SYMPTOMS



SYMPTOMS

RESPIRATORY SYSTEM

BY

Nusrum Iqbal MD

Respiratory

Cough (productive or non productive)

change in cough

sputum (amount, characteristic, duration)

wheezing

Hemoptysis

shortness of breath

chest pain

Cough

Cough is a reflex response to stimuli that irritates receptors in the larynx, trachea, or large bronchi.

These stimuli can be external or internal

It usually represents respiratory problem but can also be due to cardiovascular cause

Questions to be asked from the patients

“Do you have a cough?”

“Do you have to clear your throat in the morning?”

“Do you have a cigarette cough?”

Determine the timing of the cough

Is it a new symptom or more chronic?

How frequent is it?

When does it occur?

Is it seasonal?

Are there factors that seem to precipitate or aggravate it?

Has a chronic cough changed in any way?

Assess the cough qualitatively by asking whether it is dry or productive of sputum (phlegm)

Ask the patient to describe the volume of the sputum and its color, odor, and consistency

Symptoms associated with cough often lead you to the diagnosis

Cough

Post nasal drip

Chronic bronchitis

Bronchial Asthma

Emphysema

Pneumonia

Pulmonary tuberculosis

Laryngitis

Lung abscess

Medications (ACE inhibitors)

Gastroesophageal reflux disease

Left ventricular failure and mitral stenosis

Pulmonary emboli

Irritating particles, chemicals, or gases

Shortness of Breath

Dyspnea

Dyspnea is a nonpainful but uncomfortable awareness of breathing that is inappropriate to the circumstances

Dyspnea commonly results from the respiratory or cardiac disease, but also frequently accompanies anxiety

Questions to be asked from the patients

Ask if the patient has had any difficulty in breathing

Ask when the symptom occurs, at rest or with exercise, and how much effort produces it

Try to determine the severity based on the patient’s daily activities

How may steps or flight of stairs can the patient climb without pausing for breath?

How about work? Carrying the groceries?

Moping the floor or making the bed?

Carefully determine the timing and setting of dyspnea, associated symptoms, and factors that aggravate it or relieve it

Shortness of Breath (dyspnea)

difficulty in breathing

Bronchial Asthma

Chronic Bronchitis

Emphysema

Pneumonia

Left sided heart failure

Interstitial lung disease

Acute Pulmonary embolism

Spontaneous Pneumothorax

Anxiety with hyperventilation

HEMOPTYSIS

Hemoptysis is the coughing or “spitting up” of blood, which may vary from blood-streaked phlegm to pure blood

Assess the volume of the blood produced together with other attributes of the sputum

Focus the further questions on the setting in which the hemoptysis occurred and the associated symptoms

Identify the origin of blood

If the blood or blood streaked material appears without coughing, it may originate from mouth or pharynx

If it is vomited rather coughed, it is probably originates in the gastrointestinal tract

Hemoptysis

Chronic Bronchitis

Pulmonary tuberculosis

Bacterial pneumonia

Brochiectasis

Bronchogenic carcinoma

Lung abscess

Mitral stenosis

WHEEZING

Wheezing are musical respiratory sounds that may be audible to both to the patient and to the others

Wheezing suggest partial airway obstruction

Wheezing

Bronchial Asthma

Chronic Bronchitis

Emphysema

Bronchogenic carcinoma

Congestive heart failure

CHEST PAIN

Chest pain or discomfort frequently raises concern about the heart diseases, but it commonly originates in other structures as well

The myocardium

The pericardium

The Aorta

The trachea and large bronchi

The parietal pleura

The esophagus

The chest wall

The extrathoracic structure

Myocardial infarction, angina pectoris

Pericarditis

Dissecting aneurysm

Tracheobronchitis

Pleurisy, Pericarditis

Reflux esophagitis, esophageal spasm

Costochondritis, herpes zoster

Cervical arthritis, biliary colic, gastritis

Questions to be asked from the patients

Do you have discomfort or unpleasant feelings in your chest?

Ask the patient to show the exact location and watch for any gestures

All seven attributes of the symptom are often needed to differentiate among the various causes of chest pain

It is important to ask “is the pain related to exertion?” Does it radiate to the neck, shoulder, back, or down the arm?”

Chest pain

Myocardial infarction

Angina pectoris

Pericarditis

Pneumonia

Pulmonary embolism

Pneumothorax

Pleuritis

Pleural effusion

Bronchogenic carcinoma

Musculoskeletal pain

Sputum

Color

Quantity

Change in the color

Association with the position

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