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