Cole's Cough

Name	Cole Abbe
DOB	03/04/1941 (74 years)
Occupation	Healthcare assistant
History	I have had a chronic cough for the last 6 months and now I am fed up of it. I don\'t bring anything up with it. It occurs all the time and I have never brought up any blood. I have not noticed any shortness of breath but do find I tire more easily with exercise. If asked directly I have noticed some hand and foot joint pain, but assumed that was due to old age. I deny any dryness of my eyes or mouth, whitening or pain in my hands in the cold or any other symptoms.
Past Medical History	Nil
Drug History	Nil
Family History	Both parents died young in a horrific road traffic accident.
Social History	5 cigarettes per day. Occasional alcohol. No recreational drug use. Exposure to asbestos in previous house.

Introduces yourself	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Asks open question	0	1
Establishes onset and duration	0	1
Asks for variability in the day e.g. diurnal/worse at night (asthma)	0	1
Asks for alleviating factors (e.g. being at home/work)	0	1
Asks for exacerbating factors (e.g. exercise, seasonal (asthma, COPD), pollen (asthma), chemicals, posture)	0	1	2
Establishes if dry or productive	0	1
Establishes severity and impact on life	0	1
Asks about any recent illnesses	0	1
Screens for red flags (haemoptysis, weight loss, hoarseness, night sweats)	0	1
Screens for associated respiratory symptoms (fever, shortness of breath, wheeze, chest pain - clarifying if pleuritic/burning suggestive of reflux disease)	0	1	2
Screens for associated cardiovascular symptoms (orthopnoea, ankle oedema, calf pain or swelling)	0	1
Screens for ENT associated symptoms (throat, coryza, rhinitis)	0	1
Screens for musculokeletal and rheumatological symptoms (arthralgia, morning stiffness)	0	1
Elicits past medical history (specifically asthma, tuberculosis) and recent surgery	0	1
Elicits family history (specifically asking for atopy, tuberculosis, pulmonary fibrosis, clotting problems)	0	1
Elicits drug history (including use of ACE inhibitors, beta-blockers, methotrexate)	0	1
Checks for allergies	0	1
Checks if patient smokes or drinks	0	1
Checks occupation of patient	0	1
Asks if occupation or other involves exposure to dust or animals	0	1
Asks for exposure to asbestos	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2
Gives reasonable differential diagnosis (Pulmonary fibrosis possibly secondary to asbestosis or connective tissue disease, Asthma)	0	1