Shortness of breath Character Qualitative Ask generally Affecting daily life Unable to get air into the lungs -> obstructive lung diseases such as asthma, foreign body, atelectasis Breathing is just not enough -> perfusion issue -> anaemia, pulmonary embolus, pneumothorax. Quantitative Ask the patient to rate Need to establish patient’s baseline. Distance able to walk before and now before getting short of breath. Time questions Course: Sudden: MI, aortic dissection, tamponade, pericarditis, PE, pneumothorax Gradual -> respiratory or metabolic, valvular heart disease, HF Onset Offset Duration Frequency of episodes Duration of episodes Getting worst Onset of getting worse Relieving factors Upright Medications Rest Metal relaxation Context and aggravating factors: Context at onset Infections disease Ideas Anxiousness Lifestyle changes Physical activity: all diseases. Allergens: asthma Cold weather: hyperactive airways. Stress: anxiety, psychogenic, asthma Associated features: Cough: productive vs non-productive Fever Nausea Wheeze Fatigue Leg pain Ankle edema Swelling Dizziness Chest pain Weight loss Palpitations Loss of consciousness Abdominal distension Fatigue Shortness of breath when lying down Pallor Coughing of blood Coryzal symptoms Medications Prescription: OCP, bronchodilators, diuretics, beta blockers, anti-hypertensives, statins. Nonprescription Allergies Vaccinations Past medical history: General Resp Cardiovascular Family history Social history Diet Exercise Life stressors Alcohol Smoking Recreational drugs Occupational Differentials Pneumonia Productive cough with sputum Fever Phlegm Malaise (severe) Tachypnoea Wheeze Drowsiness and decreased levels of consciousness Chest pain Pleuritic chest pain -> retrosternal pain that is made worse with cough, swallowing and deep inspiration. Pain radiating to abdomen and epigastric region Asthma Dry cough Wheeze (end expiratory) Allergies Chest tightness Ask about atopy for both personal and family Maternal smoking or viral infection during pregnancy. Low birth weight Air pollution Exposure to high concentrations of allergens. Hygiene hypothesis. Interstitial lung disease Progressive dyspnoea Nonproductive cough Fatigue Aortic stenosis Dizziness Chest pain Loss of consciousness Wheezing Ischemic heart disease Nausea Chest pain Palpitations Hypertrophic cardiomyopathy Dizziness Chest pain Palpitations Loss of consciousness Exertional SOB Pneumothorax ASK ABOUT THE RISK FACTORS Male Marfan’s syndrome Underlying lung pathology Family History Infection or abscess Assisted ventilation -> including non-invasive ventilation Acute onset of pleuritis chest pain Acute onset of dyspneal Change in level of consciousness Pulmonary embolism: SOB Pleuritic chest pain Cough Haemoptysis Orthopneic Previous or current leg pain, swelling and change of colour. Wheeze CHF Cough Wheeze Fatigue Palpitations Chest pain SOB when lying down Leg swelling JVP distension Waking up from sleep COPD Fever Wheeze Fatigue Coryzal symptoms SOB Pursed lip breathing Tachypnoea Cyanosis due to hypoxemia Congested veins in neck Barrel chest Exercise intolerance Swelling and edema esp. at the ankle Know about patient’s weight.