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rdinal symptoms Risk factors for factor Asthma trigger DVT/PE

Dyspnoea* • Past history DVT/PE • Allergens (house dust mite, pets, pollen, moulds)
Cough • Family history DVT/PE • Cigarette smoke
Sputum • Surgery (especially pelvidorthopaedic) • Cold air
Haemoptysis • Immobility • Infection (e.g. viral URTI)
Wheeze • Pregnancy/oral contraceptive • Exercise
Pleuritic pain • Malignancy • Drugs (NSAIDs, beta-blockers)
• Thrombophilia • Poor drug compliance
• Obesity
Ask about 5 noking, home oxygen therapy, home nebLiliser therapy and the patient's normal peak flow rate.

5.1 Resplraiory causes of breathlessness


Sudden (second/minutes) Pulmonary embolism, Pneumothorax, acute asthma
Acute (hours/days) Pneumonia, Exacerbation of COPD
Intermediate (days/weeks) Pleural effusion, Bronchial carcinoma, Pulmonary tuberculosis
Chronic (months/years) CORD, bronchiectasis, Fibrosing alveolitis

5.2 Sputum
Type Appearance Cause
Serous Clear, watery, frothy (may be pink) Pulmonary oedema
Mucoid Clear, grey, white, may be black (soot) COPD, chronic asthma
Purulent Yellow, green brown Bacterial infection
Rusty Rusty, golden yellow Pnemococcal pneumonia

(D.!:!ah]!5[~I!!9l?lr..1i.lIilfpffiQ,tre~9r, tar stal~cY?hosis, boundingpulse, small muscle wa~ting

(2) He2aaV'~~Ck ~,Ho~ner'$IP~~ncoast's


syndrome,SVC obstruction, chemosis,cyanosis,
l~Jvp'lympbadenopa!.by.'J@<;heal
position,SLErash

Chest (@sf~or then anterior)


f.:ln~p,ecJ
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~rs~'!~Si9,~s:chest shape, respiratoryrate, chest expansion,peak flow
tPalpatlo0l:0hest;expanslon
';eercU's~riP,:~n6r~ch,est~·l
~ ,·Auscultation'::i. Breath sounds,vocal resonance

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®regs'~tt0g:oederna, !?r6o~ clubbing.erythema nodosum

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