130226L - HISTORY OF THE RESPIRATORY SYSTEM

Lecture for 3^rd year medical students Faculty of Medicine King Fahad Medical City Riyadh on February 26, 2013 by Professor Omar Hasan Kasule Sr.

MAJOR SYMPTOMS IN THE RESPIRATORY SYSTEM

·         Nasal symptoms

·         Cough

·         Sputum

·         Breathlessness

·         Wheezing

·         Chest pain

NASAL SYMPTOMS: runny nose

·         Secretions in allergic rhinitis are thin and runny.

·         Secretions in common are cold thicker, yellowish-green.

·         Blood stained nasal secretions vs hemoptyisis.

·         Nasal blockage: pain and blood stained secretions.

·         Total nasal blockage associated with polyps.

COUGH

·         Productive cough associated with bronchitis.

·         Dry cough associated with asthma.

·         Cough for psychological problems.

·         Worsening cough associated with bronchial carcinoma.

·         Bovine cough associated with recurrent nerve infiltration by bronchial carcinoma.

·         Stridor or whooping due to laryngeal or tracheal obstruction.

·         Association of cough with smoking,

SPUTUM:

·         Some sputum is normal.

·         Excess sputum is due to smoking.

·         Large sputum in bronchiectasis.

·         Yellow green sputum does not always indicate infection.

HEMOPTYSIS: causes

·         Acute infection:  rusty in lobar pneumonia

·         COPD

·         Pulmonary infarction

·         Pulmonary edema (pink frothy sputum)

·         Bronchial carcinoma

·         Tuberculosis (can be massive)

·         Bronchiectasis (purulent blood stained, can be massive),

BREATHLESSNESS:

·         Dyspnea is sense of awareness increasing awareness of increased respiratory effort.

·         Orthopnea is breathlessness on lying down (due to abdominal organ pressure).  

·         Tachypnea is increased rate of breathing.

·         Hyperpnoea is an increased level (depth) of breathing that is appropriate.

·         Hyperventilation is inappropriate over-breathing.

·         Paroxysmal nocturnal dyspnea.

·         Wheezing is airflow limitation eg in asthma

CHEST PAIN:

·         Localization: Shoulder pain is from the diaphragm. Central chest pain may be cardiac. Retrosternal pain may be due to tracheitis

·         Nature (sharp, dull, etc), effect of breathing on pain (pleuritic). Constant dull pain maybe due to carcinoma.

·         Chest pain may be tenderness of costochondritis.

·         Aggravating/relieving factors

RESPIRATORY DISEASES

·         Asthma

·         Lobar pneumonia

·         Tuberculosis

·         Carcinoma

ASTHMA: etiology

·         Family and allergy to environment, atopy

·         Early childhood exposure

·         Maternal smoking

·         Growing up in a clean environment

·         Asthma and obesity

ASTHMA: precipitating factors

·         Occupational exposure,

·         Cold air,

·         Exercise / exertion,

·         Air pollution,

·         Diet, nutrition

·         Emotion/psychology,

·         Drug,

·         Viral infection

·         Damp house and mouldy and asthma

·         Animals eg cats

ASTHMA: symptoms

·         Principal symptoms: cough, wheezing, dypnea,

·         Allergen induced asthma: immediate reaction, late reaction, recurrent

·         Acute asthma: cannot complete a sentence, tachycardia, tachypnea

ASTHMA: management

·         Control extrinsic factors

·         Drug treatment: Asthma and inhalants; bronchodilators and corticosteroids

·         Monosodium glutamate

LOBAR PNEUMONIA: Precipitating factors

·         Viral infection,

·         Hospitalization,

·         Smoking,

·         Alcohol,

·         Bronchiectasis,

·         Bronchial obstruction (carcinoma),

·         Immune suppression,

·         Iv drugs,

·         Inhalation

LOBAR PNEUMONIA: Presentation

·         Pleuritic pain

·         Dry cough

·         rusty sputum 1-2 days later,

·         Herpes labialis,

·         Rapid shallow breathing,

·         Affected side of chest moves more slowly and more shallow,

·         Bp diastolic low,

·         Confusion

TYPES OF PNEUMONIA

·         Opportunistic infection: HIV CMV

·         Aspiration pneumonia

·         Streptococcus vaccine

·         Strepto otitis media, pericarditis

·         Community vs hospital acquired

·         Ventilator associated pneumonia

·         Esinophilic pneumonia

TUBERCULOSIS: presentation

Vague illness with cough and wheeze, loss of weight, fever

Tiredness malaise anorexia night sweats sputum

Lymph nodes enlarge

Diagnosis: CXR,  Mantox test, sputum culture, bronchoscopy, biopsy

TUBERCULOSIS: prevention and management

·         Tb in HIV, Contact tracing, Drug resistance

·         Prevention by BCG, contact tracing,

·         Mycobacterium tuberculosis resistance

·         Latency/Dormancy and reactivation

·         Diagnosis: Serology, CXR

DISEASES THAT CAN MIMIC RESPIRATORY DISEASES

·         Cardiac conditions: pain, hemoptysis, dyspnea,

·         Abdominal conditions: gastric reflux, ulcers

·         Bone conditions

·         Skin conditions

OTHER THINGS ABOUT RESPIRATOTY CONDITION

·         Use of x-ray

·         Vaccination: strepto and tuberculosis

·         Spirometer

PRACTICAL EXERCISES

·         You will be divided into groups of 3-6.

·         Each group will be given 20 minutes to prepare to interview Prof Omar who will be a simulated patient presenting with all or some of the respiratory symptoms.

·         The task of the group will be to take a respiratory history and form an impression of what the diagnosis is.

·         The group will also record other aspects of general history that are relevant such as: personal, family, social, past medical, past surgical, etc .

·         Each group will have 5 minutes to present its findings in a systematic professional way.