Lesson 1History of present illness: chronological construction, onset, duration, exertional pattern, triggers, progressionExplains construction of the history of present illness for exertional dyspnea, emphasizing onset, duration, exertional pattern, triggers, progression, and prior evaluations, to build a coherent, time-linked semiotic narrative.
Defining onset, tempo, and first episodeCharacterizing exertional thresholds and limitsIdentifying triggers and relieving maneuversDocumenting progression and stepwise changesPrior tests, treatments, and responsesSynthesizing a chronological symptom timelineLesson 2Family history questions focused on cardiopulmonary, thromboembolic, and hereditary lung diseaseDetails how to explore family history relevant to exertional dyspnea, focusing on cardiomyopathies, arrhythmias, thromboembolic disease, and hereditary lung disorders, with wording that improves reliability and reveals subtle inherited risk patterns.
Cardiac family history and premature sudden deathInherited arrhythmias and cardiomyopathiesFamilial thromboembolic and clotting disordersHereditary pulmonary hypertension patternsGenetic lung diseases and early respiratory failurePedigree building and red flag clusteringLesson 3Relieving and aggravating factors: posture, medications, exertion, environmental exposuresDescribes how to explore relieving and aggravating factors for exertional dyspnea, including posture, medications, exertion level, and environmental exposures, and how these patterns help distinguish cardiac, pulmonary, and functional etiologies.
Postural changes and orthopnea assessmentExercise intensity and exertional thresholdsMedication timing, relief, and side effectsEnvironmental and occupational exposuresTemporal patterns and day to night variationIntegrating patterns into pathophysiologic cluesLesson 4Medication, allergy, and vaccination questions with phrasing for accuracyDetails how to question medications, allergies, and vaccinations in patients with exertional dyspnea, using precise phrasing to improve recall, detect interactions, and identify preventable respiratory or cardiac complications.
Current prescription and over the counter drugsInhalers, oxygen, and adherence assessmentDrug and food allergies with reaction detailsVaccine history for influenza and pneumococcusCOVID and other relevant immunizationsIdentifying interactions and contraindicationsLesson 5Social history questioning scripts: smoking (pack-years), occupation, environmental exposures, alcohol, recreational drugs, physical activity levelProvides scripts for social history focused on exertional dyspnea, covering smoking with pack-year quantification, occupation, environmental exposures, alcohol, recreational drugs, and physical activity level, emphasizing risk stratification and stigma-free wording.
Smoking history, pack‑years, and cessationOccupational dust, fumes, and irritant exposureHousehold and environmental inhalational risksAlcohol intake patterns and cardiopulmonary riskRecreational drugs and route of useBaseline physical activity and functional classLesson 6Structure and goals of anamnesis: identification, chief complaint, informed consent phrasingIntroduces the overall structure and goals of anamnesis in exertional dyspnea, including patient identification, chief complaint formulation, and clear, ethical informed consent phrasing that builds rapport and frames a focused, efficient interview.
Patient identification and demographic contextFormulating and recording the chief complaintExplaining purpose and scope of the interviewInformed consent and confidentiality wordingSetting agenda and time framing with patientBalancing open listening with focused inquiryLesson 7Questions for associated symptoms: orthopnea, paroxysmal nocturnal dyspnea, chest pain, cough, wheeze, hemoptysis, syncope, palpitationsFocuses on systematically eliciting key associated symptoms that accompany exertional dyspnea, such as orthopnea, paroxysmal nocturnal dyspnea, chest pain, cough, wheeze, hemoptysis, syncope, and palpitations, with phrasing that sharpens diagnostic meaning.
Orthopnea and paroxysmal nocturnal dyspneaCharacterizing exertional and resting chest painCough, sputum, and wheeze characterizationHemoptysis severity and red flag featuresSyncope, presyncope, and exertional dizzinessPalpitations, rhythm description, and triggersLesson 8Past medical history probing: cardiovascular, pulmonary, renal, thyroid, hematologic, metabolic, and psychiatric conditionsCovers targeted past medical history for dyspnea, highlighting cardiovascular, pulmonary, renal, endocrine, hematologic, metabolic, and psychiatric conditions, and how each modifies pretest probability, prognosis, and therapeutic safety in exertional symptoms.
Cardiovascular diseases and prior cardiac testingChronic lung disorders and prior exacerbationsRenal disease, volume status, and anemia linksThyroid dysfunction and exercise intoleranceHematologic and metabolic contributors to dyspneaPsychiatric comorbidity and symptom perceptionLesson 9Targeted review of systems: standardized phrasing for respiratory, cardiac, systemic (fevers, weight loss), and psychiatric symptoms to detect differential cluesExplains how to conduct a targeted review of systems using standardized, patient-friendly wording for respiratory, cardiac, systemic, and psychiatric symptoms, aiming to uncover overlooked clues, comorbidities, and alarm signs that refine the differential.
Respiratory ROS for chronic and acute symptomsCardiac ROS for ischemia and heart failureSystemic ROS for fever, weight loss, night sweatsPsychiatric ROS for anxiety and panic featuresStandardized phrasing to reduce ambiguityPrioritizing and documenting positive findingsLesson 10Exact question scripts for chief complaint and opening promptsPresents exact opening prompts and chief complaint questions tailored to exertional dyspnea, balancing open and closed formats, minimizing suggestion, and setting a collaborative tone that encourages accurate, detailed symptom narratives.
Neutral openers for first patient statementsClarifying the main breathing concernExploring patient expectations and fearsAvoiding leading or judgmental questionsTransitioning from open to focused inquiryChecking understanding with patient summaries
