Respiratory Symptoms

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Respiratory Symptoms
Zhao Li, M.D.
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Common symptoms

• Cough
• Expectoration
• Hemoptysis
• Chest pain
• Cyanosis
• Dyspnea

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Cough (a protective reflex) causes

• Respiratory diseases___ the most common causes
• Airway agents
• Bronchitis, bronchiectasis, asthma, endobronchial
  tuberculosis, tumor, pharyngitis
• Lung agents
• Infection, edema, fibrosis, tumor
• Pleural agents
• Pleurisy, pneumothorax, mesothelioma of pleura
• Cardiovascular diseases
• Cardiogenesis edema, pulmonary embolism
• Central nervous system agents
• Initiative cough, encephalitis, meningitis

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Cough manifestations

• Characteristics
• Dry cough (non-sputum non-infectious)
• Productive cough (sputum infectious, edema)
• Attack
• Time
• season
• motivation
• Tone
• Hoarseness
• High pitch
• Weak
• Brassy

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Cough accompany signs

• Fever (infection)
• Chest pain (infection, tumor, pleurisy,
  pneumothorax, pulmo embolism)
• Dyspnea
• Hemoptysis (bronchietasis, tuberculosis, tumor)
• Bulk pus sputum (bronchietasis, lung abscess)
• Wheezing (asthma, foreign body)
• Clubbing fingers (bronchietasis, lung cancer,
  chronic lung abscess)

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Sputum amount

• Bulk frothy sputum
• Pulmo edema
• Bulk serofluid sputum
• Alveolar carcinoma
• Bulk pus sputum
• Bronchiectasis
• Lung abscess
• Layering
• upper frothy,
• middle mucoid or mucopus,
• lower necrosis substance

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Sputum consistency

• Mucoid sputum
• Bronchitis (without bacterial infection)
• Asthma
• Early stage of pneumonia
• Serofluid sputum
• Pulmo edema
• Pus sputum
• Any bacterial infection
• Bloody sputum

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Sputum color

• White
• mucoid or serofluid sputum
• Yellow
• general bacterial infection
• Green
• aeruginosus Bacillus infection
• Grey or black
• dust inhalation
• Rusty
• Lobar pneumonia
• Pink
• cardiac edema
• Red
• hemoptysis

Grey or black
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Sputum foul odor

• anaerobic bacterium infection

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Hemoptysis

• Bleeding from lower respiratory tract
• The amount varies from blood-strained sputum to
  several hundreds ml pure blood
• Mild ?100ml/d
• Moderate 100-500/d
• Severe gt500ml/d, or 100-500/time
• Differential diagnosis
• Bleeding from upper respiratory tract
• Hematemesis

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Distinguished hemoptysis from hematemesis
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Hemoptysis causes

• Bronchial disorders
• Bronchiectasis
• Bronchogenic carcinoma
• endobronchial TB
• Chronic bronchitis
• Pulmo Disorders
• Pulmo TB
• Peumonia
• Lung abscess
• Pulmo embolism
• Cardiovascular disorders
• Acute left heart failure
• Mitral stenosis
• Others
• Hematologic disease, leptospirosis
  (??????),epidemic hemorrhagic fever,endometriosis
  (???????)

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Hemoptysis accompany signs

• Fever
• Infection or carcinoma
• Chest pain
• Infection, Pulmo Embolism,Carcinoma
• Pus sputum
• Bronchiectasis,Lung abscess
• Clubbing fingers
• Bronchiectasis,Lung abscess,Carcinoma
• Hemorrhagic spots
• Hematologic disease, leptospirosis, epidemic
  hemorrhagic fever

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Chest pain causes

• Chest wall
• herpes zoster, rib fracture
• Cardiovascular
• angina pectoris, myocardial infarction,
  pericarditis, dissecting aneurysm (?????)
• Respiratory
• Pleural disorders, pneumothorax, carcinoma
• Mediastinal
• Mediastinitis, mediastinal emphysema, mediastinal
  tumor
• Others
• esophageal carcinoma, liver abscess,
  subdiaphragmatic abscess, hiatal hernia (?????)

