Lesson 1Rationale for each question group: linking history elements to common causes of dyspnea and urgent red flagsExplains how each question group relates to disease processes and usual causes of breathlessness, cough, and chest pain, and how response patterns signal urgent red flags, direct tests, and form initial treatment strategies.
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 spotting red flag symptoms like pleuritic or effort-related chest pain, fainting, coughing blood, quickly worsening breathlessness, sepsis signs, and risky fever patterns needing prompt 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 steroidsReviews comorbidities and medicines systematically, covering heart disease, diabetes, blood thinners, ACE inhibitors, inhalers, and recent antibiotics or steroids, to spot interactions, side effects, and safety concerns.
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 physicianOffers tips for focused, patient-friendly questioning in short consultations, using open and closed questions, signposting, and summaries, then writing brief, organised notes for safe handover to supervising doctors.
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 gathering smoking details in pack-years, vaping and cannabis use, work and environment exposures, pets, dampness, and recent travel or infection contacts that affect lung risk and narrow 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 testsCovers checking usual exercise capacity, daily activities, sleep, recent weight or appetite shifts, and past lung function tests or scans, to measure long-term illness load, reserves, and past treatment responses.
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 predispositionLooks at family trends in asthma, eczema, hay fever, COPD, early heart disease, plus clotting disorders and clots history, to assess risks for asthma, lung clots, and other heart-lung causes of shortness of breath.
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 limitationUses structured questions on lung symptoms like start, length, worsening, cough and phlegm traits, triggers, position effects, and effort limits, to separate sudden from ongoing and mild from serious conditions.
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
