Your SlideShare is downloading. ×
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
History taking
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

History taking

4,257

Published on

clinical approach to a patient with chest pain

clinical approach to a patient with chest pain

Published in: Health & Medicine
0 Comments
8 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,257
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
186
Comments
0
Likes
8
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. CLINICAL APPROACHTO A PATIENT WITHCOUGH… HISTORYTAKING
  • 2. ►Protectivemechanism►Seeks MEDICAL CARE Discomfort from cough itself Interference with normal lifestyle Concern for cause of cough
  • 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. 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. Productive: amount; colour; consistency; smell Large amounts:-a)regular coughing up-bronchiectasisb)Single occasion-lung abcess, empyemac)Pink frothy-Pulm edema
  • 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. FROTHY SPUTUM
  • 8. PURULENT SPUTUM
  • 9. RUSTY SPUTUM
  • 10. Foul smelling sputum- bronchiectasis, lung abcess, empyemaSolid matter present in viscid secretions in asthma, allergic brochopulmonary aspergillosis, necrotic tumour, foreign body
  • 11. Haemoptysis;- C/c bronchitis, Bronchiectasis, Bronchogenic carcinoma, Pulmonary emboli, Pulmonary edema
  • 12. 3.Diurnal variationCough which gets worse in night and early morning :- AsthmaPersistent moist cough on waking up in smokers :- C/c bronchitis
  • 13. 4.Seasonal variationAsthma, C/c bronchitis5.Postural variation Bronchiectasis, Lung abcess,
  • 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. 7.Associated symptoms Fever:- RTI; lung abcess; Chest pain:-Bronchitis, bronchogenic carcinoma Pleuritic chest pain:-Pleurisy, pleural effusion,bronchiectasis
  • 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. Loss of weight:- bronchogenic carcinomaStridor:-FB,Laryngeal nerve involvmentHoarseness of voice:-Lary.N invlvmtHeart burn, regurgitation:- GERDErythema nodosum:-Sarcoidosis
  • 18. HISTORY OF PAST ILLNESSCOPD, Asthma, Postnasal drip, GERDR/c or complicated Pneumonia, tuberculosis.whooping cough:- BronchiectasisImmunosuppressionSurgery ;bed rest BCG vaccination
  • 19. Personal history Loss of appetite, sleep Smoking Occupational exposure Allergy or atopy
  • 20. FAMILY HISTORY Chronic bronchitis with emphysema, Respiratory allergy, Asthma, Cystic fibrosis TB
  • 21. TREATMENT HISTORY Angiotensin Converting Enzyme Inhibitors Past treatment of d/s like allergies,asthma,pneumonia,TB,Bron chitis Immunosuppressants
  • 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. 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. 6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature
  • 25. 7.ILD:-insidous onset exertional dyspnoea,cough8.CHF:-exertional dyspnoea,cough, fatigue,orthopnea.PND,edema
  • 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. 11.Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat12.GERD:-cough,heart burns, regurgitation
  • 28. 13.Laryngeal inflammation:-cough, hoarseness of voice,stridor14.FB:-cough,stridor,history15.ACEI:-dry cough starting within 1-6 months of treatment
  • 29. …THANK YOU

×