Lesson 1History of present illness: chronological construction, onset, duration, exertional pattern, triggers, progressionExplains building the history of present illness for exertional dyspnea, focusing on onset, duration, exertional pattern, triggers, progression, and past checks, to create a clear, time-linked semiotic story that helps in Ghanaian patient care.
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 probe family history related to exertional dyspnea, targeting cardiomyopathies, arrhythmias, thromboembolic issues, and hereditary lung problems, with wording that boosts reliability and uncovers hidden inherited risks common in Ghana.
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 probing relieving and aggravating factors for exertional dyspnea, covering posture, medications, exertion levels, and environmental exposures, and how these help separate cardiac, pulmonary, and functional causes in local contexts.
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 questioning about medications, allergies, and vaccinations in patients with exertional dyspnea, using exact phrasing to aid recall, spot interactions, and identify avoidable respiratory or cardiac issues in Ghanaian healthcare.
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 on exertional dyspnea, including smoking with pack-year counts, occupation, environmental exposures, alcohol, recreational drugs, and physical activity, stressing risk assessment and non-judgmental wording for Ghanaian patients.
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 structure and aims of anamnesis for exertional dyspnea, covering patient identification, chief complaint setup, and ethical informed consent wording that builds trust and shapes a focused, efficient interview in Ghana.
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 drawing out key associated symptoms with exertional dyspnea, like orthopnea, paroxysmal nocturnal dyspnea, chest pain, cough, wheeze, hemoptysis, syncope, and palpitations, using phrasing that enhances diagnostic clarity.
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 they affect pretest odds, outlook, and treatment safety in exertional cases.
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 a targeted review of systems with standard, patient-friendly wording for respiratory, cardiac, systemic, and psychiatric symptoms, to find missed clues, co-existing issues, and warning signs that refine the differential in Ghana.
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 precise opening prompts and chief complaint questions for exertional dyspnea, mixing open and closed styles, avoiding suggestions, and creating a teamwork tone for accurate, detailed symptom stories from patients.
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
