呼吸系統(tǒng)課件：呼吸癥狀學(xué)

RESPIRATORYSYPTOMSRESPIRATORYSYPTOMSSymptomsofRespiratoryDiseasesSymptomsofRespiratoryDiseasCoughandSputumCoughandSputumCoughCoughisadeepinspirationfollowedbyastrongexpirationagainstaclosedglottis,whichthenopenswithanexpulsiveflowofair,followedbyarestorativeinspiration;thesearetheinspiratory,compressive,expulsive(expiratoryorexplosive),andrecoveryphasesofcoughCoughCoughisadeepinspiratiThestimulithatcanelicitacoughinhaledparticles,Mucusontheliningoftheairways,Inflammatoryexudateinairwaysorparenchyma,anewgrowthorforeignbodyinanairway,pressureontheexternalwallofthebronchus.ThestimulithatcanelicitaCOUGHItisaprotectivereflexwhichremovessecretionsorinhaledsolidmaterial,provokedbyphysicalorchemicalstimulationofirritantreceptorsinthelarynx,tracheaorbronchialtree.COUGHItisaprotectivereflexClassificationAcute<3wksSubacute:3-8wksChronic:>8wksdryorproductive(sputumproduction)ClassificationAcute<3wksCough(aprotectivereflex):causesRespiratorydiseases___themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleuraCardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitisCough(aprotectivereflex):cCough:accompanysignsFever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess)Cough:accompanysignsFever(iSputum:consistency

MucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSeroussputumPulmoedemaPussputumAnybacterialinfectionBloodysputumSputum:consistencyMucoidspuCoughrhythm

咳嗽的節(jié)律Paroxysm發(fā)作性咳嗽急性咽喉炎、異物、百日咳、哮喘、支氣管內(nèi)膜結(jié)核等Chronic慢性咳嗽慢支、支擴(kuò)、肺膿腫、肺結(jié)核等Coughrhythm

咳嗽的節(jié)律Paroxysm急性咽喉ToneQuality

咳嗽的音色Hoarseness嘶啞聲帶炎、喉結(jié)核、喉癌、喉返神經(jīng)麻痹等Brassy金屬音調(diào)縱隔腫瘤、主動(dòng)脈瘤、支氣管癌等壓迫氣管Highpitch雞鳴樣咳嗽百日咳，會(huì)咽、喉部疾患及氣管受壓Weak低微或無(wú)聲極度衰弱、嚴(yán)重肺氣腫、聲帶麻痹等ToneQuality

咳嗽的音色Hoarseness嘶啞CharacterofCoughDrycoughNon-sputumProductivecoughSputum:infectious,edemaCharacterofCoughDrycoughNon

(sputum:Quantity,traits)

痰量及性狀量quantity多：肺泡細(xì)胞癌(alveolarcellcarcinoma)少:性狀traits粘：真菌(fungi)臭：厭氧(Anaerobicbacteria)韌：纖維性支氣管炎

(sputum:Quantity,traits)

