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

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Cough (a protective reflex) causes

• 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)
• Productive cough (sputum infectious, edema)
• Attack
• Time (morning, midnight, early morning)
• Season (spring, summer, fall and/or winter)
• Motivation (fume inhalation, exertion)
• 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 cell 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 gt500 ml/d, or 100-500 ml/time
• Differential diagnosis
• Bleeding from upper respiratory tract
• Hematemesis

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Distinguished hemoptysis from hematemesis
Hemoptysis Hematemesis
Causes Pulmo or cardiac digestive system
Previous symptoms Cough, chest tightness Nausea, vomiting
Spit up Cough up Vomited
Color Bright red Dark red
Mixture Sputum, frothy Gastric contents
pH alkality acidity
Tarry stools - or
Post-bleeding Sputum with blood No sputum
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Hemoptysis causes

• Bronchial disorders
• Bronchiectasis
• Bronchogenic carcinoma
• endobronchial TB
• Chronic bronchitis
• Pulmo Disorders
• Pulmo TB
• Peumonia
• Lung abscess
• Pulmo embolism

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Hemoptysis causes

• 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
• 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

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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

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Dyspnea causes

• 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

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Clubbing finger