_4 History Taking in Respiratory_Diseases

7/30/2019 _4 History Taking in Respiratory_Diseases

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Dr Musa Malkawi

MBChB (Baghdad)FRCP (London)

Consultant Chest Physician

Jordan University of Science and

Technology


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History Taking in RespiratoryDiseases


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History and Physical Exam are

Skills


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What is the Importance of

Taking History? 70% of medical problems can be

diagnosed by proper history taking

20% can be diagnosed after physical

exam


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Basic Requirements for History

Taking Satisfactory approach to the patient

Give patient adequate time to tell and

express himself

Competent interrogation and skillfulcommunication


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History Taking in Respiratory

Diseases Major symptoms

Past history

Family history

Occupational history

Social history


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Major Symptoms

Upper respiratory tract

Lower respiratory tract


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Major Symptoms

Upper respiratory tract symptoms

nasal obstruction

nasal discharge

sneezing

epistaxis

sore throathoarseness

stridor

cough


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Major Symptoms

Lower respiratory tract symptoms

cough

sputum

hemoptysis

chest pain

dyspnea

wheeze


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Cough

The 5th most common symptom seen

in outpatient clinics

An explosive expiration that clearsthe tracheobronchial tree from

secretions and foreign materials

Intrathoracic pressure may reach

300mmHg and expiratory velocity

500 miles/h


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Cough

Onset

Duration

Diurnal variation

Dry or productive


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Common Causes of Chronic

Cough of Unclear Etiology Asthma

Upper airway syndrome

Gastroesophageal reflux

Drugs


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Sputum

Amount

Character

serousmucoid

purulent

rusty Viscosity

Taste and odor


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Hemoptysis

Amount

Type

Duration


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Chest pain

Central

trachea

heartvessels

esophagus

LateralpleuriticH. zooster

root compression


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Dyspnea

Unpleasant and unexpected

awareness of breathing

Factors contributing to dyspneaincreased work of breathing

increased ventilatory drive

impaired respiratory muscle function


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Increased work of breathingairflow limitation

decreased compliancerestricted expansion

Increased pulmonary ventilation

increased physiological dead spacemetabolic acidosissevere hypoxiahysterical

Weakness of respiratory musclespoliomyelitis, myasthenia gravis, spinalcord injury


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NYHA Severity Grading of

Dyspnea Grade I no dyspnea at rest or on

moderate exertion

Grade II dyspnea on moderateexertion

Grade III dyspnea on mild exertionbut minimal at rest

Grade IV significant dyspnea at restsevere on minimal exertion


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Common Causes of Chronic

Dyspnea of Unclear Etiology Asthma

COPD

Interstitial lung disease

Myocardial dysfunction

Obesity/deconditioning


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Wheeze

Wheezes are continuous high pitched(400Hz) musical sounds produced byoscillations of airway walls. Theoscillations begins when the airflowvelocity reaches a critical value called

flutter velocity. Wheezes alwaysaccompanied by flow limitation. Rhonchiare low pitched sounds (200Hz)

Invariably louder during expiration andmay be confined to expiration

Stridor


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Past history

Previous x-rays

Tuberculosis

Pneumonia Childhood illnesses; measles and

whooping cough

Chest trauma Recent anaesthesia or loss of

consciousness


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Family history

Atopy

Cystic fibrosis

Tuberculosis

Chronic obstructive lung disease


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Occupational history

Chemicals

Organic dust

Animal proteins

Non-organic dust


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Social history

Smoking

Alcohol

Keeping pets (birds or animals)


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_4 History Taking in Respiratory_Diseases

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