痰量Sputum:ColorWhiteMucoidorserofluidsputumYellowGeneralbacterialinfectionGreenAeruginosus-bacillusinfectionGreyorblackDustinhalationRustyLobarpneumoniaPinkCardiacedemaRedHemoptysisSputum:ColorWhiteMucoidorsSYMPTOMSANDSIGNS--sputumColor,quantity,consistencyandunusualodorColorlessandtransparent:mildinflammationandnormalProductiveandpurulent-bacterialinfectionasbronchitispneumonia,lungabscess,bronchiectasisBloodstreaked-cancer,tuberculosis,lunginfarctionBloodfoamy-congestiveheartfailureRust-colored–pneumococalpneumoniaLargequantity-lungabscess,bronchiectasis,lungcancerPurulentwithfoulodor-streptococcusandanaerobeinlungabscessSYMPTOMSANDSIGNS--sputumColoAcuteCoughViralinfectionsRhinoviruses,coronaviruses,andrespiratorysyncytialvirusinfluenza,parainfluenza,andadenovirusesAllergicrhinitisExacerbationsofCOPDStreptococcuspneumoniae,Haemophilusinfluenzae,andMoraxellacatarrhalisBordetellapertussisinfectionAcuteCoughViralinfectionsChronicCoughUpperairwaycoughsyndrome(Postnasaldrip)AsthmaGastroesophagealreflux(GERD)EosinophilicbronchitisACEinhibitorsChronicbronchitisBronchiectasisInterstitialLungDiseaseLungCancerCongestiveHeartFailurePsychogenicCoughChronicCoughUpperairwaycougComplicationsofcoughpainfromintercostalmusclestraincoughfracturecoughsyncopecough-inducedincontinencepneumothorax,pneumomediastiniumComplicationsofcoughpainfroHaemoptysisHaemoptysisSYMPTOMSANDSIGNS--haemoptysisThecoughupofbloodistermedhaemoptysisBloodtingedsputumtopurebloodDifferentiation:upperairway,uppergastrointestinaltract(hematemesis-vomitingblood)Haemoptysis—bloodisbrightredmixedwithfrothysputum,alkalineHematemesis—dark,acidic,foodparticleSYMPTOMSANDSIGNS--haemoptysiBronchialcirculationmassivePulmonarycirculationairwaysPulmonaryparenchyma.VasculardisordersOriginanddisordersBronchialcirculationmassivHemoptysisBleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:>500ml/d,or100-500/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesisHemoptysisBleedingfromlowerDistinguishedhemoptysisfromhematemesisDistinguishedhemoptysisfromCommonCausesBronchialDisordersBronchiectasisBronchogeniccarcinomaEndobronchialTBChronicBronchitisPulmoDiscordersPulmoTBPeumoniaLungabscessPulmoembolismTumorOthersHematologicdisease,),leptospirosis(鉤端螺旋體病EpidemicHemorrhagicfever,endometriosisCardiovascularDisordersAcuteleftheartfailureMitralstenosis:capillaries,veinsPulmonaryhypertensionPulembolismCommonCausesBronchialDisordeAccompanySignsFeverInfectionChestpainInfectionPulmoembolismCarcinomaPussputumBronchie-ctasisLungabscessClubbingfingersBronchi-ectasisLungabscessCarcinomaHemorrha-gicspotsHematologicdiseaseLeptospirosisEpidemicHemorrhagicfeverJaundicepneumoniaLeptospiro-sis(鉤端螺旋體病PulmoinfarctAccompanySignsFeverInfectionCSYMPTOMSANDSIGNS--haemoptysisTuberculosis,bronchiectasis,lungcancerParallelsymptoms-intermittent,purulent—bronchiectasisParallelsymptoms-older,longhistoryofsmoking,chestpain—lungcancerParallelsymptoms-suddenonset,chestpain,dyspnea—pulmonaryembolismParallelsymptoms-menstrationcycle—endometriosisParallelsymptoms-oliguria—GoodpastersyndromeParallelsymptoms-epidemiologicalhistory—parasiteinfectionSYMPTOMSANDSIGNS--haemoptysiSomeCommonCausesofHemoptysisInfectionsBronchitisTuberculosisFungalinfectionsPneumoniaLungabscessBronchiectasisNeoplasmsBronchogeniccarcinomaBronchialadenomaCardiovasculardisordersPulmonaryinfarctionfromthromboembolismMitralstenosisTraumaForeignbodyHematologic/immunologicBlooddyscrasiaGoodpasture’ssyndromeSomeCommonCausesofHemoptysDIFFERENTIALDIAGNOSISTracheobronchialsourceNeoplasm(bronchogeniccarcinoma,endobronchialmetastatictumor,Kaposi’ssarcoma,bronchialcarcinoid)Bronchitis(acuteorchronic)BronchiectasisBroncholithiasisAirwaytraumaForeignbodyPulmonaryparenchymalsourceLungabscessPneumoniaTuberculosisMycetoma(“fungusball”)Goodpasture’ssyndromeIdiopathicpulmonaryhemosiderosisWegener’sgranulomatosisLupuspneumonitisLungcontusionPrimaryvascularsourceArteriovenousmalformationPulmonaryembolismElevatedpulmonaryvenouspressure(especiallymitralstenosis)Pulmonaryarteryrupturesecondarytoballoon-tippulmonaryarterycathetermanipulationMiscellaneousandrarecausesPulmonaryendometriosis(catamenialhemoptysis)SystemiccoagulopathyoruseofanticoagulantsorthrombolyticagentsDIFFERENTIALDIAGNOSISTracheoNeoplasm40-60ageLonghistoryofsmokingTroublesomecoughandchestpainthatprecedeandacompanyhemoptysisNeoplasm40-60ageInfectionStaphylococcus—rusty-looking,grosslybloodStaphylococcus—bloodmixedwithpusKlebsiella—currantjellyBrisk(濃味道)bleeding—bloodmixedwithcopiousamountoffoul-smellingpusInfectionStaphylococcus—rusty-2022/12/1632Investigation

