Slide1: HISTORY
TAKING EXAMINATION INVESTIGATIONS MANAGEMENT
HISTORY TAKING: DEVELOP A RELATIONSHIP WITH THE PERSON
LET THE PERSON DESCRIBE HIS OR HER PROBLEM
BE A MEDICAL DETECTIVE TO ESTABLISH THE DIAGNOSIS
FIND OUT ABOUT THE PERSON'S MEDICAL AND DRUG HISTORY
PUT THE ILLNESS INTO CONTEXT IN THE PERSON'S LIFE
PREPARE YOURSELF FOR SALIENT FINDINGS IN THE PHYSICAL EXAMINATION
HISTORY TAKING
THE SYMPTOMS OF RESPIRATORY DISEASE: THE SYMPTOMS OF RESPIRATORY DISEASE COUGH
SPUTUM
HEMOPTYSIS
WHEEZING
BREATHLESSNESS (DYSPNOEA)
APNOEA
CHEST PAIN
OTHER (F.E.: FEVER, WEAKNESS)
COUGH: COUGH FREQUENCY
SEVERITY
CHARACTER
IS IT DRY OR PRODUCTIVE (IS SPUTUM PRESENT?)?
IS THERE ANY OTHER ABNORMALITIES (PLEURAL PAIN, PROBLEMS WITH VENTILATION ETC.)?
WHAT IS RESPONSIBLE FOR THE COUGH?
COUGH: COUGH
SPUTUM: SPUTUM
AMOUNT
VISCOSITY
TASTE OR ODOUR
CHARACTER
SPUTUM: SPUTUM
HAEMOPTYSIS: HAEMOPTYSIS FROM LOWER RESPIRATORY TRACT
BRIGHT RED
OFTEN FROTHY
CAN BE MIXED WITH SPUTUM
OTHER CAUSES
F.E.: GASTROINTESTINAL
DENTAL PROBLEMS !!! SUSPICION OF BRONCHIAL CARCINOMA!!!
HAEMOPTYSIS - CAUSES: HAEMOPTYSIS - CAUSES COMMON
BRONCHIAL CARCINOMA
PULMONARY INFARCTION
TUBERCULOSIS
BRONCHIECTASIS
LUNG ABSCESS
ACUTE BRONCHITIS
CHRONIC BRONCHITIS
OTHER
MITRAL STENOSIS
ASPERGILLOMA
TUMORS…
CONNECTIVE TIISUE DISEASE
GOODPASTEURE’S SYNDROME
ANTICOAGULATION
HYPERTENSION
FOREIGN BODY INHALATION
CHEST TRAUMA
IATROGENIC
WHEEZING OR STRIDOR: WHEEZING OR STRIDOR WEEZING
PRODUCED BY THE
PASSAGE OF AIR
TROUGH NARROWED
BRONCHI
(LOWER DURING EXPIRATION) STRIDOR
CAUSED BY PARTIAL
OBSTRUCTION OF
A MAJOR AIRWAYS
TUMOR
FOREIGN BODY
BREATHLESSNESS (DYSPNOEA): BREATHLESSNESS (DYSPNOEA) THE UNDUE AWARENESS OF BREATHING OR OF THE NEED TO BREATHE MORE
SHORTNESS OF BREATH
FEELING PUFFFED
DIFFICULTY IN BREATHING IN OR OUT
INABILITY TO GET ENOUGH AIR ASK THE PATIENT ABOUT THE DEVELOPMENT OF
BREATHLESSNESS AND ASSOCIATED SYMPTOMS
BREATHLESSNESS (DYSPNOEA): BREATHLESSNESS (DYSPNOEA) PULMONARY CAUSES
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
PULMONARY FIBROSIS
COLLAPSE DUE TO OBSTRUCTING BRONCHIAL CARCINOMA
PULMONARY FIBROSIS
PNEUMONIA
ASTHMA
AIRWAY OCCLUSION (FOREIGN BODY OR LARYNGEAL OEDEMA – F.E.: ANAPHYLAXIS)
SPONTANEUS PNEUMOTHORAX
ACUTE PULMONARY EMBOLISM OTHER
PSYCHOGENIC
ANEMIA
RESPIRATORY MUSCLE WEAKNESS
LEFT HEART FAILURE (F.E.: AFTER MI)
ACUTE PULMONARY OEDEMA DUE TO LEFT HEART FAILURE (MYOCARDIAL INFARCTION OR CARDIAC ARRHYTHMIA)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE: CHRONIC OBSTRUCTIVE PULMONARY DISEASE DESTRUCTION OF LUNG TISSUE OR EXCESSIVE MUCUS PRODUCTION
SLOW PROGRESSION
WORSE WITH INFECTION, IRRITANTS
ALWAYS WITH COUGH
IMPORTANT PAST HISTORY
