The Respiratory System History PDF

The Respiratory System History Suleiman Momany, MD, FCCP Why to Take History? m 70% of medical problems can be diagnosed by proper history taking m 20% can be diagnosed after physical exam  BeingA Physician [sN tAanelage - To Save Human Lives - Safety First ~® Wash...

The Respiratory System History Suleiman Momany, MD, FCCP Why to Take History? m 70% of medical problems can be diagnosed by proper history taking m 20% can be diagnosed after physical exam  BeingA Physician [sN tAanelage - To Save Human Lives - Safety First ~® Wash hands W ~ Before and after “ Alcohol based gel ‘t« ~ m Use masks, gown, and - PPE when needed S > 4 =/  Handwashing Guide Fig 13 HAND S ® Wet hands with water Apply enough soap to coverall hand surfaces Rub hands palm to palm WASH ~ Right palm over back of the left Palm to palm with fingers Backs of fingers to opposing hand and left palm over back interlaced palms with fingers interlocked of the right hand.. - y b | Rotational rubbing of left Rotational rubbing, backwards Rinse hands with water = thumb clasped in right palm and forwards with clasped.~ gy and vice versa fingers of right hand in left Ed palm and vice versa Dry hands thoroughly with a towel - Communication Know the name of your patient Introduce yourself: Coat and ID Shake hands: cultural issues Gain consent Tell patient what you intend to do (Bothin Hx & P/E) Give a running commentary of what you are doing Basic Requirements for History Taking Satisfactory approach to the patient Give patient adequate time to tell and express himself/herself Competent interrogation and skillful communication - Interviewing ‘m Proper setting for interview Chief complaint History of present illness Continue the patient centered history of present illness Transition to clinician centered process m Patient’s profile [Age, Sex, Residence, Occupation(s) ] ® Chief Complaints = Major symptom(s) = Duration m History of present illness Past history (Medical &Surgical) Medication history Family history Social history = Qccupational history  sinuses Major Symptoms nasal cavity external nares Upper Respiratory tract symptoms Nasal obstruction VVVVYVYV Nasal discharge g diaphragm Sneezing Lower Respiratory tract Epistaxis Sore throat symptoms Cough » Dyspnea » Chest pain Hoarseness » Cough \ A4 Stridor » Sputum » Hemoptysis > Wheezes » Cyanosis Symptoms of Sleep Apneas m Snoring m Excessive Daytime Somnolence m Witnessed Apneas Dyspnea: o4 weeks in hyperreactivity Bronchiectasis children Rhinitis/sinusitis Cigarette smoking Drugs, especially angiotensin-converting i # enzyme inhibitors Irritant dusts/fumes  Sputum ® Amount m Character = Serous = Mucoid = Purulent = Rusty m Viscosity m Taste and odor  Types of Sputu e9 i., faadl iype Appearance Cause “serous Clear, watery Acute pulmonary oedema Frothy, pink Alveolar cell cancer Mucoid Clear, grey Chronic bronchitis/chronic e9 obstructive pulmonary disease White, viscid Asthma Purulent Yellow Acute bronchopulmonary infection Asthma (eosinophils) e9 Green Longer-standing infection Pneumonia Bronchiectasis Cystic fibrosis Lung abscess e9 Rusty Rusty red Pneumococcal pneumonia Hemoptysis ® Amount m Type: frank, streaks, dots, clots m Duration MASSIVE HEMOPTY SIS Causes of Hemoptysis Tumour Malignant Benign * Lung cancer * Bronchial carcinoid ¢ Endobronchial metastases Infection * Bronchiectasis * Mycetoma ® Tuberculosis e (Cystic fibrosis ® Lung abscess Vascular e Pulmonary infarction o Arteriovenous malformation ® Vasculitis ¢ Goodpasture’s syndrome Polyangiitis e |atrogenic Trauma © Bronchoscopic biopsy o Inhaled foreign body Transthoracic lung biopsy