诊断学英文课件：Respiratory Symptoms

1、Respiratory Symptoms,The “five-finger” approach,Interrogation,Physical examination,Assistant examination,Auxiliary examination,Routine laboratory examination,Common symptoms,Cough Expectoration Hemoptysis Chest pain Cyanosis Dyspnea,Common symptoms,Cough Expectoration Hemoptysis Chest pain Cyanosis

2、Dyspnea,Concept,cough,A protective reflex act The most common respiratory symptom. clean excessive secretion & foreign material Severe cough is a serious clinical problem. Initiated by miscellaneous stimuli or by voluntary exertion.,Attack Motivation,Irritant type: mechanical chemical inflammatory t

3、hermal Haze, dust, fume cold air emotion exercise,Cough: causes,Respiratory diseases_ the most common causes Airway agents Airway stimulation by chemicals & foreign material (smoker & occupational exposure) Airway infection & inflammation Bronchitis, bronchiectasis, asthma, endobronchial tuberculosi

4、s, tumor, pharyngitis, laryngitis,Cough: causes,Respiratory diseases Lung agents Infection, edema, fibrosis, tumor Pleural agents Pleurisy, pneumothorax, mesothelioma of pleura,Cough: causes,Cardiovascular diseases Pulmo edema, pulmo embolism,Pulmo edema,Cough: causes,GERD (gastroesophageal reflux d

5、isease) Central nervous system agents Initiative cough, encephalitis, meningitis,Mechanisms,A coordinated series of movement complete the cough. Briefness quick inspiration diaphragm down-expiration effort with glottis closed- expiratorymuscle (abdominal muscle, diaphragm) contraction- intrathoracic

6、 pressure- glottis open abruptly high velocity of airflow brings out secretions from airways.,Some questions should be ask:,1 describe your cough 2 How long ? 3 sudden onset? 4 characteristic? 5 produce sputum? Color ,amount, foul odor? 6 worse position? 7 some associated symptoms: fever, chest pain

7、, Night sweat, weight loss, 8 smoke? feed birds? Exposed to dust ? 9 effect of treatment,Cough : manifestations (1),Characteristics Dry cough (non-sputum) Productive cough (sputum: infectious, edema) Tone Hoarseness (rough quality of voice) Disorders in larynx (inflammation, TB, cancer) impaired fun

8、ction of the recurrent laryngeal nerve High pitch (barking, breaking) Epiglottitis, pertussis Brassy (stridor) Obstruction or compression in main airway Inadequate Emphysema Weakness Clearing of throat postnasal discharge (rhinitis, nasosinusitis) postnasal drip syndrome (PNDS),Cough : manifestation

9、s (2),The duration and pattern of cough Suddenly onset Acute airway infection or foreign body in the trachea or bronchi. Chronic cough Chronic bronchitis, bronchial asthma and tuberculosis.,Cough : manifestations (3),Attack Time Morning COPD, bronchiectasis, lung abscess (accumulation of sputum in t

10、he lower airway) Midnight or early morning Asthma, TB, left heart failure (excitability of vagus nerve increased at the time),Cough : manifestations (4),Attack Season Spring or summer Asthma (allergic to pollen) fall and/or winter COPD,Cough: accompany symptoms and signs,Fever (infection) Chest pain

11、 (infection, tumor, pleurisy, pneumothorax, pulmo embolism) Dyspnea Hemoptysis (bronchiectasis, tuberculosis, tumor) Bulk pus sputum (bronchietasis, lung abscess) Wheezing (asthma, foreign body inhalation) Clubbed fingers (bronchiectasis, lung cancer, chronic lung abscess),Clubbed fingers,Sputum: co

12、nsistency,Mucoid sputum Bronchitis (frothy,without bacterial infection) Asthma Early stage of pneumonia Serofluid sputum Pulmo edema Pus sputum Any bacterial infection Bloody sputum,Sputum: amount,Bulk pink frothy sputum Pulmo edema Bulk serofluid sputum bronchioalveolar carcinoma Bulk pus sputum Br

13、onchiectasis Lung abscess Relation of the amount and the posture Pulmo edema Bronchiectasis Lung abscess,Bronchiectasis,Sputum: color,White mucoid or serofluid sputum Yellow general bacterial infection Green Pseudomonas aeruginosa bacillus infection Grey or black dust inhalation Rusty Lobar pneumoni

14、a Pink Acute left heart failure Red hemoptysis,Sputum: foul odor,anaerobic bacterium infection,CASE Brief History,Name: LinXX Sex: female Age: 43 years old Occupation: housewife Married status: married,Chief Complaint,Cough with mucopurulent sputum for more than 5 years,Present Illness,Cough with mu

