patients with pulmonary disease

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Objectives

` To discuss the basic elements needed in thehistory taking of a patient with pulmonary

disease

` To enumerate the common symptomspresented by patients with pulmonary

disease

` To go thru the process of how to dissectattributes of a symptom in a patient with

pulmonary disease

History taking in patients with pulmonary disease

` Basic Same as general principles in history

taking

x Make patient comfortablex Concern for privacy make

patient feel respected and at

ease able to extract

information

x Subjective Listen well.

x Make patient feel that theinterviewer is truly interested in

his or her problem.

x Showing that the patient isimportant to the physician

x Must lead or guide the patientthru the discussion

x Avoid lengthy digressionsx Start with broad question going

for localization

x Avoid leading questions,questions answerable by yes or

no

Not too restrictive.x Patient also has the freedom to

mention important items

Avoid using medical terms` Basic Objective

Should lead to a list of reasonable list ofdifferential diagnosis

x Age / Sexx Risk Factorsx Clinical considerationsx History

x Physical examinationPrimary impression

Forms the basis of a diagnostic andtherapeutic plan

MEDICALHISTORY

I.General Data

II.ChiefComplaint (CC)

` Common problems why patients consults apulmonary clinic

Upper respiratory tract symptomsx Nasal congestion / catarrhx Cough

Some Causes and Characteristics ofCough

Cause Characteristics

Sinusitis or

nasopharygnitis

Cough following an upper respiratory

syndrome or sinus symptoms; sensation of a

need to clear the throat; postnasal drip

Acute infections of lungs

Tracheobronchitis Cough associated with sore throat, running

nose and eyes

Lobar pneumonia Dough often preceded by symptoms of upper

respiratory infections; cough dry, painful at

first; later becomes productive

Bronchopneumonia Cough dry or productive , usually begins as

acute bronchitis

Myoplasma and viral

pneumonia

Paroxysmal cough, productive of mucoid or

blood-stained sputum associated with flulike

syndrome

Exacerbation of

chronic bronchitis

Cough productive of mucoid sputum becomes

purulent

Chronic infections of lungs

Bronchitis Cough productive of sputum on most days for

more than 3 consecutive months and for

more than 2 yearsSputum mucoid until acute exacerbation,

when it becomes mucopurulent

Bronchiectasis Cough copious, foul, purulent, often since

childhood ; forms layers upon standing

Tuberculosis or fungus Persistent cough for weeks to months, often

with blood-tinged sputum

Parenchymal inflammatory processes

Interstitial fibrosis and

infiltrations

Cough nonproductive, persistent, depends on

origin

Smoking Cough usually associated with injected

pharynx; persistent, most marked in morning,

usually only slightly productive unless

succeeded by chronic bronchitis

Tumors

Bronchogenic

carcinoma

Cough nonproductive to productive for weeks

to months; recurrent small hemoptysis

common

Alveolar cell carcinoma Cough similar to that with bronchogenic

carcinoma except in occasional instances,

when large quantities of watery, mucoid

sputum are produced

Benign tumors in

airways

Cough nonproductive; occasionally

hemoptysis

Mediastinal tumors Cough, often with breathlessness, caused by

Subject: Physical DiagnosisTopic: Hx Taking: patients withpulmonary diseaseLecturer: Dr. Gary N. CarlosDate of Lecture: -----Transcriptionist: elkie Editor: -----Pages: 4

SY

2011-2012


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compression of trachea and bronchi

Aortic aneurysm Brassy cough

Gastrointestinal

Gastrioesophageal

reflux (GERD)

Nonproductive cough often following meals

or with recumbancy; may (or may not) be

accompanied by other symptoms ofGERD

(e.g., heartburn, a bitter oral taste , belching)

Foreign body

Immediate, while

still in upper

airway

Cough associated with progressive evidence

of asphyxiation

Later, when lodged in

lower airway

Nonproductive cough, persistent, associated

with localizing wheeze

Cardiovascular

Left ventricular failure Cough intensifies while supine, along with

aggravation of dyspnea

Pulmonary infarction Cough associated with hemoptysis, usually

with pleural effusion

Medication-induced

Angiotensin-

converting enzyme

(ACE) inhibitors

Nonproductive cough, more common in

women, may occur at any time (following

soon after drug initiation or with years of use)

