Fatima's Cough

Name	Fatima Ahmad
DOB	07/06/1974 (41 years)
Occupation	Decorator
History	I have been coughing for almost two months now bringing up yellow-greenish sputum. If asked directly, at first I thought it was a chest infection but even after antibiotics from the GP that never cleared up. It is pretty severe all day and night and interferes with my sleep. I also wake up with night sweats. There\'s occasionally been a pink tinge to my sputum and I have had a kilogram of weight loss over the last 2 months. I travelled to India around 3 months ago and lived with my family in a crowded flat. I don\'t remember any of them being ill. I deny any other symptoms. I am convinced it is cancer due to my smoking.
Past Medical History	Nil
Drug History	If asked directly, took a course of unknown antibiotics recently
Family History	Father had heart attack at 45 years.
Social History	10 cigarettes per day. Occasional alcohol. No recreational drug use.

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
Elicits character of sputum (bloodstained, clots, green/yellow, offensive smell)	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
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 (Tuberculosis, Atypical pneumonia, Bronchiectasis)	0	1