精品（钩端螺旋体病）课件

Respiratory Symptoms,Zhao Li, M.D.,Common symptoms,Cough Expectoration Hemoptysis Chest pain Cyanosis Dyspnea,Cough (a protective reflex): causes,Respiratory diseases_ the most common causes Airway agents Bronchitis, bronchiectasis, asthma, endobronchial tuberculosis, tumor, pharyngitis Lung agents Infection, edema, fibrosis, tumor Pleural agents Pleurisy, pneumothorax, mesothelioma of pleura,Cough (a protective reflex): causes,Cardiovascular diseases Cardiogenesis edema, pulmonary embolism Central nervous system agents Initiative cough, encephalitis, meningitis,Cough : manifestations,Characteristics Dry cough (non-sputum) Productive cough (sputum: infectious, edema) Attack Time (morning, midnight, early morning) Season (spring, summer, fall and/or winter) Motivation (fume inhalation, exertion) Tone Hoarseness High pitch Weak Brassy,Cough: accompany signs,Fever (infection) Chest pain (infection, tumor, pleurisy, pneumothorax, pulmo embolism) Dyspnea Hemoptysis (bronchietasis, tuberculosis, tumor) Bulk pus sputum (bronchietasis, lung abscess) Wheezing (asthma, foreign body) Clubbing fingers (bronchietasis, lung cancer, chronic lung abscess),Sputum: amount,Bulk frothy sputum Pulmo edema Bulk serofluid sputum Alveolar cell carcinoma Bulk pus sputum Bronchiectasis Lung abscess Layering upper: frothy, middle: mucoid or mucopus, lower: necrosis substance,Sputum: consistency,Mucoid sputum Bronchitis (without bacterial infection) Asthma Early stage of pneumonia Serofluid sputum Pulmo edema Pus sputum Any bacterial infection Bloody sputum,Sputum: color,White mucoid or serofluid sputum Yellow general bacterial infection Green aeruginosus Bacillus infection Grey or black dust inhalation Rusty Lobar pneumonia Pink cardiac edema Red hemoptysis,Grey or black,Sputum: foul odor,anaerobic bacterium infection,Hemoptysis,Bleeding from lower respiratory tract The amount varies from blood-strained sputum to several hundreds ml pure blood Mild: 100ml/d Moderate: 100-500/d Severe: 500 ml/d, or 100-500 ml/time Differential diagnosis Bleeding from upper respiratory tract Hematemesis,Distinguished hemoptysis from hematemesis,Hemoptysis: causes,Bronchial disorders Bronchiectasis Bronchogenic carcinoma endobronchial TB Chronic bronchitis Pulmo Disorders Pulmo TB Peumonia Lung abscess Pulmo embolism,Hemoptysis: causes,Cardiovascular disorders Acute left heart failure Mitral stenosis Others Hematologic disease, leptospirosis （钩端螺旋体病），epidemic hemorrhagic fever，endometriosis （子宫内膜异位症）,Hemoptysis: accompany signs,Fever Infection or carcinoma Chest pain Infection， Pulmo Embolism，Carcinoma Pus sputum Bronchiectasis，Lung abscess Clubbing fingers Bronchiectasis，Lung abscess，Carcinoma Hemorrhagic spots Hematologic disease, leptospirosis, epidemic hemorrhagic fever,Chest pain: causes,Chest wall herpes zoster, rib fracture Cardiovascular angina pectoris, myocardial infarction, pericarditis, dissecting aneurysm （夹层动脉瘤） Respiratory Pleural disorders, pneumothorax, carcinoma Mediastinal Mediastinitis, mediastinal emphysema, mediastinal tumor Others esophageal carcinoma, liver abscess, subdiaphragmatic abscess, hiatal hernia （食道裂孔疝）,Chest pain: characteristics,location Referred pain feature Burning pain, pressing pain, bursting pain, pricking pain Duration Influential factors Exertional, respiration, foodintake, administration,Chest pain: accompany signs,Cough, sputum and/or fever Respiratory disease Dyspnea Severe pneumonia, pneumothorax, pleurisy, pulmo embolism Hemoptysis Carcinoma, pulmo embolism Shock myocardial infarction, dissecting aneurysm (rupture ), large area pulmo embolism Dysphagia (吞咽困难) Esophageal disease,Cyanosis,An excess of desaturated hemoglobin causes a blue coloration of the skin or mucosae. methemoglobinemia (高铁血红蛋白血症） Poisoning by nitrite,Cyanosis: classification,Central (warm) Deficient oxygenation Right-to-left shunt Peripheral (cold) Reduced cardiac output Local vasoconstriction Mixed Heart failure,Cyanosis: accompany signs,Dyspnea Severe cardiac or respiratory disorder Clubbing fingers Congenital heart disease Chronic respiratory disease Unconsciousness Poisoning, shock, Severe cardiac or respiratory disorder,Dyspnea: causes,Respiratory system Obstruction: asthma, COPD, tumor Pulmo Diseases: pneumonia, interstitial lung disease, Chest wall or pleura: pleurisy, pneumothorax, trauma neuro-muscles: poliomyelitis ( 脊髓灰质炎), myasthenia gravis (重症肌无力) Diaphragma movement disorder: obviously elevated pressure in abdominal cavity,Dyspnea: causes,Cardiovascular system Heart failure Pulmo embolism Poisoning ketoacidosis Central nervous system cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis hematological system Severe anemia,Respiratory Dyspnea,Inspiratory dyspnea _obstruction in large airway Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal space Expiratory dyspnea_obstruction in small airway or alveolar elasticity decreased Prolonged expiratory time Expiratory rhonchi Mixed dyspnea_deficient gas exchange Respiratory rate increased Shallow breathing,Cardiac dyspnea _ Heart failure,Features of left heart failure,Underlying diseases Mixed dyspnea Position related dyspnea Moist crackles or rhonchi in both lungs Relief of symptoms after digitalis, diuretic, vasodilator agent used,Nocturnal paroxysmal dyspnea,Characteristics Awoken due to chest tightness or dyspnea Forced sitting position or orthopnea Severe sweat Tachycardia Moi