Pulmonary: History
  1. Cough
  2. Sputum, hemoptysis
  3. Dyspnoea
  4. Wheeze
  5. Chest pain
  6. Apnea, hoarseness, sinus symptoms
  7. Fever, night sweats
  8. Past medical, surgical history
  9. Family, social, drug history
  10. Systems
Cough
  • Duration of having cough.
  • Productive vs. non-productive.
  • Chest tightness (acute bronchitis).
  • Onset: environment (allergy, asthma).
  • Character:
    • Bark-like (larynx).
    • Whoop (whooping cough).
    • Dry, with post-nasal drip (pharynx).
  • Exacerbating: night (CHF, asthma).
Sputum, hemoptysis
  • Volume.
  • Color:
    • Yellow-green [purulent] (bronchiectasis, lobar pneumonia).
    • Clear [serous].
    • Grey [mucoid] (chronic bronchitis).
    • Pink froth secretion (pulmonary edema).
    • Red jelly (Klebsiella).
  • Viscosity (mucoid more viscous than purulent).
  • Foul smell (lung abscess, bronchiectasis).
Dyspnoea
  • Exertional: how far can you walk?
  • Orthopnoea: sleep with pillows?
  • Paroxysmal nocturnal dyspnoea: gasp at night?
  • Timing: worsened over the years (pulmonary fibrosis) vs. rapid onset (RTI).
Wheeze
  • Heard louder on expiration.
  • Prolonged expiration.
  • Precipitating factors.
  • Pt. could use term wheeze, when it's an inspiratory stridor, etc.
Chest pain
  • SOCRATES.
  • Character: stabbing. 
  • Exacerbating: deep inspiration (pleurisy, rib fracture), anxiety.
Apnea
  • Do you snore?
  • Loudness of snoring.
  • Interruption of activity next day.
Hoarseness
  • Laryngitis attacks.
  • Voice hoarseness (CA, nerve palsy).
Sinus symptoms
  • Blocked sinuses sensation.
  • Number of times draining sinuses in day.
  • Post nasal drip.
Fever, night sweats
  • Fever (RTI, TB).
  • Timing: day or night.
  • Temperature reached, if known.
  • Sweating at night (TB).
Past medical, surgical history
  • RTIs: pneumonia, TB, bronchitis.
  • Asthma.
  • Measles, pertussis during childhood.
  • Laryngitis.
  • Lung CA.
  • HIV (PCP).
  • Surgery: for TB, tumor.
Family history
  • Condition in a relative, what age.
  • Asthma.
  • Emphysema, other COPDs.
  • CF.
  • TB.
  • MI, angina.
Social history
  • Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew].
  • Passive smoking in the home, workplace.
  • Alcohol (aspiration).
  • Occupation type:
    • Farmer (farmer's lung).
    • Construction, shipyard (asbestos).
    • Miner, factory worker, stonemason (toxins).
    • Animal worker (M. psitacci).
    • Air conditioners (Legionella).
  • Occupation details:
    • Tasks done at work.
    • How long of exposure.
    • Protection used.
    • Illness in fellow workers. 
  • Describe your home: stairs, etc.
  • Pets at home (allergy, M. psittaci).
  • Who is with you there at home.
Drug history
  • Drugs currently on, including delivery method.
    • Steroids (TB risk).
    • ACE inhibitors (cough).
    • OCP (PE risk).
    • Beta-blockers (bronchospasm).
  • OTCs, including antihistamines.
  • Ventilators.
  • Recreational drugs:
    • Marijuana (cigarette-like).
    • Cocaine (fibrosis).
    • IV users (pulmonary edema, abscess).
  • Allergies, especially to inhaled substances.
  • Allergies to drugs, dyes.
Systems
  • Cardiovascular: (chest pain, dsypnoea).
  • Alimentary: GERD (chest pain cause, cough worse after eating).
  • Alimentary: fistula (cough worse after eating).
  • Nervous (respiratory depression).

Pulmonary Exam