15、copurulent sputum, hemoptysis ,paroxysmal cough in the morning. Regular felt chest tightness, Shortness of breath that gets worse with exercise.,Personal History,Food allergy: nil Drug allergy: nil Smoking: denied Alcohol drinking: denied,PHYSICAL EXAMINATION,Moist rales in the lung. Clubbed fingers

16、.,Hemoptysis Definition,Bleeding from lower respiratory tract Hemoptysis is the expectoration of blood from the airway below larynx, nose, mouth and upper respiratory tract Hematemesis ,hemtemss,Distinguished hemoptysis from hematemesis,Hemoptysis: causes,Bronchial disorders Bronchiectasis Bronchoge

17、nic carcinoma endobronchial TB Chronic bronchitis Pulmo Disorders Pulmo TB Peumonia (pneumococcal pneumonia is classically described as rusty“) Lung abscess Pulmo embolism, metastasis,Hemoptysis: causes,Cardiovascular disorders Mitral stenosis Acute left heart failure (Pink,frothy sputum) Pulmonary

18、infarction rupture of endobronchial vessels Others Hematologic disease (leukemia), epidemic hemorrhagic fever，connective tissue disease. endometriosis ,end()mitrss,Hemoptysis: manifestations (1),Age Youth:pulmonary tuberculosis, bronchiectasis, and rheumatic heart disease (mitral stenosis) Elder peo

19、ple: 40, heavy smoker,bronchogenic carcinoma Amount The amount varies from blood-streak sputum to several hundreds ml pure blood Mild: 100ml/d Moderate: 100-500/d Severe: 500 ml/d, or 100-500 ml/time,Hemoptysis: manifestations (2),Color and character Bright red: TB, bronchiectasis Rusty: pneumococca

20、l pneumonia Brick-red jelly: Klebsiellar pneumonia Dark red: mitral stenosis Pink frothy: acute left cardiac failure,Hemoptysis: accompany signs,Fever Infection Chest pain Infection， Pulmo Embolism，Carcinoma Pus sputum Bronchiectasis，Lung abscess Irritating cough bronchogenic carcinoma, mycoplasma p

21、neumonia. Hemorrhagic spots Hematologic disease, leptospirosis, epidemic hemorrhagic fever Jaundice leptospirosis, lobar pneumonia, pulmonary infarction.,Chest pain: causes,Chest pain: causes,Diseases of chest wall Cardiac and blood vessel causes Respiratory diseases Mediastinal disease Extrathoraci

22、c structure gallbladder, stomach,Chest pain: mechanisms,Any stimulus to sensory nerve of chest hypoxia, inflammation, tumor, necrosis, physical or chemical intercostal nerve sympathetic nerves of heart and aorta vagus nerve of bronchus Sensory nerve of diaphragm Radiating pain: referred pain Retrost

23、ernal pain, radiates to L shoulder or L arm. Others: neck, jaw or back,Chest pain: diseases(1),Chest wall herpes zoster rib fracture Costochondritis Chest wall tumors cervical spondylosis,Chest pain: diseases(2),Cardiovascular myocardial ischemia angina pectoris Acute coronary syndrome(ACS) Unstable

24、 angina Non-st-segment Elevation Myocardial Infarction (NSTEMI) St segment Elevation Myocardial Infarction (STEMI),Acute coronary syndrome,Chest pain: diseases(2),Cardiovascular pericarditis, dissecting aortic aneurysm Pulmonary embolism,pericarditis,Chest pain: diseases(3),Respiratory Bronchitis, p

25、neumonia, pleuritis , pneumothorax, carcinoma,Chest pain: diseases(4),Mediastinal disease mediastinitis Reflux esophagitis esophageal carcinoma,esophagitis,Chest pain: diseases(5),Extrathoracic subdiaphragmatic abscess, liver abscess cancer gastritis,Chest pain: characteristics,Age Location Referred

26、 pain Feature (quality) Duration severity Aggravated factors,Chest pain: accompany signs,Cough, sputum and/or fever Respiratory disease Dyspnea Severe pneumonia, pneumothorax, pleurisy, pulmo embolism, angina pectoris, Hemoptysis Carcinoma, pulmo embolism Shock myocardial infarction, dissecting aort

27、ic aneurysm (rupture), large area pulmo embolism Dysphagia Esophageal disease,Life Threatening Causes of Chest Pain,Acute Coronary Syndromes Pulmonary Embolism Tension Pneumothorax Aortic Dissection Esophageal Rupture Pericarditis with Tamponade,Cyanosis,Cyanosis,Cyanosis is a bluish discoloration o

28、f the skin or mucous membranes resulting from increased amount of reduced hemoglobin or of abnormal hemoglobin pigments in the blood perfusing these areas. Methemoglobinemia methi:mu,lubini:mi Sulfhemoglobinemia Cyanosis becomes apparent at a mean capillary concentration of 50 g/L deoxyhemoglobin Cy

