HISTORY-TAKING-IN-RESPIRATORY-SYSTEM-converted.pdf

Pulmonology

3. SYMPTOMS
•Cough
•Sputumproduction
•breathlessness
•ChestPain
•Hemoptysis
•Wheeze /Stridor

4. COUGH
•Reflex act of forceful expiration against a
closed glottis generating positive intrathoracic
pressure as high as 300 mm Hg.
•Aim is to clear the airways.

6. Acute cough (<3wks)
•Upper respiratory tractinfections
•Pneumonia
•Pulmonaryembolism
•Congestive CardiacFailure

7. Subacute cough (3-8weeks)
•Viralinfections
•Postinfective
•Post nasaldrip
•GERD

8. Chronic cough >8wks
•PulmonaryTuberculosis
•BronchialAsthma
•COPD
•Bronchogeniccarcinoma
•Eosinophilicbronchitis
•Post nasaldrip
•GERD
•Drugs like ACE inhibitors
•Congestive cardiacfailure

9. Nocturnalcough
•Post nasaldrip.
•GERD
•Chronicbrochitis.
•Bronchial asthma.
•Obstructive sleepapnea
•Left VentricularFailure
•Aspiration

10. SPUTUM
•Consistency
•Amount
•Color
•Posturalvariation
•Smell

11. CONSISTENCY
•Serous -Upper Respiratory tract Infection,
Bronchoalvelolar carcinoma
•Mucoid -Chronic bronchitis, BronchialAsthma
•Mucopurulent -Bacterialinfection

12. CopiousAmount
–Bronchiectasis
–LungAbscess
–Necrotizingpneumonia
–Alveolar cell carcinoma
–Empyema rupturing intobronchus
(Bronchorrhoea->100mlsptum/day)

13. –Yellow / Green —Bacterialinfection
–Black —coal workerpneumoconiosis
–Pink frothy sputum —Pulmonaryedema
–Rusty sputum-pneumococcalpneumonia
–Red currant jelly sputum-klebsiella
–Blood tinged / streaking of sputum-tuberculosis
–Anchovy sauce —Ruptured amoebic liver
abscess.

14. –Lung Abscess
–Bronchiectasis

15. –Lungabscess
–Bronchiectasis
–Anaerobic bacterialinfection

16. DYSPNEA
•Onset
•Duration
•Severity
•Aggravating and relievingfactors
•Posturalvariation
•Diurnalvariation

17. Withinminutes
–Pneumothorax
–Pulmonaryembolism
–Inhalation of foreignbody
–Larygeal edema
–Left heartfailure

18. –Acute Respiratory DistressSyndrome
–BronchialAsthma
–Pneumonia
–Left heartfailure

19. –COPD
–ILD
–Pleuraleffusion
–Anemia
–Thyrotoxicosis
–Left ventricular failure

20. Grade Description ofBreathlessness
0 I only get breathless with strenuousexercise.
1 I get short of breath when hurrying on level ground or walking up a slight
hill.
2 On level ground, I walk slower than people of the same age because of
breathlessness, or have to stop for breath when walking at my ownpace.
3 Istopforbreathafterwalkingabout100yardsorafterafewminuteson
levelground.
4 I am too breathless to leave the house or I am breathless whendressing.

21. •Aggravatingfactors
–Exposure toallergen
–Exercise
–Drugs
–Cold whether
•Relievingfactors
–Medication
–Rest
–Removal ofallergen

22. –Bronchialasthma
–Lungabscess
–Bronchiectasis

23. Types
•Frank-expectoration of bloodonly
•Spurious-secondary to upper respiratory tract
infection above the level oflarynx
•Pseudo hemoptysis-due to pigment produced
by gram negative bacteria, Serratia
marcescens

24. Severity
•Mild <100ml/day
•Moderate100-150ml/day
•Severeupto 200ml/day
•Massive > 600ml /day or 100ml/day for more
than 3 days or 150ml/hr.

25. HAEMOPTYSIS
Nausea & vomiting precedes
No air, mixed with food particles
pHacidic
Darkbrown
Coughprecedes
Frothy, may be mixed withsputum
Ph
alkaline
Brightred
H/o respiratory disease
No h/omalena
Investigation: bronchoscopy
h/o peptic ulcer or chronic liverdisease
h/o malena present
Investigation:endoscopy

26. Infection-
–TB
–LungAbscess
–Bronchiectasis
–Pneumonia
–Fungal infection (aspergillosisblastomycosis)

27. –Bronchogenicca
–Bronchialadenoma
–Metastatictumour

28. CVS
–MS
–PHT
–Pulmonaryembolism
–AVmalfromation

29. •Collagen vasculardisorder
–Vasculitis
–Wegener’ sgranulomatosis
–Microscopicpolyangitis
–Churgstrasusssyndrome
–Goodpastures’ssyndrome
•Traumatic
•Iatrogenic.
•Bleedingdisorder

30. CHESTPAIN
•Site
•Onset
•Duration
•Severity
•Character
•Radiation
•Associated symptoms
•Aggravating/Relievingfactor
•Diurnal /seasonalvariation
•Retrosternal Pain:-

31. •Upper
–Tracheatis
•Mid andLower
–Mediastinitis
–Mediastinaltumor
–GERD
–Achalasiacardia
•Diffuse esophagealspasm

32. •Pleural Inflammation–Catchy pain, increases on
deep inspiration and on pressure is stabbing in
chararcter.
•Pancoasttumor–shoulderandarmpaindueto
compressionofC8,T1-2rootsissharpshooting
painalongthecourseofnerve.
•Erosionofribs–constantdullachingchestpain.
•Tietze’ssyndrome–costochondritis(usually2
nd
costochondraljunction),unknownetiology.
“Always keep ‘Angina’ inmind”