o Chest trauma e Bronchoscopic diathermy 0 Cardiac Acute left ventricular failure ¢ Mitral valve disease o Anticoagulation 0 Haematological & Blood dyscrasias e  Wheezes Wheezes are continuous high pitched (400Hz) musical sounds produced by oscillations of airway walls. Wheezes are always accompanied by airflow limitation/ obstruction Louder during expiration Rhonchi are low pitched sounds (200Hz) Stridor is a high-pitched wheezing sound resulting from turbulent airflow in upper airways  Causes of wheezes Bilateral Unilateral Bronchial Asthma m Focal Pathology: CCkD = Foreign body Bronchitis - Mass Bronchiolitis - Pneumonia Bronchicctasis/ = Bronchiectasis (focal) Cystic fibrosis Allergic reaction/ Anaphylaxis Review of systems Symptoms of importance in chest diseases : » Dysphagia and hoarseness of voice. » Constitutional Symptoms as fever, night sweats, loss of appetite and weight. » Cardiac Symptoms: Abdominal symptoms » Systemic symptoms > Anemia ~ Past History ] Previous similar attack or disease Hospitalizations; Ward Vs ICU admission ] Pneumonia/ Recurrent chest infections ] Past Tuberculosis Blood component transfusion n Childhood illnesses; measles and Previous Mechanical Ventilation whooping cough ® Vaccination History Recent anesthesia, loss of m Allergic disorders consciousness, or convulsions [] Travel history (recent or remote) Chest trauma /Chest surgery (& [] Previous illnesses (Duration, other surgeries) Medications, & Interventions) Past History » T.B and history of treatment of T.B. » Medicines, duration of the treatment and the adherence to it. » Previous radiological examination: omparison with the current radiograph  Medication History m History of previous drug allergies m List all current and past medications (duration) m Side effects / drug interactions m Response to treatment m Proper Device use (inhalors) m Follow up of disease severity ( SABA Calendar) ® Drug Induced Lung Disease Respiratory devises Nebulizer Home Oxygen CPAP/BiPAP Home ventilator Family history Atopy Asthma Chronic obstructive lung disease Cystic fibrosis Tuberculosis Obstructive Sleep Apnea Cancer Social history Residence, housing, crowding Occupation Smoking (Pack-Year) Alcohol Hobbies: Keeping pets (birds or animals) Health insurance and financial issues m Extent & Duration of exposure m Previous occupations & exposure m Adherence to safety measures as wearing special masks. m Chemicals m Organic dust ® Animal proteins m Non-organic dust The Spectrum of Occupational Lung Disease Tracheitis, bronchitis and Bronchiolitis Asthma and COPD Cancer Interstitial Disease  Exposure Occupation Lung disease Asbestos Shipyard/construction workers, plumbers, Pulmonary fibrosis boilermakers Miners, quarry workers, stone masons Quartz (silica) ) ) Coal Coal miners Nuclear, aerospace industr ies Beryllium Coal Coal miners COPD Asbestos Shipyard/construction workers, plumbers, - Malignancy boilermakers Radon Metal miners Cotton, flax, hemp Cotton, flax, hemp manufacturing Byssinosis Hypersensitivity pneumonitis Farmer’s lung Fungal spores of thermophilic Farm workers exposed to mouldy hay actinomycetes or Micropolyspora faeni - Malt worker’s lung Aspergillus clavatus Exposure to whisky maltings Bird fancier's lung Bloom on birds’ feathers/excreta Pigeon fanciers, bird owners Asthma Animals Vets, laboratory workers Grains, flour Farmers, bakers, millers Hardwood dusts Joiners, carpenters Colophony Soldering, welders Enzymes Detergent manufacturing, pharmaceuticals Isocyanates Spray painting, varnishing Epoxy resins Adhesives, varnishing Drugs Pharmaceutical industry Formaldehyde, paraldehyde, latex Hospital workers