Lesson 1Rationale for each question group: linking history elements to common causes of dyspnea and urgent red flagsExplains how each question group maps to pathophysiology and common causes of dyspnea, cough, and chest pain, and how patterns of responses highlight urgent red flags, guide investigations, and shape initial management plans.
Linking symptom patterns to major diagnosesDistinguishing cardiac from primary lung causesUsing risk factors to refine pretest probabilityInterpreting red flags for time-critical illnessHistory cues guiding initial investigationsHistory-driven early management decisionsLesson 2Red flag screening: chest pain, syncope, hemoptysis, severe dyspnea, sudden deterioration, fever patternTeaches recognition of red flag symptoms such as pleuritic or exertional chest pain, syncope, hemoptysis, rapidly worsening dyspnea, sepsis features, and high-risk fever patterns that require urgent escalation and possible emergency referral.
Characterizing chest pain and pleuritic featuresSyncope, presyncope, and circulatory compromiseAssessing hemoptysis volume and clotting riskSevere or rapidly progressive dyspnea signsFever pattern, rigors, and sepsis indicatorsEscalation thresholds and emergency referralLesson 3Comorbidities and medication review: hypertension, cardiovascular disease, anticoagulants, ACE inhibitors, inhalers, recent antibiotics or steroidsCovers systematic review of comorbidities and medications, including cardiovascular disease, diabetes, anticoagulants, ACE inhibitors, inhalers, and recent antibiotics or steroids, to identify interactions, side effects, and safety issues.
Key cardiometabolic and renal comorbiditiesACE inhibitors, beta-blockers, and coughAnticoagulants, antiplatelets, and bleeding riskInhaler types, technique, and adherenceRecent antibiotics, steroids, and resistancePolypharmacy, interactions, and deprescribingLesson 4Techniques for focused questioning in time-limited encounters and documenting answers concisely for handover to supervising physicianProvides strategies for focused, patient-centered questioning in time-limited encounters, using open and closed questions, signposting, and summarizing, then documenting concise, structured notes for safe handover to supervising physicians.
Using open and closed questions effectivelyPrioritizing key respiratory history domainsManaging tangents and maintaining rapportSummarizing and checking patient understandingSBAR and problem-focused note structureDocumenting red flags and safety nettingLesson 5Social and environmental history: smoking history quantification (pack-years), occupational exposures, recent travel, household contactsFocuses on eliciting smoking exposure in pack-years, vaping and cannabis use, occupational and environmental inhalants, pets, mold, and recent travel or infectious contacts that modify respiratory risk and guide differential diagnosis.
Calculating smoking history and pack-yearsDocumenting vaping, cannabis, and passive smokeOccupational dust, fume, and chemical exposuresHousehold factors: pets, mold, heating, ventilationRecent travel, TB risk, and endemic infectionsClose contacts with respiratory or febrile illnessLesson 6Functional and baseline status: baseline exercise tolerance, ADLs, recent weight change, prior respiratory function testsAddresses assessment of baseline exercise tolerance, ADLs, sleep, recent weight or appetite change, and prior spirometry or imaging, to gauge chronic disease burden, functional reserve, and response to previous respiratory treatments.
Baseline exercise tolerance and activity levelImpact on ADLs, work, and social participationSleep quality, nocturnal symptoms, and PNDUnintentional weight loss and appetite changePrior spirometry, peak flow, and imagingTracking progression and response to therapyLesson 7Family history and allergy history: atopy, premature cardiovascular disease, venous thromboembolism predispositionExplores family patterns of asthma, eczema, allergic rhinitis, COPD, and early cardiovascular disease, plus inherited thrombophilia and VTE history, to refine risk of asthma, PE, and other cardiopulmonary causes of breathlessness.
Family history of asthma, COPD, and atopyEczema, allergic rhinitis, and food allergiesPremature cardiovascular disease in relativesFamily venous thromboembolism or thrombophiliaDrug, latex, and contrast media allergiesEnvironmental allergy patterns and seasonalityLesson 8Systematic exploration of presenting symptoms: onset, duration, progression, character of cough, sputum, triggers, positional factors, exertional limitationCovers structured questioning about respiratory symptoms, including onset, duration, progression, cough and sputum features, triggers, positional change, and exertional limits, to distinguish acute from chronic and benign from serious disease.
Clarifying onset, duration, and symptom chronologyCharacterizing cough type, timing, and associated painAssessing sputum volume, color, and hemoptysisIdentifying triggers, irritants, and relieving factorsEvaluating orthopnea, PND, and positional changeGrading exertional dyspnea and activity limitation
