Confirms Patient S Name and Age s2

28 Haemoptysis

Checklist / P / MP / F /
Appropriate introduction
Confirms patient’s name and age
Explains reason for consultation
Obtains consent
Open question to elicit presenting complaint
Allows patient to open up, listens carefully, remains silent and does not interrupt the patient
Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’
History of presenting complaint
Elicits further details of haemoptysis:
• Onset (how did it start)
• Duration of symptoms
• Approximate quantity of blood
• Appearance of blood (and sputum)
• Streaks
• Fresh red
• Dark clots
• Exacerbating factors: smoke, dust, exertion
• Alleviating factors
• Asks whether patient is suffering from any other symptoms
• Asks about any recent illnesses
• Previous episodes of chest pain
Associated symptoms:
• Weight loss
• Night sweats (TB)
• Fevers (TB, pneumonia, vasculitis)
• Hoarseness (cancer)
• Chest pain (cancer)
• Shortness of breath (pulmonary embolism)
• Ankle swelling
• Wheeze (cancer)
• Bony pains (cancer)
• Throat pain (throat malignancy)
• Nosebleeds
• Bleeding elsewhere (haematological disorders): haematuria, haematemesis, epistaxis, bruising, blood in stool
Elicits risk factors for pulmonary embolism/deep vein thrombosis:
• Calf pain/swelling
• Recent travel
• Recent surgery
• Family history of clotting disorders
• Malignancy
• Oral contraceptive pill (if patient female)
• Pregnancy (if patient female)
Review of systems
Past medical history:
• Lung disease
• Heart disease
• Blood disorders
• Any cancer
• Kidney disease, haematuria
• Autoimmune conditions
Family history:
• Lung disease
• Vasculitis
• Bleeding/coagulation disorders
• Kidney disease
Drug history:
• Anticoagulant medication
• NSAIDs
Allergies
Social history:
• Smoking:
• Type of cigarettes/pipes, roll-ups, ‘sheesha’
• Number
• Duration
• Exposure to asbestos
• Alcohol
• Travel history and BCG
• Contact with possible TB patients
• Current and previous occupation(s)
• Pets
Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture
Systematic approach
Explores and responds to ICE:
• Ideas
• Concerns
• Expectations
Shows empathy
Non-verbal skills
Avoids technical jargon
Devises holistic management plan and addresses psychosocial issues as well as medical problems
Summarises
Offers to answer any questions
Thanks patient

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.