Respiratory System History & Symptoms PDF

Respiratory System THE HISTORY PROFESSOR ANDREW L MBEWE Introduction Respiratory Diseases third most common cause of death in Zambia As with any disease: The key to diagnosis is a clear and carefully recorded history. Recall History Physical Examination Differential diagnosis Labora...

Respiratory System THE HISTORY PROFESSOR ANDREW L MBEWE Introduction Respiratory Diseases third most common cause of death in Zambia As with any disease: The key to diagnosis is a clear and carefully recorded history. Recall History Physical Examination Differential diagnosis Laboratory Investigations Diagnosis Treatment Discharge/Death Follow up History Presenting complaint-Symptoms History of presenting Complaint Past Medical History Drug History Smoking and alcohol History Social History Immunization History Occupational History Health Status of Guardian/Parents Review of systems Most common Symptoms Breathlessness Cough Excessive sputum Haemoptysis Wheeze Chest Pain BREATHLESSNESS Strenuous exertion Breathlessness inappropriate to the level of physical exertion, or even occurring at rest is called DYSPNOEA HYPOXIA-Lowered blood oxygen tension HYPERCAPNIA-Raised blood carbon dioxide tension CARDIAC DISEASE ANAEMIA THYROTOXICOSIS METABOLIC ACIDOSIS PRIMARY RESPIRATORY DISEASE LIKE PNEUMONIA COUGH-1 COUGH REFLEX The COUGH RECEPTORS, located mainly on the posterior wall of the TRANCHEA, PHARYYNX, and at the CARINA OF THE TRACHEA, the point where the trachea branches into the main bronchi. The receptors are less abundant in the distal airways and absent beyond the respiratory BRONCHIOLES. COUGH-2 COUGH REFLEX When triggered, impulses travel via the INTERNAL LARYNGEAL NERVE, a branch of the SUPERIOR LARYNGEAL NERVE which stems from the VAGUS NERVE (CN X) to the medulla of the brain. This is the AFFERENT NEURAL PATHWAY. Going to the Brain There is no definitive area that has been identified as the cough centre in the brain. COUGH-3 COUGH REFLEX THE EFFERENT NEURAL PATHWAY then follows, with relevant signals transmitted back from the CEREBRAL CORTEX AND MEDULLA via the VAGUS and SUPERIOR LARYNGEAL NERVES to the glottis, external intercostals, diaphragm, and other COUGH-4 The mechanism of a cough is as follows: Diaphragm (innervated by phrenic nerve) and external intercostal muscles (innervated by segmental intercostal nerves) contract, creating a negative pressure around the lung. Air rushes into the lungs in order to equalise the pressure. The glottis closes (muscles innervated by recurrent laryngeal nerve) and the vocal cords contract to shut the larynx. COUGH-5 The abdominal muscles contract to accentuate the action of the relaxing diaphragm; simultaneously, the other expiratory muscles contract. These actions increase the pressure of air within the lungs. The vocal cords relax and the glottis opens, releasing air at over 100 mph. The bronchi and non-cartilaginous portions of the trachea collapse to form slits through which the air is forced, which clears out any irritants attached to the respiratory lining. COUGH -6 May be dry or productive. Determine duration Is cough worse at anytime of day or night? Is cough aggravated by anything? SPUTUM COLOR YELLOW OR GREEN-Purulent SMALL AMOUNTS, VERY THICK OR JELLY LIKE-Asthma AMOUNT A lot exceeding one cupful- BRONCHIECTASIS HAEMOPTYSIS Coughing up of blood in the sputum. Epistaxis Ask about malaena Tuberculosis Carcinoma Injury WHEEZING Wheezing happens when the airways are tightened, blocked, or inflamed, making a person's breathing sound like whistling or squeaking. Common causes include a cold, asthma, allergies, or more serious conditions, such as chronic obstructive pulmonary disease (COPD). PAIN IN THE CHEST INFLAMED PLEURA SOME CAUSES OF CHEST PAIN PNEUMONIA CANCER PNEUMOTHORAX PULMONARY EMBOLUS MYOCARDIAL ISCHAEMIA RELEVANT HISTORY TO RESPIRATORY SYSTEM UPPER AIRWAY RHINOSINUSITIS POST NASAL DRIP OF RHINITIS CHANGE IN VOICE PROBLEMS OF EAR NOSE AND THROAT. SMOKING HISTORY THE FAMILY HISTORY OCCUPATIONAL HISTORY EXAMINATION OF THE RESPIRATORY SYSTEM