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Chest pain characteristics

• location
• Referred pain
• Level or feature
• Burning pain, pressing pain, bursting pain,
  pricking pain
• Duration
• Influential factors
• Exertional, respiration, foodintake,
  administration

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Chest pain accompany signs

• Cough, sputum and/or fever
• Respiratory disease
• Dyspnea
• Severe pneumonia, pneumothorax, pleurisy, pulmo
  embolism
• Hemoptysis
• Carcinoma, pulmo embolism
• Shock
• myocardial infarction, dissecting aneurysm
  (rupture ), large area pulmo embolism
• Dysphagia (????)
• Esophageal disease

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Cyanosis

• An excess of desaturated hemoglobin causes a blue
  coloration of the skin or mucosae.
• methemoglobinemia (????????)
• Poisoning by nitrite (Methylthioninium Chloride
  iv, ???)

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Cyanosis classification

• Central (warm)
• Deficient oxygenation
• Right-to-left shunt
• Peripheral (cold)
• Reduced cardiac output
• Local vasoconstriction
• Mixed
• Heart failure

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Cyanosis accompany signs

• Dyspnea
• Severe cardiac or respiratory disorder
• Clubbing fingers
• Congenital heart disease
• Chronic respiratory disease
• Unconsciousness
• Poisoning, shock, Severe cardiac or respiratory
  disorder

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Dyspnea causes

• Respiratory system
• Obstruction asthma, COPD, tumor
• Pulmo Diseases pneumonia, interstitial lung
  disease,
• Chest wall or pleura pleurisy, pneumothorax,
  trauma
• neuro-muscles poliomyelitis ( ?????), myasthenia
  gravis (?????)
• Diaphragma movement disorder obviously elevated
  pressure in abdominal cavity
• Cardiovascular system
• Heart failure
• Pulmo embolism
• Poisoning
• ketoacidosis
• Central nervous system
• cerebral tumor , trauma, abscess, hemorrhage,
  encephalitis, meningitis
• hematological system
• Severe anemia

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Respiratory Dyspnea

• Inspiratory dyspnea
• ____obstruction in large airway
• Three depression sign
• depression in suprasternal fossa,
  supraclavicular fossa, intercostal space
• Expiratory dyspnea
• ____obstruction in small airway or
  alveolar elasticity decreased
• Prolonged expiratory time
• Expiratory rhonchi
• Mixed dyspnea
• ____deficient gas exchange
• Respiratory rate increased
• Shallow breathing

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Cardiac dyspnea ____ Heart failure
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Features of left heart failure

• Underlying diseases
• Mixed dyspnea
• Position related dyspnea
• Moist crackles or rhonchi in both lungs
• Relief of symptoms after digitalis, diuretic,
  vasodilator agent used

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Nocturnal paroxysmal dyspnea

• Characteristics
• Awoken due to chest tightness or dyspnea
• Forced sitting position or orthopnea
• Severe sweat
• Tachycardia
• Moist crackles or rhonchi in both lungs
• Pink frothy sputum

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Nocturnal paroxysmal dyspnea
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Poisoning dyspnea

• Underlying diseases of metabolic acidosis
  (uremia, diabetic ketoacidosis )
• deep breathing (Kussmaul breathing)

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Dyspnea accompany signs (1)

• Rhonchi
• Asthma
• Acute left heart failure (cardiac asthma)
• Foreign body in large airway
• Acute laryngeal edema
• Chest pain
• Infection
• Pneumothorax
• Pulmo embolism
• Lung cancer
• Acute myocardial infarct

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Dyspnea accompany signs (2)

• Fever
• Infection
• Cough and sputum
• COPD
• Infection
• Left heart failure
• Unconsciousness
• CNS disorder
• Uremia
• diabetic ketoacidosis