stridor
14.FB:-cough,stridor,history14.FB:-cough,stridor,history
15.ACEI:-dry cough starting within 15.ACEI:-dry cough starting within 1-6 months of treatment1-6 months of treatment
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…THANK YOU