(TABACCO, TOXINS, OFTEN INFECTIONS)
PNEUMONIA: PNEUMONIA INFLAMATION OF LUNG TISSUE
DIFFERENT DURATION (DEPENDENT ON FACTOR EVOKING INFECTION)
CHEST PAIN
COUGH
SPUTUM PRODUCTION (OFTEN PURULENT)
FEVER PRESENT
ASTHMA: ASTHMA HYPERRESPONSIVE AIRWAYS RELEASING INFLAMMATORY MEDIATORS, INCREASING SECRETIONS AND CONSTRICTING AIRWAYS
ACUTE EPISODES AND SYMPTOM FREE PERIODS
OFTEN AT NIGHT
AGGRAVATED BY ALLERGENS, INFECTIONS, EXERCISE, STRESS, DRUGS
WHEEZING AND COUGH PRESENT
SPONTANEUS PNEUMOTHORAX: SPONTANEUS PNEUMOTHORAX LEAKAGE OF AIR INTO PLEURAL CAVITY WITH PARTIAL LUNG COLLAPSE
WITH PAIN AND COUGH
YOUNG HEALTHY TALL THIN ADULT
ACUTE PULMONARY EMBOLISM: ACUTE PULMONARY EMBOLISM OCCLUSION OF A PULMONARY ARTERIAL TREE BY A BLOOD CLOT
DYSPNEA
MAY BE:
PAIN
COUGH
HEMOPTYSIS RISK FACTORS:
POST – PARTUM
POST – OPERATIVE
BED REST
FRACTURE
CANCER
COAGULOPATHY
ARTIFICIAL IMPLANTS
APNOEA: APNOEA VOLUNTARILY HELD OF BREATH FOR SHORT PERIOD
APNOEA ALTERNATE WITH OVERVENTILATION IN CHEYENE – STOKES BREATHING
APNOEA DURING SLEEP IS OF TWO MAIN TYPES:
- OBSTRUCTIVE SLEEP APNOEA
(UPPER AIRWAYS IS INTERMITTENTLY OBSTRUCTED – OBESE SHORT – NECKED ADULTS WHO SNORE LOUDLY)
- CENTRAL SLEEP APNOEA
(FOR UP TO 10s IN HEATLY PEOPLE)
CHEST PAIN: CHEST PAIN RETROSTERNAL
TRACHEOBRONCHITIS
MEDIASTINAL TUMORS
ACUTE MEDIASTINITIS
MEDIASTINAL EMPHYSEMA
LESIONS OF HEART AND GREAT VESSELS
OESOPHAGEAL DISORDERS
NON – CENTRAL (LATERAL)
PLEURAL PAIN
PLEURISY
PNEUMONIA
NEOPLASM
PULMONARY INFARCTION (FROM PULMONARY EMBOLISM)
RIB FRACTURES
DIRECT INVASION OF CHEST WALL BY TUMOR OR RIB METASTATIC LESIONS
SPINAL NERVE ROOT INVOLVEMENT BY VERTEBRAL DISEASE (USUALLY VERTEBRAL BODY COLLAPSE)
HERPES ZOSTER
COXACKIE B INFECTION (BRONHOLM DISEASE)
TRACHEOBRONCHITIS: TRACHEOBRONCHITIS RESULTS FROM INFLAMMATION OF TRACHEA AND LARGE BRONCHI.
LOCATED UNDER THE UPPER STERNUM OR ON EITHER SIDE OF THE STERNUM.
BURNING IN QUALITY AND MILD TO MODERATE IN SEVERITY.
TIMING OF THE PAIN IS VARIABLE AND IT IS MADE WORSE BY COUGH WHICH OFTEN ACCOMPANIES IT.
PLEURAL PAIN: PLEURAL PAIN LOCATED IN THE AREA OF THE CHEST WALL OVERLYING THE PROCESS
BURNING AND KNIFE-LIKE AND OFTEN SEVERE
PERSISTENT
WORSENED BY BREATHING, COUGHING, MOVING THE TRUNK
RELIEVED BY LYING ON THE INVOLVED SIDE
SYMPTOMS OF THE UNDERLYING ILLNESS, FOR EXAMPLE SHORTNESS OF BREATH WITH PULMONARY EMBOLISM
PAST MEDICAL HISTORY: PAST MEDICAL HISTORY
FAMILY HISTORY: FAMILY HISTORY
ALLERGIC DISORDERS
TUBERCULOSIS CONTACT
CHRONIC INFLAMATION
NEOPLASMATIC PROBLEMS IN FAMILY
PROFESSIONAL AND SOCIAL HISTORY: PROFESSIONAL AND SOCIAL HISTORY OCCUPATIONS
HOBBIES
PETS
TABACCO
CHEMICAL SUBSTANCES
(COAL, SILICA, ASBESTOS, ORGANIC DUSTS)
Thank you: Thank you