29、anosis may be absent in patients with severe anemia despite marked arterial desaturation,Cyanosis: causes(1),Deoxyhemoglobin increased Respiratory disease: Pulmonary ventilation disorder Cardiovascular disease heart failure congenital heart disease Peripheral abnormal circulation Reduced cardiac out

30、put Local vasoconstriction Low oxygen pressure in high altitude area,Cyanosis: causes(2),Cyanosis resulting from abnormal hemoglobin pigments in the blood. Methemoglobinemia methi:mu,lubini:mi Hereditary, idiopathic, drugs or chemical poisoning (methemoglobin 30 g/L) such as nitrite salt, sulfa drug

31、s etc. Sulfhemoglobinemia (sulfhemoglobin 5 g/L),Cyanosis: classification,Central (warm) Deficient oxygenation Right-to-left shunt Peripheral (cold) congestive peripheral cyanosis and ischemic peripheral cyanosis Reduced cardiac output Local vasoconstriction, obstruction Mixed Heart failure,Cyanosis

32、: accompany signs,Dyspnea Severe cardiac or respiratory disorder Clubbing fingers Congenital heart disease Chronic respiratory disease Unconsciousness Poisoning, shock, Severe cardiac or respiratory disorder,Male, 18 years old He was suffered from increasing shortness of breath for one week, accompa

33、nied with a high fever. And he also had chest pain on the right side that worsens with deep inspiration.,Case,Chest examination revealed dullness to percussion, the absence of fremitus, and diminished breath sounds on the right side. No distended neck veins, no peripheral edema was observed. The che

34、st radiograph was showed as picture,dense white shadow with a concave upper edge,Dyspnea: definition,Dyspnea is defined as an awareness of difficulty in breathing. Most patients suffer from actual difficulty, some patients just taste an awareness of hyperventilation,How to describe these sensations,

35、Cannot get enough air Air does not go all the way down Smothering feeling in the chest Tightness in the chest Fatigue in the chest,Definition,Dilatation of nares, cyanosis, use of accessory muscles of respiration Abnormalities of respiratory rate, depth or rhythm,Etiology,Respiratory disease Cardic

36、disease Toxic Neuro-Psychogenic Haematological disease Normal person may experience the physiologic dyspnea during heavy exercise Environment short of oxygen,Dyspnea: causes,Respiratory system Obstruction: asthma, COPD, tumor Pulmo Diseases: pneumonia, interstitial lung disease, Chest wall or pleura

37、: pleurisy, pneumothorax, trauma neuro-muscles: poliomyelitis ,plmalats myasthenia gravis Diaphragm movement disorder: Increase of abdominal pressure (massive ascites, pregnancy etc) Respiratory dyspnea is caused by abnormal ventilation and gas exchange.,Respiratory Dyspnea,Inspiratory dyspnea Expir

38、atory dyspnea Mixed dyspnea,Respiratory Dyspnea,Inspiratory dyspnea _obstruction in large airway Stenosis and obstruction of larynx, trachea, and bronchi Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal space Accompanied by a coarse, high pitched inspiratory

39、 wheezing and dry cough.,Respiratory Dyspnea,Expiratory dyspnea obstruction in small airway or alveolar elasticity decreased Clinical characteristics: expiration is prolonged and laboured with wheezing. Prolonged expiratory time Expiratory rhonchi,Respiratory Dyspnea,Mixed dyspnea _deficient gas exc

40、hange Respiratory rate increased Shallow breathing Breathing is difficult during both inspiration and expiration.,Cardiac dyspnea,Cardiac dyspnea is usually attributable to pulmonary vascular congestion resulting from the left and/or right heart failure. Dyspnea is the primary symptom of left heart

41、failure.,Left heart failure,Basal diseases: Coronary heart disease Hypertensive heart disease Rheumatic heart disease Congenital heart disease,Cardiac dyspnea _ Heart failure,Features of left heart failure,Underlying diseases Mixed dyspnea Position related dyspnea Moist crackles or rhonchi in both l

42、ungs Relief of symptoms after digitalis, diuretic, vasodilator agent used,Left heart failure,Clinical representation: Exhausted dyspnea Orthopnea Paroxysmal nocturnal dyspnea,Orthopnea,Difficulty in breathing in the supine position relived by sitting up Reduce the degree of pulmonary congestion by p

43、ooling blood in the lower extremities Improve the diaphragmatic movement Increase vital capacity,Nocturnal paroxysmal dyspnea,Characteristics Awoken due to chest tightness or dyspnea Forced sitting position or orthopnea Severe sweat Tachycardia Pink frothy sputum moist rales at the both lung bases, wheezing and bronchospasm Cardiac asthma,Nocturnal paroxysmal dyspnea,Right heart failure,Basal diseases: Acute cor pulmonale which caused by pulmonary embolism Chronic cor pulmonale which caused by chronic obstructive pulmonary disease,Rig