Name/Age/sex/Occupation/address

Presenting Complaints:
History of presenting complaints:
Cough with expectoration:
Duration
Mode of onset
Paroxysmal
Dry / productive
Postural / diurnal
Aggravating / reliving factors
Associated factors - chest pain, syncope
Sputum:
Duration and mode of onset
Quantity
Colour and odour
Character - mucoid /serous, purulent / mucopurulent
With / without blood
Postural and diurnal variation
Hemoptysis:
Duration
Episodes
Fresh or altered blood
Associated with purulent sputum or food particles
Breathlessness:
Duration
Onset
Grade
Progression
Aggravating/relieving factors
PND/orthopnea
Chest pain:
Duration
Site
Mode of onset
Nature - pricking/stabbing
Severity
Radiation
Postural variation
Aggravating or relieving factors
Associated with food intake
Associated with nausea, vomiting
Negative History:
H/o wheeze(duration, diurnal variation, aggravating/relieving factors)
H/o halitosis
Symptoms of TB:
o H/o fever with evening rise of temperature
o H/o loss of weight
o H/o loss of appetite
o H/o night sweats
Symptoms of cardiac involvement
o H/o pedal edema
o H/o abdominal distension
o H/o right hypochondrial pain
o H/o puffiness of face
o H/o palpitation
o H/o syncope
o H/o oliguria
Symptoms suggestive of malignancy
o H/o hoarseness
o H/o dysphagia
Mode of onset
Solids/liquids
Progression
o H/o loss of appetite
Past History:
H/o previous similar episodes
H/o HT/DM
H/o TB
o Any contact
o Age
o Treatment - if incomplete - why?
History suggestive of pneumonia
o Aspiration(A - aspiration, B - Booze, C - coma, D - Drowning, E - Epilepsy, F - Foreign
body)
o Exanthematous fever
o Tooth, extraction, tonsillectomy, allergy
o Trauma
o Exposure to STDs
History suggestive of PE
o Acute abdominal distress
(Subphrenic abscess, amoebic abscess, Pancreatitis)
H/o past infections
o Measles, Whooping cough
o Recurrent respiratory tract infections
Family History:
Elaborate
Ask for
o H/o TB/primary complex
o H/o allergies
o H/o infertility/abortions
Personal History:
Smoking
Alcohol
Diet
Exposure - occupational, STD elaboration
Treatment history:
Summary:
Age/sex/name? Personal History? Family history? Presenting complaints? Other relevant positive
findings
System RS
Acute/Chronic
Rt/Lt/Both
Parenchyma/pleura/airway
Obstructive/restrictive
Suppurative/non suppurative
Etiology
With/without complications? Cor pulmonale
Obstructive lung diseases(Hypercarbia)
Head ache
Drowsiness
Restrictive Lung disease
Tachypnea
Convulsions( O
2
tetany)
Extra pyramidal symptoms( O
2
of basal ganglia)
Muscle twitching
Examination of Respiratory system
General examination:
Comfortable
Conscious
Oriented
Built
Nourishment
Febrile/ afebrile
Pallor (Anemic/not anemic)
Icteric/not
Clubbing
Cyanosis
Pedal oedema
Significant lymphadenopathy
Conjunctival suffusion
See for
IVC obstruction
Halitosis
Horners syndrome: Ptosis, anhydrosis, miosis, enophthalmos, loss of ciliospinal reflex
Troisers sign: Enlargement of Lt. supraclavicular lymph node
Markers of pulmonary malignancy:
o Acanthosis nigricans
o Gynaecomastia
o Clubbing, HPOA
Markers of sarcoidosis:
o Hilar, mediastinal lymph node enlargement
o Tonsillar enlargement
o Hepatospleenomegaly
o Eye: iritis, iridocyclitis, choroid retinitis
o Skin: SC nodules, erythematous plaques, Erythema nodosum
o Parotitis
o Nasal polyps
o Joint pain
Markers of TB:
o Phlycten, choroids, tubercles
o Scars/sinuses in the neck
o Scrofula - SC lymphadenitis in neck
o Lupus vulgaris
o Erythema nodosum
o Cold abscess/ collar stud abscess
o Tinea versicolor
o Gynaecomastia - INH (bronchogenic CA)
Markers of HIV
o Hairy Leucoplakia
o Oral candidiasis
o Molluscum contagiosum
o Premature greying of hair
o Long eye lashes(trichomegaly)
o Herpetic infections
o Generalised lymphadenopathy
Vital signs:
Pulse rate: elaborate (expect pulsus paradoxus)
BP: .. mm Hg ..limbsposture
Respiratory rate, rhythm, type
Temperature
JVP
Systemic examination of Respiratory system:
1. Inspection:
Upper respiratory tract
o Nasal septum
o Sinus tenderness
o Polyps
o Tonsils
o Oral hygiene
o Halitosis
o Post nasal drip
Chest
o Symmetry
o Shape - flat, barrel chest(emphysema, pigeon chest, funnel chest (marfan syndrome)
o Costochondral bending ( Rachitic rosary), Scorbutic rosary
o Movement with respiration
o Scars, IC fullness, IC indrawing, crowding of ribs, discharging sinuses(TB)
o Tracheal position with Trails sign
o Apical impulse
o Drooping of shoulders
o Supraclavicular and IC hallowing
o Harrisons sulcus
o Prominence of medial border of scapula
o Kyphoscoliosis
o Dilated veins over chest, tracheal movement during inspiration
2. Palpation:
o Tracheal position
o Apical impulse
o AP diameter
o Transverse diameter
o Ratio
o Chest movement by palpation
o Chest expansion measurement - bilateral and hemi thorax
o Tactile fremitus, IC tenderness
o Vocal fremitus
o Lymph nodes - Cervical, Supraaxillary, axillary, Scalene
3. Percussion
o Directly on clavicle
o Anteriorly
o Supraclavicular (apex)
o Infraclavicular
o Mammary
o Axilla
o Axillary
o Infra axillary
o Posterior
o Suprascapular
o Infrascapular
o Interscapular
Upper
Middle
Lower
o Tidal percussion
o Traubes space - left sixth rib, the left axillary line and the left costal margin
o Shifting dullness, straightline dullness
4. Auscultation:
o Auscultation in above areas
o Breath sounds
o Normal vesicular breath sound(harsh / normal)
o Bronchial breath sound
Pitch tubular
Pitch cavernous
Amphoric
o Bronchovesicular breath sound
o Absent breath sounds
o Added sounds
o Crepitations/ crackles
Inspiratory/ expiratory / both phases
Fine/medium/coarse leathery
Change afer coughing
o Ronchi/ wheeze
Inspiratory / expiratory both
Pitch
Monophonic / polyphonic
Change after coughing
o Pleural rub
o Post tussive suction
o Vocal resonance
o Compare both sides
o Bronchophony
o Aegophony (E to A)
o Whispering pectoriloquy
o Others
o Succession splash
o Coin test

Other systems:
CVS : see for RHF, CCF
Abdomen: see for liver abscess - tenderness
CNS: see for asterexis
Diagnosis:
.sided..disease(PE/fibrosis) probably due to
(with / without signs of RHF)