HPIM Chapter 278 Chronic disorders s/a tracheomalacia
APPROACH TO THE PATIENT WITH DISEASE OF THE o Hemoptysis
RESPIRATORY SYSTEM >1 symptom: identify which symptom is primary
Identify other constitutional symptoms:
Cardinal symptoms: cough and/or dyspnea o Fever
Categories o Weight loss
o Night sweats
Dyspnea
o Useful descriptive words:
Dyspnea with chest tightness/ inability to get a deep
breath COPD
Air hunger/ sense of suffocation CHF
o Tempo of dyspnea:
Acute SOB: laryngeal edema, bronchospasm, MI, PE,
PTX
Gradual progression of dyspnea on exertion:
INTERSTITIAL PULMONARY FIBROSIS/COPD
Intermittent episodes of dyspnea/ cough/chest
tightness: Asthma
o What to ask?
Factors that incite/relieve dyspnea
Determine degree of activity that results in SOB
(dyspnea on exertion)
Cough
o Duration
o Productive/nonproductive
Quality of sputum – blood-streaked, frankly bloody
o Timing
Acute cough productive of phlegm infection of
respiratory system
HISTORY Upper airways: sinusitis, tracheitis
Common symptoms Lower airways: bronchitis, bronchiectasis
o Dyspnea Lung parenchyma: pneumonia
o Cough Chronic cough (>8wks)
o Chest pain Obstructive Lung Diseases
o Wheezing Nonrespiratory diseases: GERD/postnasal drip
High-pitched whistling noise produced by movement Persistent nonproductive cough
of air through narrowed or compressed small Interstitial pulmonary fibrosis
airways Other symptoms
Airflow through a narrowed or compressed segment o Wheezing – suggestive of airway disease (Asthma)
of a small airway becomes turbulent, causing o Hemoptysis
vibration of airway walls Respiratory tract infection, bronchogenic carcinoma,
More common during expiration because increased PE
intrathoracic pressure during this phase narrows the o Chest pain
airways and airways narrow as lung volume NOTE: Lung parenchyma is not innervated by pain
decreases. fibers; chest pain results from diseases of parietal
o Stridor pleura or pulmonary vascular diseases
High-pitched, whistling, predominantly inspiratory o Diseases of the lung strain R side of the heart cor
sound pulmonale, abdominal bloating, distention, pedal
D/t rapid, turbulent flow of air through a narrow/ edema
partially obstructed segment of extrathoracic upper Additional History
airway (pharynx, epiglottis, larynx, extrathoracic o Cigarette smoking, secondhand smoke, inhalational
trachea) exposures (occupational and envt’l)
Acute disorders s/a foreign body aspiration
APPROACH TO THE PATIENT WITH DISEASE OF THE o Hemoptysis
RESPIRATORY SYSTEM >1 symptom: identify which symptom is primary
Identify other constitutional symptoms:
Cardinal symptoms: cough and/or dyspnea o Fever
Categories o Weight loss
o Night sweats
Dyspnea
o Useful descriptive words:
Dyspnea with chest tightness/ inability to get a deep
breath COPD
Air hunger/ sense of suffocation CHF
o Tempo of dyspnea:
Acute SOB: laryngeal edema, bronchospasm, MI, PE,
PTX
Gradual progression of dyspnea on exertion:
INTERSTITIAL PULMONARY FIBROSIS/COPD
Intermittent episodes of dyspnea/ cough/chest
tightness: Asthma
o What to ask?
Factors that incite/relieve dyspnea
Determine degree of activity that results in SOB
(dyspnea on exertion)
Cough
o Duration
o Productive/nonproductive
Quality of sputum – blood-streaked, frankly bloody
o Timing
Acute cough productive of phlegm infection of
respiratory system
HISTORY Upper airways: sinusitis, tracheitis
Common symptoms Lower airways: bronchitis, bronchiectasis
o Dyspnea Lung parenchyma: pneumonia
o Cough Chronic cough (>8wks)
o Chest pain Obstructive Lung Diseases
o Wheezing Nonrespiratory diseases: GERD/postnasal drip
High-pitched whistling noise produced by movement Persistent nonproductive cough
of air through narrowed or compressed small Interstitial pulmonary fibrosis
airways Other symptoms
Airflow through a narrowed or compressed segment o Wheezing – suggestive of airway disease (Asthma)
of a small airway becomes turbulent, causing o Hemoptysis
vibration of airway walls Respiratory tract infection, bronchogenic carcinoma,
More common during expiration because increased PE
intrathoracic pressure during this phase narrows the o Chest pain
airways and airways narrow as lung volume NOTE: Lung parenchyma is not innervated by pain
decreases. fibers; chest pain results from diseases of parietal
o Stridor pleura or pulmonary vascular diseases
High-pitched, whistling, predominantly inspiratory o Diseases of the lung strain R side of the heart cor
sound pulmonale, abdominal bloating, distention, pedal
D/t rapid, turbulent flow of air through a narrow/ edema
partially obstructed segment of extrathoracic upper Additional History
airway (pharynx, epiglottis, larynx, extrathoracic o Cigarette smoking, secondhand smoke, inhalational
trachea) exposures (occupational and envt’l)
Acute disorders s/a foreign body aspiration
