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HISTORY AND SYMPTOMS IN PULMONARY DISEASES

HISTORY AND SYMPTOMS IN PULMONARY DISEASES. Dr. S. Özdoğan. Patient name Age Sex Occupation 1 Place of birth. Date Smoking history 2 (pack-years) Personal habits 3 Drugs used. Complaints: Should be written in a word, with the patients expression. History. Listen to the patient

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HISTORY AND SYMPTOMS IN PULMONARY DISEASES

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  1. HISTORY AND SYMPTOMS IN PULMONARY DISEASES Dr. S. Özdoğan

  2. Patient name Age Sex Occupation1 Place of birth Date Smoking history2 (pack-years) Personal habits3 Drugs used Complaints: Should be written in a word, with the patients expression

  3. History • Listen to the patient • Can be guided at some points • Write the history afterwards in a chronological order • Dates should be mentioned • Past history, Family history • System inquery

  4. Main Symptoms of Pulmonary Diseases Cough Sputum production Hemopthysis Chest pain Dyspnea General Symptoms Fever Weight loss Fatigue Night sweats (Cyanosis)

  5. Cough • Cough is an explosive expiration that protects the lungs against aspiration and promotes the movement of secretions upward toward the mouth • A reflex act usually arises from the stimulation of cough receptors in the bronchial mucosa and/or interstitium

  6. Mechanism of Cough • Cough receptors: (RAR, C fibers) • Nose, paranasal sinus (N.Trigeminus) • Farenx (N. Glossofaringicus) • Larenx, trachea, main bronchia, interstitium, stomach (N. Vagus) • Pericardium, diaphragma (N. Frenicus) • Efferent ways to respiratory muscles • N Vagus • N Frenicus • Spinal nerves

  7. The categories of cough stimuli • Mechanical (inhalation of irritants; distortions of the airways) • Inflammatory • Chemical • Thermal • Psychogenic

  8. Factors that depress cough • Old age • Unconciousness • Local or general anesthesia • Alcohol • Drugs or neural diseases • Larengeal pathologies • Recurrent stimuli

  9. Cough • Acute or chronic (>6/8 weeks) • Productive or non productive (Swallowed?) • Change in the nature? in chronic coughing patients • Prominent day time (night or daytime)

  10. Acute cough Exogenious irritant inhalation Aspiration, foreign body Common cold, viral infections Acute bacterial sinusitis Exacerbation of chronic bronchitis Rhinitis Pneumonia Congestive hearth failure Pulmonary embolism Chronic cough Postnasal drip syndrome Asthma Gastroesophageal reflux disease Chronic bronchitis Drugs Bronchiectasis Bronchogenic carcinoma, adenoma Chronic interstitial pneumonia Psychogenic Causes of Cough

  11. Complications of Cough • Syncope • Vomiting • Pneumothorax / Pneumomediastinum • Fractures • Inguinal hernia • Urinary incontinans

  12. Sputum • Amount • Mucoid or loose • Duration, positional change • Color • Odor (Bronchore, melanoptisis, biliptisis)

  13. Hemoptysis • The coughing up of blood. Varies from blood tinged sputum to virtually pure blood • Hemoptysis or hematemesis (vomited blood) should be distinguished • Blood from the upper airways should be distinguished • Massive hemopthysis (>100-600 ml/day) • Bleeding diathesis should be considered • Chest x ray should be taken

  14. Infections Pneumonia Tuberculosis Lung abscess Bronchiectasis Fungal and parasitic disease Bronchitis Neoplasm Bronchial carcinoma Bronchial adenoma Foreign body Bleeding diathesis Idiopathic Cardiovascular Pulmonary infarct(embolism) Mitral stenosis Pulmonary edema AV malformation Trauma Pulmonary contusion Iatrogenic Alveolar hemoragie Good pasture sendr SLE Vasculites Behçet sendr Endometriosis Main Causes of Hemoptysis

  15. Diagnostic algoritm for hemopthysis Thorax CT Specific tests normal Appropiate therapy Low risk of malignancy Neoplasm/ Infection Bronchiectasis ILD No Yes FOB Observation

  16. Chest Pain • May originate from • Pleura (inspiratory pain) • Mediastinum (retrosternal) • Chest wall (Changes in body position) • Trachea and main bronchi • Cardiac pain • Abdominal pain

  17. Approach to chest pain • Onset • Duration • Location and radiation pattern • Character • Intensity

  18. Pleural Pleural effusion Pneumothorax Pulmonary embolus Mesothelioma Pulmonary Pulmonary hypertension Tracheobronchitis Tumour Mediastinal Myocardial infarction Angina pectoris Pericarditis Aortic dissection Mediastinitis or emphysema Esophagitis, reflux Causes of Chest pain

  19. Chest wall Myalgia Costochondritis Subacromial bursitis Shoulder and spinal arthritis İntercostal muscle cramps Fibromyalgia Rib fractures Sternal marrow pain Breast inflammation Chest wall tumours Diaphragm spasm Herpes zoster Abdominal Peptic ulcus Cholesistitis Panic attacks

  20. Dyspnea • Dyspnea is a term implying an unusual awareness of breathing or the need to breathe more

  21. Dyspnea is related to: • An increase in airway resistance • An increase in the elastic recoil of the lungs or chest wall • Hyperventilation

  22. Respiratory Airway disease COPD, Emphsema Asthma Bronchiectasis Tumoral obstructions of the airways Bilateral vocal cord paralysis Paranchymal Alveolitis Sarcoidosis Fibrosis Pneumonia Respiratory distress syndrome İnfiltrative tumour Causes of Dyspnea

  23. Pulmonary circulation P. Embolism P. Hypertension P. Arteritis Chest wall and pleura Effusion Pneumothorax Tumour Rib fracture Nöromuscular diseases Thoracal deformities Diaphragmatic paralysis Cardiac Left ventricular failure Mitral valve disease Cardiomyopaties Pericardial effusion, constriction Non cardiorespiratory Psychogenic Anemia Asidosis Hypotalamic lesions

  24. Types of dyspnea • Ortopnea: Dyspnea that occurs when lying flat • Paroxysmal nocturnal dyspnea: Wakes the patient at night • Platipnea: Dyspnea that occurs in sitting position • Trepopnea: Dyspnea occurs when lying aside • İnspiratory dyspnea • Expiratory dyspnea

  25. Medical Research Council (MRC) Dyspnea Scale • Stage 1: Breathless on hills or during a rapid movement on the level • Stage 2: Unable to keep up with people of similar age on the level • Stage 3: Able to walk only 100 m or few minutes on the level and have to rest • Stage 4: Breathless at rest, home bounded

  26. Asthma

  27. General Symptoms • Fever • Weight loss, loss of appetite • Fatigue • Night sweats • Hoarseness

  28. Upper airway Hoarsness Nasal poliposis (obstruction) Postnasal drip Keratokonjonktivitis sicca Hypertrophy in parotis glands ..... Endocrinologic Cushing Gynecomasty D. İnsipitus Carsinoid syndrome Neuromuscular Peripheral neuropathy Myastenic syndrome Encephalomyelitis Connective tissue Clubbing Hypertrophic osteoarthropathy Thromboflebitis Purpura Skin lesions Extrapulmonary symptoms

  29. Thank you %50 of the Diagnosis

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