2. SYMPTOMS of CHYEST DISORDERS （胸部疾病的症状） Zhengcuixia

3. Cough ( 咳嗽 )  A protective reflex that uncommon in healthy personal  cleanse secretion & foreign material from the airway  Initiated by miscellaneous stimuli or by voluntary exertion.  The most common respiratory symptom.

4. Cough reflex （咳嗽反射 ） Afferent inform.from: ENT, trachea, bifurcation of the bronchi. skin of the face & neck; pleura Irritant type: mechanical, chemical, inflammation Afferent fibers (vague nerve) cough center.

5. Cough reflex （咳嗽反射） Efferent signals larynx: glottis close or open Relating muscles ( diaphragm,chest wall, abdomen ) A coordinated series of action to perform the cough movement. Deep inspiration – expiration effort with glottis closed- glottis open abruptly – high volocity of airflow brings out screations from airways.

6. Influencing factors （影响因素）  Supressed afferant or efferent nerve function :coma, senior age  Failed glottis function  Diminished muscle force: cachexy( 恶液质）  Obstructed airway seen in severe COPD  Trachea intubation  Chest or abdominal pain limit cough movement

7. Main Causes （原因） AAirway infection & inflammation LLung parenchyma disorders AAirway stimulation by chemicals & foreign material PPleural & chest wall disorders CCardiovascular abnormalities AAfferent nerve fiber OOther causes Psychiatric cough

8. Classification ( 分类） NNon production ( dry cough ，干咳 ) EExpecteration (with sputum ，咳痰 )

9. Clinical appearance in common diseases （常见疾病中的临床表现） Acute infection or exasperation of chronic infectious illnesss Neoplasms ： insidiously initiation Pleural disease Cardiovascular diseases General disease affecting the respiratory system

10. Accompanied symptoms ( 伴随症状） Fever Chest pain Dyspnea & wheezing Sputum production

11. Complication （并发症）  Cough syncope syndroma  Fatigue  Fractures due to severe persistent cough  Pneumomediastinum, pneumothorax, and subcutaneous emphysema due to high intrathoracic pressure during cough.

12. Chronic cough(>3weeks): postualnasal drip syndroma( 鼻后滴漏综 合征） cough type asthma smoker Post URW infection GERD

13. Sputum expecteration （咳痰） Denote airway secretions being coughed out.

14. Characters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serous Volume: Accompanied manifestation Special conditions

15. Laboratory examination  Rutine  Microbiologic test ( including culture & drug sensitivity)  Cellular

16. Hemoptysis ( 咯血 )  Blood originate below the level of the larynx that being coughed out. Usually bright red  Degrees: from blood-tinged sputum to massive gross blood,even leading to airway occlusion (apnea ) & shock. The latter is much less seen.

17. Common causes （常见原因）  Infectious respiratory disease: bronchitis, bronchiectasis, TB  Neoplasm:  Cardiovascular disease: MS, PE, PAH, deformity of blood vessels  Other less seen disease leading to hemoptysis ： CTDs & hemologic disorders.

18. Classification ( 分级 )  Small amount  Moderate  Massive (>600ml/24hrs)

19. Differentiating from hematemesis hemoptysishematemesis Coughed up with frothyVomited without frothy Preceded by coughPreceded nausea, vomiting Bright redDark red or brown alkalineacid History of coughingHist. of gastric, liver disease Blood-tinged sputumNo blood-tinged sputum Mixed with sputum materials Mixed with food particles Anemia variableBlood loss common

20. Differentiating from upper airway bleeding by intenssive investigation and examination Post nasal bleeding Mouth and farynxil membrane bleeding

21. Investigation  whether coughed out or vomitted out  Volume: how much  Time duration  Any accompanied appearances

22. Chest pain （胸痛）  Character （性质）  Degree （强度）  Location （部位）  Reflection （牵涉 痛）

23. Common causes Cardiovascular & pulmonary vascular (iscamic) Pleural Chest wall Emanating pains of neighboring abnormalities

24. Cardiovascular （心血管） Location blured press like discomfort Eradiation Cardiavascular & pulmonary vascular Angina, MI, aortic stenosis (ischemic), Myocarditis, pericarditis, (inflamation)

25. Pleorial （胸膜疾病） Pleoritis

26. Chest wall ( 胸壁疾病） :  Injury  Inflamation  Costal Neuritis

27. Other diseases causing chest pain Acute abdominal syndroms