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Dr Musa Malkawi
MBChB (Baghdad)FRCP (London)
Consultant Chest Physician
Jordan University of Science and
Technology
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History Taking in RespiratoryDiseases
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History and Physical Exam are
Skills
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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
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Basic Requirements for History
Taking Satisfactory approach to the patient
Give patient adequate time to tell and
express himself
Competent interrogation and skillfulcommunication
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History Taking in Respiratory
Diseases Major symptoms
Past history
Family history
Occupational history
Social history
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Major Symptoms
Upper respiratory tract
Lower respiratory tract
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Major Symptoms
Upper respiratory tract symptoms
nasal obstruction
nasal discharge
sneezing
epistaxis
sore throathoarseness
stridor
cough
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Major Symptoms
Lower respiratory tract symptoms
cough
sputum
hemoptysis
chest pain
dyspnea
wheeze
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Cough
The 5th most common symptom seen
in outpatient clinics
An explosive expiration that clearsthe tracheobronchial tree from
secretions and foreign materials
Intrathoracic pressure may reach
300mmHg and expiratory velocity
500 miles/h
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Cough
Onset
Duration
Diurnal variation
Dry or productive
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Common Causes of Chronic
Cough of Unclear Etiology Asthma
Upper airway syndrome
Gastroesophageal reflux
Drugs
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Sputum
Amount
Character
serousmucoid
purulent
rusty Viscosity
Taste and odor
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Hemoptysis
Amount
Type
Duration
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Chest pain
Central
trachea
heartvessels
esophagus
LateralpleuriticH. zooster
root compression
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Dyspnea
Unpleasant and unexpected
awareness of breathing
Factors contributing to dyspneaincreased work of breathing
increased ventilatory drive
impaired respiratory muscle function
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Increased work of breathingairflow limitation
decreased compliancerestricted expansion
Increased pulmonary ventilation
increased physiological dead spacemetabolic acidosissevere hypoxiahysterical
Weakness of respiratory musclespoliomyelitis, myasthenia gravis, spinalcord injury
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NYHA Severity Grading of
Dyspnea Grade I no dyspnea at rest or on
moderate exertion
Grade II dyspnea on moderateexertion
Grade III dyspnea on mild exertionbut minimal at rest
Grade IV significant dyspnea at restsevere on minimal exertion
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Common Causes of Chronic
Dyspnea of Unclear Etiology Asthma
COPD
Interstitial lung disease
Myocardial dysfunction
Obesity/deconditioning
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Wheeze
Wheezes are continuous high pitched(400Hz) musical sounds produced byoscillations of airway walls. Theoscillations begins when the airflowvelocity reaches a critical value called
flutter velocity. Wheezes alwaysaccompanied by flow limitation. Rhonchiare low pitched sounds (200Hz)
Invariably louder during expiration andmay be confined to expiration
Stridor
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Past history
Previous x-rays
Tuberculosis
Pneumonia Childhood illnesses; measles and
whooping cough
Chest trauma Recent anaesthesia or loss of
consciousness
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Family history
Atopy
Cystic fibrosis
Tuberculosis
Chronic obstructive lung disease
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Occupational history
Chemicals
Organic dust
Animal proteins
Non-organic dust
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Social history
Smoking
Alcohol
Keeping pets (birds or animals)
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