Lower respiratory tract symptomsx Cough-Generally caused by irritation

of the cough receptors

-Change in character and

frequency of cough

-May be acute and self limiting

but may be progressive and

problematic

x Sputum production-Can be caused by a variety of

conditions:

Chronic stimulationand hypertrophy of

the bronchial

glands as a defense

mechanism

-Should inquire about

Duration C

haracter Volume Associated

hemoptysis

x Chest pain-Visceral chest pain

Not well localized May be related to a

variety of organs

related to the chest

wall (Cardiac,esophageal, great

vessels)

-Chest wall pain

Sharp, welllocalized (pleuritic)

Associated withinflammation of the

parietal pleura

(Infectious or

inflammatory)

x Difficulty in breathing orbreathlessness

-Sensation of difficulty of breathing

-Subjective

-Difficult to quantitate-Usually caused by:

Increased awareness innormal breathing (anxiety)

Increased in work ofbreathing (Restrictive and

obstructive lung diseases)

Abnormality of theventilatory system

(Dysfunction of the nerves,

respiratory muscles orthoracic cage)

- Causes of Dyspnea

Pulmonary edema Asthma Injury to chest wall and

intrathoracic structures

Spontaneouspneumothorax

Pulmonary embolism Pneumonia Adult respiratory distress

syndrome

Pleural effusion Pulmonary hemorrhage Left ventricular failurex Hemoptysis

-Coughing out of fresh blood

-Can come from any part of the

upper respiratory or lower

respiratory tract

-Should be differentiated from

hematemesis

-Some Common Causes of

Hemoptysis:

Infectiouso Bronchitiso Tuberculosiso Fungal infectionso Pneumoniao Lung abscesso Bronchiectasis

Neoplasmso Bronchogenic

carcinoma

o Bronchial adenoma Cardiovascular disorders


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o Pulmonary infarctionfrom thromboembolism

o Mitral stenosis Trauma

o Foreign body Hematologic/ immunologic

o Blood dyscrasiao Goodpasteures

syndrome

Abnormal laboratory findingsIII.History of Present Illness (HPI)

` 7Attributes1. Location2. Quality3. Quantity or Severity4. Timing onset, duration, frequency5. Setting6. Factors that aggravate or relieve7. Associated manifestations` Symptom analysis / Attributes (OPQRSTU)1. Onset

Acutex Causes ofAcute Dyspnea:

Acute Pulmonary edema *Asthma Injury to chest wall and

intrathoracic structures

Spontaneous pneumothorax Pulmonary embolism Pneumonia Adult respiratory distress

syndrome

Pleural effusion Pulmonary hemorrhage *Left Ventricular failure

Chronicx Causes ofChronic Dyspnea:

Chronic progressive Chronic obstructive pulmonary

disease

*Left Ventricular failure Diffuse interstitial fibrosis *Asthma Pleural effusions Pulmonary thromboembolic

disease

Pulmonary vascular disease Psychogenic dyspnea Anemia, severe Postintubation tracheal stenosis Hypersensitivity disorders

Acute on top of chronic

Overlaps Sequence of events

-Which came first

-Temporal relationship

-complications

2. Palliative/Precipitating

3.Quality/Quantity

MMRCDyspnea Scale: GradeDescription ofBreathlessness

0 I only get breathless withstrenuous exercise.

1 I get short of breath whenhurrying on level ground or walking

up a slight hill.

2 On level ground, I walk slowerthan people of the same age

because of breathlessness, or have

to stop for breath when walking at

my own pace.

3 I stop for breath after walkingabout 100 yards or after a few

minutes on level ground.

4 I am too breathless to leave thehouse or I am breathless when

dressing.

4.Region/Radiation

5.Severity / Setting

Severity-Effects on daily activities

-Rating scale

Setting-Environmental factors

-Personal activities

-Emotional reactions

-Circumstances that may have triggered

the symptoms

6.Time

7.Usual associated sign/symptoms

Other Upper respiratory tract symptoms:x Rhinorrhea, conjunctivitis, sneezingx Allergic rhinitis, asthmax Postnasal dripsx Common cause of chronic coughx Nosebleeds/epistaxisx Tumors, FB, hematologic problems,

hypertension

x Upper respiratory tract abnormalitiesx Infections of the lungs and pleura

IV. Past Medical History

` Allergies to food and drugs?` Previous hospitalization / Surgery` Immunizations` Asthma` Pulmonary tuberculosis


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patients with pulmonary disease

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