History taking

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clinical approach to a patient with chest pain

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History taking

  1. 1. CLINICAL APPROACHTO A PATIENT WITHCOUGH… HISTORYTAKING
  2. 2. ►Protectivemechanism►Seeks MEDICAL CARE Discomfort from cough itself Interference with normal lifestyle Concern for cause of cough
  3. 3. HISTORY1.Onset & Duration Acute :- URTI; pneumonia; aspiration; foreign body; pulmonary emboli; CHF Chronic :-COPD; bronchogenic CA; post nasal drip; asthma; GERD; TB; ILD; psychogenic
  4. 4. 2.Character and timing Short,dry irritating cough with pain behind jaw or neck:- Pharyngeal Harsh,irritative and repetitive with stridor and cyanosis:- Laryngeal
  5. 5. Productive: amount; colour; consistency; smell Large amounts:-a)regular coughing up-bronchiectasisb)Single occasion-lung abcess, empyemac)Pink frothy-Pulm edema
  6. 6. Types of sputumTypes Appearance CauseSerous Clear,watery A/c pulm frothy pink edemaMucoid Clear grey- C/c bronchitis, white viscid COPD,AsthmaPurulent Yellow/green Bronchopulmona ry infectionRusty Rusty,golden Pneumococcal yellow pneumonia
  7. 7. FROTHY SPUTUM
  8. 8. PURULENT SPUTUM
  9. 9. RUSTY SPUTUM
  10. 10. Foul smelling sputum- bronchiectasis, lung abcess, empyemaSolid matter present in viscid secretions in asthma, allergic brochopulmonary aspergillosis, necrotic tumour, foreign body
  11. 11. Haemoptysis;- C/c bronchitis, Bronchiectasis, Bronchogenic carcinoma, Pulmonary emboli, Pulmonary edema
  12. 12. 3.Diurnal variationCough which gets worse in night and early morning :- AsthmaPersistent moist cough on waking up in smokers :- C/c bronchitis
  13. 13. 4.Seasonal variationAsthma, C/c bronchitis5.Postural variation Bronchiectasis, Lung abcess,
  14. 14. 6.Aggravating & Relieving factors Cold,smoke,dust,exertion:- asthma Swallowing of liquids:- NM d/s of oropharynxOtogenic cough:- impacted wax or foreign body in ext auditory meatus: …..subsides with removal of cause
  15. 15. 7.Associated symptoms Fever:- RTI; lung abcess; Chest pain:-Bronchitis, bronchogenic carcinoma Pleuritic chest pain:-Pleurisy, pleural effusion,bronchiectasis
  16. 16. Dyspnoea:- COPD, Asthma, ILD, Pneumonia, Bronchogenic carcinoma, Sarcoidosis, CHF ( orthopnoea & PND)Wheeze:- asthma “cough variant asthma”Nasal discharge, tickling sensation in throat:- Postnasal drip
  17. 17. Loss of weight:- bronchogenic carcinomaStridor:-FB,Laryngeal nerve involvmentHoarseness of voice:-Lary.N invlvmtHeart burn, regurgitation:- GERDErythema nodosum:-Sarcoidosis
  18. 18. HISTORY OF PAST ILLNESSCOPD, Asthma, Postnasal drip, GERDR/c or complicated Pneumonia, tuberculosis.whooping cough:- BronchiectasisImmunosuppressionSurgery ;bed rest BCG vaccination
  19. 19. Personal history Loss of appetite, sleep Smoking Occupational exposure Allergy or atopy
  20. 20. FAMILY HISTORY Chronic bronchitis with emphysema, Respiratory allergy, Asthma, Cystic fibrosis TB
  21. 21. TREATMENT HISTORY Angiotensin Converting Enzyme Inhibitors Past treatment of d/s like allergies,asthma,pneumonia,TB,Bron chitis Immunosuppressants
  22. 22. …DDs1.Pneumonia:-fever, cough,dyspnoea, rigor,night sweats2.Asthma:-episodic wheeze,dyspnea, c/c dry or productive cough worst at night,chest tightness3.COPD:-persistent cough,large amount sputum,shortness of breath
  23. 23. 4.Bronchiectasis:-c/c cough,copious amount of foul smelling sputum, hemoptysis,pleuritic chest pain, dyspnoea,loss of weight,anemia5.Bronchogenic carcinoma:-new cough/change in cough,dyspnoea, hemoptysis,anorexia,loss of weight, chest pain
  24. 24. 6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature
  25. 25. 7.ILD:-insidous onset exertional dyspnoea,cough8.CHF:-exertional dyspnoea,cough, fatigue,orthopnea.PND,edema
  26. 26. 9.Sarcoidosis:- cough,dyspnoea,erythema nodosum, eye inflammation,fatigue,fever10.Cystic fibrosis:-c/c or r/c cough with sputum,dyspnoea,wheeze, hemoptysis..young adult
  27. 27. 11.Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat12.GERD:-cough,heart burns, regurgitation
  28. 28. 13.Laryngeal inflammation:-cough, hoarseness of voice,stridor14.FB:-cough,stridor,history15.ACEI:-dry cough starting within 1-6 months of treatment
  29. 29. …THANK YOU

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