Chapter 27 Shortness of breath

Checklist Checklist Appropriate introduction Conrms patients name and age Explains reason for consultation Obtains consent Open question to elicit presenting complaint Allows patient to open up, listens carefully, remains silent and does not interrupt the patient Signposts: e.g. Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right? History of presenting complaint: Onset (how it started, gradual/sudden) Time (duration) Alleviating factors Exacerbating factors: Exertion/exercise Pollen/chemicals (asthma) Orthopnoea (worse when lies at) Severity: Exercise tolerance on a at surface Exercise tolerance when walking upstairs/up an incline Shortness of breath (SOB) at rest Variability: Is the SOB continuous throughout the day, intermittent or progressively worse? If intermittent, when is it worse/better? Asks if patient is suffering from any other symptoms Asks about any recent illnesses Previous episodes of SOB Asks about other respiratory symptoms: Cough Sputum Wheeze Orthopnoea Paroxysmal nocturnal dyspnoea Chest pain is it pleuritic, sharp, worse with inspiration? Ankle oedema Fevers Red ags: Haemoptysis Weight loss Night sweats Hoarseness P MP F Past medical history Family history: Lung cancer Atopy: Asthma Eczema Hayfever Ischaemic heart disease/myocardial infarction Pulmonary brosis Drug history: Methotrexate Amiodarone NSAIDs Over-the-counter medication Allergies Social history: Smoking Alcohol Illicit drug use Occupation Exposure to asbestos Activities of daily living/functional assessment and impairment due to SOB Review of systems Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture Systematic approach Explores and responds to ICE: Ideas Concerns Expectations Shows empathy Non-verbal skills Avoids technical jargon Devises holistic management plan and addresses psychosocial issues as well as medical problems Summarises Offers to answer any questions Thanks patient P MP F

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran. 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.