Diagnosis of disorders of resporatory

system

 1. History taking

 2. Physical examination

 3. Diagnostic tests
 History taking

 - actual symptoms

 Dyspnea  fever
 cough  weight lost
 hemoptysis  night sweat
 chest pain  snoring
 cyanosis
 hoarseness
 Dyspnea is a cardinal manifestation of
diseases involving the respiratory and
cardiovasculaer systems.

 Occurs whenever the work of breathing

is excessive
 In most patients with dyspnea there is
obvious clinical evidence of disease of either
heart or lung (asthma,COPD )
Dyspnea secondary to cardiac disease

-presence of evidence of heart failure such as

- cardiac enlargement,
-gallop rythms,
-cardiac murmurs,
-symmetrical edema of the legs
-orthopnea
 Acute dyspnea at rest

pulomary emboli

pneumothorax (spontaneous)

acute asthma
 Chronic dyspnea

 COPD
 Emphysema
 Pulmonary fibrosis
Dyspnea– symptom of obturation

 angioedema of the glottis (stridor-large

extrathoracic airway obstrution)
 aspiration of foreign body
 tumor

 during respiratory infections

 asthma
 chronic bronchitis
 bronchiectasis
 Cough
 - acute (infection),<3 weeks
 -subacute 3-8 weeks
 - chronic (COPD) >8weeks
 - seasonal
 - with wheezing
 - with fever
 - dry or with sputum , kind of sputum
mucoid, purulent (color)
 cough

Any change in the nature or character of a

chronic cigarette cough should initiate
immediate diagnostic evaluation, with
particular attention directed to detection of
bronchogenic carcinoma
 Cough-causes

 Flow secretions on the back wall of the throat

(generally),
 Asthma, COPD
 Gastro-oesophageal reflux
 Upper respiratory tract infection
 Bronchitis, pneumonia
 ACEI treatment
 Left ventricular heart failure, mitral stenosis
 Idiopathic, psychogenic
Major causes of hemoptysis
Inflamatory:
bronchitis, tuberculosis, bronchiectasis,
pneumonia, lung abscess

Neoplastic:
lung cancer, bronchial adenoma
Major causes of hemoptysis

Other
pulmonary thromboembolism,
mitral stenosis, left ventricular failure,
bronchovascular vistula, primary pulmonary
hypertension,
pulomary vasculitis (incl. Wegener’s
granulomatosis, Goodpasteure’s syndrome),
anticoagulant therapy
Chest pain of respiratory origin:

- central, substernal, characteristically worse

on coughing, f.e. tracheitis

- lokalized, laterally in the chest, worse on

taking a deep breath, pleuritic pain (can be
mimicked by herpes zoster)
Chest pain of other origin

angina pectoris
myocardial infarction
acute pericarditis
dissection of the ascending aorta
oesophageal chest pain
 Central cyanosis
A. Decreased arterial oxygen saturation
1.Decreased atmospheric pressure – high altitude
2.Impaired pulmonary function (pneumonia,pulmonary
edema,emphysema, pulmonary fibrosis)
a. Alveolar hypoventilation
b. Uneven relationship between pulmonary ventilation and perfusion
c. Impaired oxygen diffusion
3.Anatomic shunts
a. Certain types of congenital heart disease
b. Pulmonary arteriovenous fistulas
c. Multiple small intrapulomary shunts
4. Hemoglobin with low affinity for oxygen
 Central cyanosis

 B. Hemoglobin abnormalities

1. Methemoglobinemia – hereditary,
acquired
2. Sulfhehemoglobinemia – acquired
3. Carboxyhemoglobinemia
(not true cyanosis)
 Peripheral cyanosis

a. Reduced cardiac output

b. Cold exposure
c. Redistribution of blood flow from
extremities
d. Arterial obstruction
e. Venous obstruction
Hoarseness

 Dysphonia is commonly caused by overuse of

vocal cords, upper respiratory tract
infections, smoking

 Invasion od the recurrent laryngeal nerve by

tumor
Snoring

 High-pitched oral snoring implies upper

airway obstruction during sleep and may be a
manifestation of the sleep apnea
 Style of live

Cigarette smoking (pack-years)

Alcohol abuse (aspiration pneumonia)

Risk groups of AIDS (opportunistic infections)

Drugs exposure: amiodaron, bleomycin,

sulfonamids, nitrofurantoin (intrestitial
infiltrative lung reaction)
 Style of live

Oral contraceptives
Anabolic steroids
Intravenous drug abuse (lung abscess)
Contact with animals
* wild
* domestic (birds dogs etc)
 Occupational history

 - occupation

- exposure to:
 Asbestos
 Coal
 Silica
 Beryllium
 Cotton dust

Air conditions
 Family history

- genetic disorders
cystic fibrosis
emphysema, alfa1 antitrypsyn deficiency
asthma
infections (tbc, fungi)
cancer in family
allergy
 Physical examination

hands (finger clubbing)

cyanosis
rate of breathing (12-15)
movement of the chest
lymph node enlargement
Perrcussion of the chest

 normal lung resonance

 dullness
 hyper - resonance
 Ausculation of the chest

 Normal breath sounds

 Additonal sounds
 Respiratory crackles (crepitations)
 Pleural rub
 Rhonchi (wheezes)


 Bronchial asthma

ausculation
percussion prolonged exp.
hyperresonant wheezes (ins. and exp)
 Pneumothorax

percussion auscultation
hyperresonant absent breath
sounds
 pleurall effusion

percussion ausculation
dullness or flatnes absent breath
sounds
 Atelectasis
(lobar obstruction)

percussion auscultation
dullness absent breath
or flatness sounds
 Consolidation
(pneumonia)

percussionauscultation
dullness bronchial
breath sounds
crackles
 Diagnostic tests
chest X-ray P-A, lateral
computer tomography
USG
respiratory function tests
gazometry
Diagnostic tests

microbiological examination
bronchoscopy ,EBUS
aspiration of pleural fluid
pleural biopsy
lymph node biopsy
tuberculin skin test