The Respiratory History
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Transcript of The Respiratory History
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8/3/2019 The Respiratory History
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complaintshistory of present complaint
past historyfamily historypersonal and social history
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CoughSputumHaemoptysisDyspnoeaWheezeChest pain
FeverNight sweatsHoarseness
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Duration ?Time of appearance?
Character?Exacerbating factors?Dry or Productive?
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Acute cough (
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C hronic cough
A sthmaUpper airway cough syndromeBronchiectasisA CE inhibitor medicationCarcinoma of the lungCardiac failure
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Worse at night asthma or heart failure
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Barking - A cute croup (emergency), followedby stridor
Loud and brassy -Tracheal compression by atumourHollow sound ( bovine cough ) - Recurrentlaryngeal nerve palsy
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Immediately after eating or drinking oesophageal reflux, rarely a tracheo-
oesophageal fistula.
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What color?How much do you cough up?
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Yellow/ green sputum suggests infection, eg.bronchiectasis or lobar pneumonia
Foul-smelling dark-coloured sputum mayindicate the presence of a lung abscess withanaerobic organismsPink frothy secretions suggest pulmonaryoedema due to left heart failure
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Volume?Mild haemoptysis
- less than 20 mL in 24 hours- appears as streaks of blood discolouring
sputum.Massive haemoptysis
- more than 250 mL of blood in 24 hours andrepresents a medical emergency
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Favours haemoptysis Favours haematemesis
Mixed with sputum Follows nausea
Occurs immediately after coughing
Mixed with vomitus;follows dry retching
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Common Causes of Hemoptysis
a) RespiratoryBronchitisBronchial carcinomaBronchiectasis
PneumoniaPulmonary infarctionCystic fibrosisLung abscessTuberculosisForeign body
Goodpasture s syndromeRupture of a mucosal blood vesselb) Cardiovascular
Mitral stenosisA cute Left ventricular failure
c) Bleeding diastheses
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O nset?Duration?
Severity?- Worsens progressively over a period of
weeks, months or years may be due topulmonary fibrosis.V ariability?
- Diurnal variation: asthma
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A llergens- asthmaPhysical exertion
Lying flatWaking up
Left heart failure
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C lass SymptomsI Heart disease present, but no undue dyspnoea
from ordinary activityII Comfortable at rest; dyspnoea on ordinary
activitiesIII Less than ordinary activity causes dyspnoea,
which is limitingIV Dyspnoea present at rest, all activity causes
discomfort
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A whistling sound made by the flow of high-velocity air through narrowed airwaysMaximal during expiration and isaccompanied by prolonged expirationCauses: A sthma, COPD, infections such asbronchiolitis, airways obstruction by a foreign
body or tumour.
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Pleural pain:- sharp and made worse by deep inspiration
and coughing- typically localised to one area of the chest- may be of sudden onset in patients with lobar
pneumonia, pulmonary embolism andinfarction or pneumothorax, and is oftenassociated with dyspnoea
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Bacterial pneumoniaV iral pneumonia
Tuberculosis
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Episodes of drenching sweating at night :Tuberculosis
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Previous repiratory diseasePrevious repiratory investigations
SpirometryPrevious lung surgeryTreatment
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MinerFactory workers
Exposure to mouldy hay, humidifiers or airconditionersExposure to animals including birds
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SmokingCalculate the number of packet-years of smoking
Number of pack years =(number of cigarettes smoked per day x number of
years smoked)/20A lcohol consumptionIntravenous drug users
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A sthma or other atopic diseasesLung cancer
Emphysema ( A lpha1-antitrypsin deficiency)Tuberculosis