1. 1 SYMPTOMS

2. 2 Symptomatology imaging Doctor,I feel bad! What ’ s the bad? DiscomfortFever? Headache? Dyspnea? Chest pain? …… symptoms

3. 3 Symptom: Subjective disturbances that arise from diseases.

4. 4 Symptoms General symptoms Respiratory system Circulatory system Digestive system Kidney and urinary system Hematologic system Endocrine system

5. 5 General Symptoms Fever Edema Fatigue Weight reduction 。。。。

6. 6 Fever Upward shift of temperature. Normal body temperature: Axilla,rectal,oral

7. 7 Fever How it happens?

8. 8 Etiology Infective fever Viruses,bacteria,fungi,parasite

9. 9 Non-infective fever Connective tissue disorders Hypersensitive reaction Endocrinologic disease Neoplasms Hemorrhage or thromboembolic disease Central fever Others

10. 10 Physiology: Activity,ovulation,smoking, …… In the morning,elder, ……

11. 11 Clinical manifestation Low:37.4-38 ℃ Middle:38.1-39 ℃ High:39.1-41 ℃ Excessively high: ＞ 41 ℃

12. 12 Fever type Type of temperature curve 1. Continuous fever T 39-40 ℃ continue for days and fluctuation ＜ 1 ℃

13. 13 2. Remittent Fever Fever continue for days, fluctuation ＞ 2 ℃,does not fall to normal. & Rheumatic fever

14. 14 3. Intermittent (Periodic ) Fever T rises for several hrs and fall to normal or below & Malaria

15. 15 4. Undulant fever T rises last for 7-14 days and falling to normal,recurring over weeks or months. & Brucella infection

16. 16 5.Relapsing fever T rises abruptly for days and falls abruptly to normal. & Lymphoma

17. 17 6.Irregular fever Irregular curve & Bronchopneumonia

18. 18 Fever Accompany symptoms Rigor or shivering attack Rash Tachycadia Splenomegaly or lymphadenopathy Facial feature

19. 19 Inquiry??? Fever of unknown origin, FUO

20. 20 Edema Defination: Excessive collection of fluid in the interstitial space.

21. 21 Mechanism of edema Hydrostatic pressure Oncotic pressure Disrupted capillary permeability

22. 22 Etiology Localized edema & Deep vein thrombophlebitis

23. 23 Generalized edema Congestive heart failure Liver disease Kidney Idiopathic

24. 24 心原性水肿与肾原性水肿的鉴别 肾原性水肿 心原性水肿 ──── ———————————— ————————— — 开始部位 从眼睑、颜面开始 从足部开始 发展快慢 发展常迅速 发展较缓慢 水肿性质 软而移动性大 比较坚实 移动性较小 伴随病征 伴有其他肾脏病病征 伴有心功能不全病征 ( 高血压、蛋白尿、血尿、管型 ) 心脏增大、心杂音、肝肿大 ——————————————————

25. 25 水肿的诊断 1. 是否水肿 2. 全身性 or 局限性 3. 压陷性 or 非压陷性 4. 炎症性 or 非炎症性 5. 水肿的程度

26. 26 Pulmonary system Cough and expectoration Wheezing Hemoptysis Cyanosis Dyspnea Chest pain

27. 27 Cough The most commom symptom of lung disease The cough reflex is a normal defense mechanism of lungs that protects them from foreign bodies and excessive secretions. Coughing may be voluntary or involuntary, productive or nonproductive. Smoking :the most common cause of the chronic caugh Coughing may be psychogenic

28. 28 Expectoration(sputum production) Normally approximately 75-100ml of sputum is secreted by the bronchi daily An increase in the quantity of sputum production: early manifestation of bronchitis Sputum should be described according to color, consistency, quantity, number of times daily, and the presence of blood. Mucoid and purulent

29. 29 Dyspnea Subjective sensation of shortness of breath Important manifestation of cardiopulmonary disease

30. 30 Acute dyspnea Pulmonary diseases: pneumonia, asthma, pulmonary embolus, spontaneous pneumothorax Cardiopumonary edema Acute hyperventilation syndrome is a relatively frequent neuropsychiatric cause of dyspnea

31. 31 Chronic dyspnea Chronic obstructive airway disease Chronic bronchitis, … Restrictive lung disease Interstitial lung disease, … Nonpulmonary disease Congestive heart failure Anemia Hyperthyroidism …

32. 32 Some types of dyspnea Exertional dyspnea Acute pulmonary edema Orthopnea Paroxysmal nocturnal dyspnea Cardiac asthma

33. 33 Hemoptysis It is the expectoration of blood or bloody sputum. The most common cause: Bronchitis,bronchiectasis and bronchogenic carcinoma

34. 34 Differentiation of hemoptysis and hematemesis -------------------------------------------------------------- hemoptysis hematemesis -------- ------------------------------------------------------ History respiratory disease indigestion Presymptoms cough nausea Color bright red dark red or brown Contents alveolar macrophages food particle pH high low Hematochezia (-) (+) Postproduction stained for days no Confirmed by bronchoscopy gastroscopy --------------------------------------------------------------------- -

35. 35 Hemoptysis Accompany findings Fever Chest pain Cough Purulent sputum Skin or mucosal hemorrhage LHF ？

36. 36 Cyanosis A bluish color of the skin and mucous membranes

37. 37 Central cyanosis: It results from arterial hypoxemia caused by right-to-left cardiac shunt,pulmonary arteriovenous fistula,or acute or chronic pulmonary disease. Peripheral cyanosis: It is caused by stagnant circulation through the peripheral vascular bed.

38. 38 Cardiovascular system Palpitation Chest pain Dyspnea Cyanosis Fatigue Syncope

39. 39 Chest pain A common symptom of many diseases Different causes of chest pain Pulmonary disease Pheumothorax,pneumomia,pulmonary embolism, Musculoskeletal disease Rib fracture,osteoarthritis,herpes zoster Esophageal and other gastrointestinal disease esophagitis,esophageal spasm

40. 40 Chest pain Cardiovascular disease Angina pectoris Acute myocardial infarction Pericarditis Dissecting hematoma of the aorta The most important symptom of cardiac disease Angina pectoris is the true symptom of CHD.

41. 41 Chest pain Angina for example Onset:typically builds up over a few minutes,and may be brought on by exercise, emotion, or cold weather Duraton:2 to 10 minutes Site and radiation: retrosternal pain, often radiates to the left shoulder or arms especially Intensity: moderate Always ask the patient what they were doing when the pain came on.

42. 42 Chest pain Progression:resolves on resting or with sublingual nitroglycerin Associated symptoms:dispnea risk factors:smoking,family history,diabetes,hypertension, Examination Electrocardiogram(ECG) Chest x-ray

43. 43 Thanks for your attention!