CLINICAL MEDICINE I

THORAX AND LUNGS

Chest and Lungs
Patients complains:
Cough ---> most common symptom
Dyspnea
Chest pain
Sputum production !" or !"o#
$oarseness --> pro%lem in laryn&
Snoring
Altered mental 'unction --> due to (ery se(ere lung pro%lem Inc) Co* and +*#
---> can also %e due to meta%olic pro%lem Dec) %lood sugar or Inc)
%lood sugar#
S& :
Dyspnea
Cough " e&pectoration
$emoptysis
Chest pain
$oarseness
Snoring
Altered mental 'unction
, Past Medical $istoy --> arri(ing at the correct diagnosis
, -or. $istory --> +ccupational ha/ard " dust
, Li'estyle --> smo.er " non smo.er0 alcoholic " non alcoholic consumptions 1uite important#
, 2ra(el --> Endemic conditions ME3S : Middle east respiratory syndrome#
C+45$
6orce'ul pro7ection o' air under pressure 'rom the trachea - %ronchial tree and al(eoli
MEC$ANISM:
8+L4N2A39 3E6LE:
, A''erent Lim% - sensory distri%ution o' CN 80 I:0 superior laryngeal and :)
, E''erent Lim% - recurrent laryngeal ner(e - 'or opening and closing glottic closure0 spinal ner(es
causes contraction o' the thoracic ner(e and a%dominal diaphragm # -Phrenic ner(e)
C+45$
e&pose to stimulants
,Stimulus initiates deep inspiration
5lottic closure
3ela&ation o' diaphragm
,Muscle contraction o' respiration against a close glottis
,Increased intra thoracic and air!ay pressure
,Sudden opening o' the glottis
Sudden release o' pressure and tracheal narro!ing
,8ery 'ast air'lo!
air close to speed o' light#
6orces mucus and 'oreign %ody out o' the air!ay
C+45$ E2I+L+59 :
In'lammation : Pneumonia0 %ronchitis0 %roncholitis0 cigarette smo.ing0 may%e %ecause
o' in'ection0 e&posure to no&ious gas
Mechanical Irritation : inhalation o' dust particles
Decrease pulmonary compliance : heart 'ailure; pleural e''usion --> Lungs hard to
e&pand ---> e&ert more e''ort)
Chemical : aspirates gastic secretions0 e&posure to ammonia
2hermal : hot air; cold air
Primary Comple& : pnuemonic in'iltrates; large lymph nodes in mediastinum --> area in
heart that cause pressure and tension in trachea and right and le't %ronchus)
C+MPLICA2I+N :
Cough Syncope : increase intra thoracic pressure --> !" loss o' consciousness0 decrease %lood
'lo! to the heart0 dec) 8olume < pressure --> dec) cardiac output < %lood pressure --> decrease
per'usion to the %rain)
3upture o' Emphysematous =le% --> Pneumothora& --) Se(ere 'orce o' Contraction o' the
2horacic Cage --> May cause ri% 'racture --> Costochondritis)
+NSE2
AC42E +NSE2 : Lasts 'or less than > !.s; assoc) !" lung air!ay or lung parenchyma0
in'ections o' upper and lo!er air!ays)
Laryngitis
2racheatis
=ronchitis
=ronchiolitis
Acute pulmonary edema
432I
Pneumonia
Asthma -- > 23IAD: Cough0 dyspnea < !hee/es
Pleural E''usion
C$3+NIC +NSE2 : Lasts 'or more than > !.s ; insidous in'ections
P2= - Chronic in'ection
C+PD - Common cause o' Chronic cough ; Emphysema0 Chronic =ronchtitis
assoc) !" cigarette smo.ing)
Lung tumor
=ronchiectasis
6ungal In'ection
Mediastinal mass
Interstitial lung disease
Chronic rhinitis " sinusitis
5I pro%lem
C8 disease
E:: Producti(e cough secondary to !hat .ind o' sputum0 amount o' sputum0 minimal0 copiuos# and
smell)
C$A3AC2E3:
=rassy Cough - dry0 trachea " Le't or 3ight =ronchus
=ar.y Cough - Epiglottis
Purulent sputum - yello!ish; (ery (iscous %acterial in'ections#
Mucoid - -hitish; less dense " (iscous consistency Atypical micro organism#
6oul Smelling - in'ection - anaero%es micro organism
Purulent sputum - AC42E# -> Lung A%cess
- C$3+NIC# -> =ronchiectasis more than * months; pt) cough !hole
day o' ? glasss o' sputum)
D9SPNEA
Sensation e&perienced %y the patient !hen act o' %reathing %ecomes uncom'orta%le0
distressing0 di''icult and la%ored)
23EP+PNEA : di''iculty o' %reathing in le't or right decu%itus posistion)
PLA29PNEA : di''iculty o' %reathing on upright posistion)
+32$+PNEA : di''iculty o' %reathing on supine posistion ; suggesti(e o' heart 'ailure)
AC42E D9SPNEA
?) AS2$MA
*) AC42E P4LM+NA39 EDEMA
a) Narcotic o(erdose
%) Inc) Altitude
c) Neurogenic
>) Pneumothora&
@) Pneumonia
A) Acute Pulmonary em%olism
B) Chest In7ury
C) A3DS
D) Peural E''usion
E) Pulmonary $emorrhage
AS2$MA -->$yper reacti(e ari!ays !" chronic in'lammation0 hypersecretions and %ronchi
constriction) %ecause o' allergic condition0 hyperresponsi(e air!ay --> D+=)
SP+N2ANE+4S PNE4M+2$+3A: --> A collection o' air in the pleural ca(ity0 sudden
lea.age o' air --> sudden D+=; can %e primary !"under lying dse) or secondary !" pathology;
acute onset; preceded %y pleuritic pain (ery sharp#; precipitated %y (alsal(e maneu(er)
P4LM+NA39 EM=+LISM --> Sudden o%struction o' (asculature %y throm%us 'rom deep
(ein and lo!er e&tremities) Seen most commonly in prolong immo%ility ; Long 'lights ;
Increase Coagula%ility o' the %lood ; +ral contracepti(es)
AN:IE29 -I2$ $9PE38EN2ILA2I+N --> pt) may%e an&ious - precipitated %y emorional
stress0 light headedness0 num%ness o' the head < chest including e&cessi(e %lo!ing o'' o' C+*
--> decrease Pc+* --> Al.alosis --> some result to 2E2AN9)
C$3+NIC P3+53ESSI8E D9SPNEA --> Symptoms de(elop gradually)
?) C+PD
Eg) Empysema - o(er distension o' air spaces distal to terminal %ronchiole)
More o' dyspnea rather than cough)
*) AS2$MA
>) PLE43AL E664SI+N
@) PS9C$+5ENIC E664SI+N
A) 23AC$EAL S2EN+SIS
B) $9PE3 SENSI2I8I29 DIS+3DE3
C) LE62 8EN23IC4LA3 6AIL43E
D) DI664SE IN2E3S2I2IAL 6I=3+SIS
E) P4LM+NA39 2$3+M=+EM=+LISM
?F) ANEMIA0 Se(ere - due to se(ere chronic %lood loss such as in colonic CA)
??) P4LM+NA39 8ASC4LA3 DISEASE - o%structed pulmonary (asculature -->
pulmonary hypertension)