Dr Musa Malkawi

MBChB (Baghdad) FRCP (London)

Consultant Chest Physician Jordan University of Science and Technology

History Taking in Respiratory Diseases

History and Physical Exam are Skills

What is the Importance of Taking History?

70% of medical problems can be diagnosed by proper history taking 20% can be diagnosed after physical exam

Basic Requirements for History Taking

Satisfactory approach to the patient
Give patient adequate time to tell and express himself Competent interrogation and skillful communication

History Taking in Respiratory Diseases

Major symptoms Past history Family history Occupational history Social history

Major Symptoms
Upper respiratory tract
Lower respiratory tract

Major Symptoms
Upper respiratory tract symptoms
nasal obstruction nasal discharge sneezing epistaxis sore throat hoarseness stridor cough

Major Symptoms
Lower respiratory tract symptoms cough sputum hemoptysis chest pain dyspnea wheeze

Cough
The 5th most common symptom seen in outpatient clinics An explosive expiration that clears the tracheobronchial tree from secretions and foreign materials Intrathoracic pressure may reach 300mmHg and expiratory velocity 500 miles/h

Cough
Onset Duration Diurnal variation Dry or productive

Common Causes of Chronic Cough of Unclear Etiology

Asthma Upper airway syndrome Gastroesophageal reflux Drugs

Sputum
Amount Character
serous mucoid purulent rusty

Viscosity Taste and odor

Hemoptysis
Amount Type Duration

Chest pain
Central
trachea heart vessels esophagus

Lateral
pleuritic H. zooster root compression

Dyspnea
Unpleasant and unexpected awareness of breathing Factors contributing to dyspnea
increased work of breathing increased ventilatory drive impaired respiratory muscle function

 Increased work of breathing airflow limitation decreased compliance restricted expansion Increased pulmonary ventilation increased physiological dead space metabolic acidosis severe hypoxia hysterical Weakness of respiratory muscles poliomyelitis, myasthenia gravis, spinal cord injury

NYHA Severity Grading of Dyspnea

Grade I
Grade II Grade III

Grade IV

no dyspnea at rest or on moderate exertion dyspnea on moderate exertion dyspnea on mild exertion but minimal at rest significant dyspnea at rest severe on minimal exertion

Common Causes of Chronic Dyspnea of Unclear Etiology

Asthma COPD Interstitial lung disease Myocardial dysfunction Obesity/deconditioning

Wheeze
Wheezes are continuous high pitched (400Hz) musical sounds produced by oscillations of airway walls. The oscillations begins when the airflow velocity reaches a critical value called flutter velocity. Wheezes always accompanied by flow limitation. Rhonchi are low pitched sounds (200Hz)

Invariably louder during expiration and may be confined to expiration

Stridor

Past history
Previous x-rays Tuberculosis Pneumonia Childhood illnesses; measles and whooping cough Chest trauma Recent anaesthesia or loss of consciousness

Family history
Atopy Cystic fibrosis Tuberculosis Chronic obstructive lung disease

Occupational history
Chemicals Organic dust Animal proteins Non-organic dust

Social history
Smoking Alcohol Keeping pets (birds or animals)