Case 1 – Productive Cough

You are seeing Mr. Smith, a 60 year old man, in your outpatient clinic today for a worsening productive cough. Take a focused history of his complaint.


  • Onset of cough
  • Worsening cough
  • Sputum production and volume
  • Change in sputum color
  • Presence of blood in sputum
  • Associated shortness of breath
  • Fever
  • Chest pain
  • Recent respiratory illnesses
  • Smoking history (quantity in pack-years)
  • Other drug use
  • Personal history of lung disease
  • Occupational history to airborne toxins/irritants
  • Infectious contacts
  • Exposure to environmental allergens
  • Recent travel
  • TB exposure history



  • Comments on presence of central/peripheral cyanosis (frenulum, lips, fingernails)
  • Comments on respiratory status – tachypnea /intercostal indrawing/accessory muscle use, etc.
  • Examines for thoracic deformities


  • Percusses all anterior and posterior fields and comments on findings
  • Uses percussion to estimate diaphragmatic excursion on the posterior chest
  • Assesses fremitus in all anterior and posterior fields and comments on findings
  • Evaluates chest expansion using palpation


  • Instructs patient to breathe while auscultating; listens for at least one full breath at each location of auscultation
  • Auscultates both lung fields in at least 5 different locations
  • Auscultates posterior fields, and asks patient to cross arms in order to shift scapulae away from the lung fields
  • Comments on of breath sounds and presence of adventitious sounds, e.g. crackles and wheezes
Case 1 – Productive Cough