In the name of god

History taking lung disease

Common Symptoms:Chest pain

Shortness of breath (dyspnea)WheezingCoughBlood-streaked sputum (hemoptysis)

CHEST PAIN

•The myocardiumangina pectoris, myocardial infarction

•The pericardiumPericarditis

•The aortaDissecting aortic aneurysm

•The trachea and large bronchiBronchitis

•The parietal pleuraPericarditis, pneumonia

•The chest wall, including the musculoskeletal system and skinCostochondritis, herpes zoster

•The esophagusReflux esophagitis, esophageal spasm

•Extrathoracic structures such as the neck, gallbladder, and stomach.

Cervical arthritis, biliary colic, gastritis

Your initial questions should be as broad as possible. “Do you have any discomfort or unpleasant feelings in your chest?” As you proceed to the full history, ask the patient to point to where the pain is in the chest .You should elicit all seven attributes of .this symptom

THE SEVEN ATTRIBUTES OF A SYMPTOMLocation. Where is it? Does it radiate?Quality. What is it like?

Quantity or severity. How bad is it? (For pain, ask for a rating on a scale of 1 to 10.)Timing. When did (does) it start? How long does it

last? How often does it come?Setting in which it occurs. Include environmental factors, personal activities, emotional reactions, or other circumstances that may have contributed to the illness.

Remitting or exacerbating factors. Is there anything that makes it better or worse?

Associated manifestations. Have you noticed anything else that accompanies it?

:Pleuritic PainInflammation of the parietal pleura, as in pleurisy, pneumonia, pulmonary infarction, or neoplasmChest wall overlying the processSharp, knifelikeOften severePersistentInspiration, coughing, movements of the trunk

Shortness of Breath (Dyspnea) and Wheezing

Dyspnea is a nonpainful but uncomfortable awareness

of breathing

dyspnea commonly results

from cardiac or pulmonary

disease.

Ask “Have you had any difficulty breathing?” Find out when the symptom occurs, at rest or with exercise, and how much effort

produces onset.

How many steps or flights of stairs

can the patient climb before pausing for

breath?

Carefully elicit the timing and setting of dyspnea, any associated symptoms, and relieving or

aggravating factors.

Most patients with dyspnea relate shortness of breath to their level

of activity

Anxious patients may have episodic dyspnea during both rest and exercise, and hyperventilation, or rapid, shallow breathing. At other times, they may sigh frequently

Heart failureAsthmaChronic bronchitisCopdDiffuse interstial lung diseasePnumoniaPneumothoraxPulmonary embolianxiety

Anxiety With Hyperventilation

More often occurs at rest than after

exercise..Sighing,

lightheadedness, numbness or tingling of the hands and feet,

palpitations, chest pain

Wheezing:

Wheezes are musical respiratory sounds that may be audible to the patient and to others.

Wheezing suggests partial airway obstruction from secretions, tissue inflammation, or a foreign body.

Cough:

cough is a reflex response to stimuli that irritate receptors in

the larynx, trachea, or large bronchi.

These stimuli include mucus, pus, and blood, as well as external agents such as dust, foreign bodies, or even extremely hot or cold air. Other causes include inflammation of the respiratory mucosa and pressure or tension in the air passages from a tumor or enlarged peribronchial lymph nodes.

Duration of the cough is important: is the cough acute, or lasting less than 3 weeks; subacute, or 3 to 8 weeks; or

chronic, more than 8 weeks?

Viral upper respiratory infections are the most common cause of acute cough; also

consider acute bronchitis, pneumonia, left ventricular heart failure, asthma, foreign body. Postinfectious cough,

bacterial sinusitis, asthma in subacute cough; postnasal drip, asthma,

gastroesophageal reflux, chronic bronchitis, bronchiectasis in chronic

cough.

Ask whether the cough is dry or produces sputum, or

phlegm?

Mucoid sputum is translucent, white, or gray; purulent

sputum is yellowish or

greenish

Ask the patient to describe the volume of any sputum and its

color, odor, and consistency

Foul-smelling sputum in anaerobic lung abscess; tenacious sputum

in cystic fibrosis

“How much do you think you cough up in 24 hours: a teaspoon, tablespoon, quarter cup, half cup, cupful?” If possible, ask the patient to cough into a tissue; inspect the phlegm and note its characteristics.

:Hemoptysis

Hemoptysis is the coughing up of blood from the lungs; it may vary from blood-streaked phlegm to frank, assess the volume of

blood .

source of the bleeding:may originate in the mouth, pharynx, or gastrointestinal tract. When vomited, it probably originates in the gastrointestinal tract. Occasionally, however, blood from the nasopharynx or the gastrointestinal tract is aspirated and then coughed out.

Blood originating in the stomach is usually darker than

blood from the respiratory tract and may be mixed with

food particles.