Onset:

Sudden: PE/pneumothorax
Hours to days: infection, asthma, exacerbation of COPD
Weeks to months: COPD, LHF, malignancy(weight loss, fatigue, chronic cough, night
sweats), pulmonary fibrosis

Cardiac vs Respiratory
Chest pain: worse on exertion, location/radiation, wheeze
Fluid overload: leg edema, Orthopnea, PND, hypertension
Infection: fever, chills, cough

Past Hx
Heart : Infarction, hypertension,
Resp: COPD

Meds:
Beta-blockers (lung spasm)
Past surgeries
Anticoagulants

Social
Smoking (20/pack), in years
Alcohol
Occupational: Asbestos, mines, silicones, bird, farmer, hair dresser
Travel: TB, PE, sexual history
ADL: SOB scale

Exam

Inspection:
Sputum Cup, Breathing
Cyanosis
Tripod/walking aid
Breathing: SOB, use of accessory muscle

Exam hands : nails, HPOA, Asterix, refill,

Vital signs
Face: eyes, cyanosis
Neck tracheal tug, deviation, lymph nodes

Inspect chest
Expansion

Breath sounds: vesicular, bronchial(consolidation), wheeze (high pitched expiratory

sound, restrictive bronchial spasm (asthma, COPD),
crackles/crepitations(fine(fibrosis), coarse,), strider, absence breath sound

Geeky medicine