Presentation on theme: "Dr. Hesham Atef AbdelHalim Lecturer of Pulmonary Medicine"— Presentation transcript:
1 Dr. Hesham Atef AbdelHalim Lecturer of Pulmonary Medicine HISTORYDr. Hesham Atef AbdelHalimLecturer of Pulmonary MedicineAin Shams University
2 Taking a patient’s history is the most important skill in medicine; it is the keystone of clinical diagnosis and the foundation for the doctor–patient relationship. The history will help you to formulate a differential diagnosis and focus your physical examination. As important, it will also help you in getting to know patients, winning their confidence and understanding the social context of their illness.
3 The consultation is best viewed as a ‘meeting of two experts’: the patient, an expert on the experience of illness and the unique context in which it has occurred, and the clinician, an expert on the diagnosis and management of illness.
4 The aims of history taking To identify the relevant organ system(s) responsible for symptoms.To clarify the nature of the pathological processes at play.To characterize the social context of patients’ illness, their concerns, their interpretation of symptoms, beliefs and attributions and any limitations of daily activities consequent upon their illness.
5 Components of Chest Case History Personal historyComplaintHistory of present illnessCardinal chest symptomsMinor chest symptomsPast historyFamily history
6 Personal history Name Age Sex Marital history (+\- children) race ResidenceOccupationHabits of medical importance
16 History of present illness (cont’d) All symptoms should be analyzed as regards onset, course, and duration .All should be arranged chronologicallyNegative cardinal chest symptoms should be mentioned
17 The 6 Chest Cardinal Symptoms DyspneaCoughExpectorationHemoptysisChest PainChest Wheezes
18 DyspneaDyspnea is a term used to characterize a subjective experience of breathing discomfort.
19 The cause of dyspnea may be either: Organic:( cardiac, chest, general).RespiratoryCardiacGeneral causesFunctional (e.g. exercise, emotion)
20 Dyspnea is clinically divided into: ExertionalMild, moderate or severe.At restOrthopnea (advanced CHF, COPD or asthma- massive ascites, late months of pregnancy)ParoxysmalCardiac / bronchial asthmaOthers?(e.g. Carcinoid, Uremic asthma)
21 Modified Medical Research Council Grading of dyspneaModified Medical Research CouncilDyspnoea ScaleGrade 0 “I only get breathless with strenuous exercise” 1 “I get short of breath when hurrying on the level or walking up a slight hill” 2 “I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level” 3 “I stop for breath after walking about 100 yards or after a few minutes on the level” 4 “I am too breathless to leave the house” or “I am breathless when dressing” NB: This is the modified MRC scale that uses the same descriptors as the original MRC scale in which the descriptors are numbered 1-5. The modified MRC scale (0-4) is used for calculation of BODE index.
23 CoughCough is the sudden and explosive forcing of air through the closed glottis. NB: There is no normal cough
24 Analysis of cough Dry or productive Dry: URTI, irritant inhalation Productive: Abscess, chronic bronchitis, pneumoniaTiming:MorningNightNo relation
25 Short or paroxysmal Short: URTI, Pleurisy Paroxysmal: FB, asthma Character e.g.Brassy: (cough with a metalic hard quality) intrathoracic tumors or aneurysm compressing on the trachea.Bovine: (a cough that lost its expulsive character and becomes prolonged with wheezing) affection of recurrent laryngeal nerve.SuppressedCroupComplications……..Back
26 Expectoration Time. Amount. Color: Whitish: Bronchitis, asthma, acute pulm. edema.Yellowish: Purulent infections, eosinophilia.Greenish: Retained pus, pyocyaneous infection.Rusty: Pneumococcal pneumonia.Chocolate or anchovy sauce: Amoebic abscessRed current jelly: Freidlander pneumonia, mycoplasma pneumonia, bronchogenic carcinoma.Black: Coal worker pneumoconiosis.Grey: Admixture with carbon as in town dwellers.Pink: Acute pulmonary congestion.
28 Haemoptysis Definition: Coughing of blood Analysis: Amount Frequency Type & color (frank, mixed or blood tinged)AmountFrequencyLast attackEffect on general conditionManagement / Blood transfusion
29 Life threatening: If more than 150cc Causes: Massive: If more than 200 to 600ml within 24 hrs or 400 ml within 3 hrs.Life threatening: If more than 150cc(which equals the anatomical dead space)Causes:TBBronchiectasisMycetomaBronchogenic carcinomaLung abscessNecrotizing pneumoniaVascular anomaliesFalse (spurious) or true: Above or Below vocal cords
30 Haemoptysis Hematemesis HistoryChest or cardiac diseaseDyspepsia, vomiting, alcoholismBloodBright red, with froth of sputumCoffee ground, + food particlesSputumRemains blood tinged for few days after attackNo sputumStoolNormalMelenaReaction to LitmusAlkalineAcidicExaminationEvidence of chest orcardiac diseaseEpigastric tenderness or liver cirrhosis, splenomegaly
31 DD of Haemoptysis (most common causes) Acute/ chronic bronchitisTBMSLung abscess, BronchiectasisBronchogenic carcinoma/ adenomaPulmonary infarctionBack
32 Chest Pain Analysis: Onset, course & duration Site Character Severity Reference / RadiationWhat precipitates & what relievesAssociated symptoms
36 Chest WheezesDefinition: Sound of breathing Could be inspiratory, expiratory, or both
37 Analysis:TimeDurationFrequencySeverityWhat Precipitates ?What relieves ?Response to usual medicationCondition between attacksHospitalizationAssociated symptoms
38 Causes of Chest Wheezes Obstructive diseases e.g upper airway obstruction, bronchial asthma, COPDRestrictive diseases e.g. EAA, EosinophiliaPulmonary vascular diseasesTumors of lungInfectious lung diseasesMiscellaneous e.g. FB, drug-induced, CarcinoidBack
39 Minor chest symptoms Chronic toxemia Corpulmonale: DD of LL edema in chest caseMediastinal compressionDyspnea, Dysphagia, hoarseness of voice, brassy cough, edema of face or eye lid or neck swellingRespiratory failureHypoxia: Cyanosis, irritability, lack of concentration, fine tremors, tachycardia.Hypercapnia: Headache, flappy tremors, drowsiness, disturbed sleep rhythm.CyanosisJaundice: DD of jaundice in chest case
40 Past history Similar conditions DM, HTN, Bilharziasis. Fever hospital or sanatorium admission or anti TB.Surgery or blood transfusion.Drug allergy.Vaccination.Trauma.FB inhalation
41 Family history Similar disease in the family. Chest diseases in family e.g. TB, Bronchial asthma,……Important diseases in the family e.g. DM, HTNAtopyConsanguinity