Ifcoughedoutorvomittedout[文本】Age,sex,colourVolume:howmuchTimedurationAnyaccompaniedappearances2022/12/1132Investigation

IfcChestPainChestPainSYMPTOMSANDSIGNS—chestpainPleuritis,lunginfection,lungtumor,lunginfarctionarethemajorcauses.Pleuriticchestpain—respirationSuddenonsetwithdyspnae–pneomothorax,lunginfarctionSuperficialpainofchestwall—intercostalneuropathy,viralinfectionPericardialandpoststernal-myocardialinfarction--substernal"pressure,""constriction,"or"squeezing",neckorbotharms.

SYMPTOMSANDSIGNS—chestpainPPleuriticPainPulmonaryPainChestWallPainCardiacPainPleuriticPainCommonCausesChestwallHerpeszosterRibfractureCardiovas-cularAngina(心絞痛）

MyocardialinfarctionPericarditisDissectinganeurysmRespirato-ryPleuraldisordersPneumotho-raxCarcinomaPneumoniaMediastin-alMediastinitisMediastinalemphysemaMediastinaltumorEsophageallesionsHiatalhernia(食管裂孔疝OthersLivercarcinomaLiverabscessSubdiaph-ragmaticabsessSpleeninfartCommonCausesChestwallHerpesChestwallpainPersistentcoughorbreathlessnessMuscularstrainsIntercostalmyositisThoracicherpeszosterCoxsackieBinfectionThoracicdisclesionornervecompressionIntercostalnervecompressionorinfiltrationRibfractureRibtumour:primaryormetastaticTietze’ssyndromeSlippingribsyndromePleuralpainInfectivepleurisyPneumothoraxAutoimmunediseaseAsbestospleuralfibrosisMesotheliomaMetastatictumourAirwaypainTracheitisInhalationofirritantgasIntubationCentralbronchialcarcinomaMediastinalpainCardiacischaemia/infarctionMassivepulmonaryembolismOesophagitisPericarditisSarcoidadenopathyLymphomaMediastinitisAorticdissectionAorticaneurysmChestwallpainPleuralpainMedClinicalManifestationAgeTheyoungTheoldCharacteristicsBurningpainPressingpainBurstingpainPrickingpainDurationParoxysmPersistenceInfluentialfactorsExerciseRespirationFoodintakeAdministration(responsetotrentment)ClinicalManifestationAgeTheyAccompaniedSignsCough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumoniaPneumotho-raxpleurisyPulmo-embolismHemoptysisCarcinomaPulmo-embolismPneumoniaShockMyocarialinfarctionDissectinganeurysm(rupture)Largeareapulmo-embolismEatingrelated(Dysphagia)EsophagealdiseaseAccompaniedSignsCough,sputum2022/12/1640AssistantExamiantionCarefulphysicalexammingSerumD-dimerSerumCreatineKinase,CK-MB,CardiacTroponinIArterialbloodgasElectrocardiogramChestRadiology:X-Ray,CT-scan2022/12/1140AssistantExamiantDspneaorBreathlessnessDspneaorBreathlessnessSYMPTOMSANDSIGNS—dyspneaMedicaltermforbreathlessnessorshortnessofbreathcausedbyairhungerwithaccessoryrespiratorymusclejoininginrespiration.ThistermisusedtodesignateavarietyofsensationsthatrangefromanawarenessofbreathingtorespiratorydistressChangesinrespiratoryrateandrhythmKussmaulbreathing--acidosisCheyne-Strokerespiration(Tidalbreathing)--Unchanged-hypercapnia,narcotics,PsychogenicSYMPTOMSANDSIGNS—dyspneaMediSOMEDESCRIPTIONSANDPATHOPHYSIOLOGICMECHANISMSOFSHORTNESSOFBREATHSOMEDESCRIPTIONSANDPATHOPHYDYSPNEAPATHOPHYSIOLOGYDYSPNEAPATHOPHYSIOLOGYSYMPTOMSANDSIGNS—dyspneaAcute,chronicandrecurrentLunginfarction—acutewithchestpainNocturnalorthoradoxdyspnea—congestiveheartfailureandasthmaProgressive(afewwkstomonths)–pleuraleffusionChronicprogressive–interstitiallungdiseaseRucurrentandseasonal—asthmaInspirational—largeairwayobstructionExpiratory–distalairwayasasthma,bronchitisSYMPTOMSANDSIGNS—dyspneaAcutRespiratorycausesofbreathlessnesstheairways---airflowobstruction;thelungparenchyma---progressivetypeofbreathlessnesswitharestrictivepatternoflungfunction.thepulmonarycirculation---progressivedyspnoeaoftenwithverysevereexerciselimitationthepleura---Thechestwall.RespiratorycausesofbreathleSomecausesofbreathlessness.AirwaysdiseaseChronicbronchiolitisandemphysemaAsthmaBronchiectasisandcysticfibrosisLaryngealorpharyngealtumourBilateralcordpalsyCricoarytenoidrheumatoidTrachealobstructionTracheomalaciaAmyloidofairwaysParenchymaldiseaseAllergicalveolitisSarcoidosisFibrosesanddiffusealveolitisObliterativebronchiolitisPneumoniasandtoxicpneumonitisDiffuseinfectionsRespiratorydistresssyndromeInfiltrativeandmetastatictumourPneumothoraxPulmonarycirculationPulmonaryembolismandhypertensionPulmonaryarteritisandthrombosisChestwallandpleuraEffusionorpleuralfibrosisFracturedribsAnkylosingspondylitisKyphoscoliosisNeuromuscular,bilateraldiaphragmparalysisSomecausesofbreathlessness.Somecausesofbreathlessness.CardiacLeftventricularfailureMitralvalvediseaseCardiomyopathyPericardialeffusionorconstrictionNon-cardiorespiratoryPsychogenicAnaemiaHaemorrhageAcidosisHypothalamiclesionsSomecausesofbreathlessness.CausesofAcuteandChronicDyspneaAcutePulmonaryedemaAsthmaInjurytochestwallandintrathoracicstructuresSpontaneouspneumothoraxPulmonaryembolismPneumoniaAdultrespiratorydistresssyndromePleuraleffusionPulmonaryhemorrhageChronic,progressiveChronicobstructivepulmonarydiseaseLeftventricularfailureDiffuseinterstitialfibrosisAsthmaPleuraleffusionsPulmonarythromboembolicdiseasePulmonaryvasculardiseasePsychogenicdyspneaAnemia,severePostintubationtrachealstenosisHypersensitivitydisordersCausesofAcuteandChronicDy呼吸系統(tǒng)課件：呼吸癥狀學(xué)Dyspnea:causesRespiratorysystemObstruction:asthma,COPD,tumorPulmoDiseases:pneumonia,interstitiallungdisease,Chestwallorpleura:pleurisy,pneumothorax,traumaneuro-muscles:poliomyelitis(脊髓灰質(zhì)炎),myastheniagravis(重癥肌無(wú)力)Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavityCardiovascularsystemHeartfailurePulmoembolismPoisoningketoacidosisCentralnervoussystemcerebraltumor,trauma,abscess,hemorrhage,encephalitis,meningitishematologicalsystemSevereanemiaDyspnea:causesRespiratorysyRespiratoryDyspneaInspiratorydyspnea____obstructioninlargeairway

Threedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea____obstructioninsmallairwayoralveolarelasticitydecreased

ProlongedexpiratorytimeExpiratoryrhonchiMixeddyspnea____deficientgasexchange

RespiratoryrateincreasedShallowbreathingRespiratoryDyspneaInspiratoryFeaturesofleftheartfailureUnderlyingdiseasesMixeddyspneaPositionrelateddyspneaMoistcracklesorrhonchiinbothlungsReliefofsymptomsafterdigitalis,diuretic,vasodilatoragentused

FeaturesofleftheartfailureNocturnalparoxysmaldyspneaCharacteristicsAwokenduetochesttightnessordyspneaForcedsittingpositionororthopneaSeveresweatTachycardiaMoistcracklesorrhonchiinbothlungsPinkfrothysputum

NocturnalparoxysmaldyspneaCPoisoningdyspneaUnderlyingdiseasesofmetabolicacidosis(uremia,diabeticketoacidosis)deepbreathing(Kussmaulbreathing)PoisoningdyspneaUnderlyingdiDyspnea:accompanysigns(1)RhonchiAsthmaAcuteleftheartfailure(cardiacasthma)ForeignbodyinlargeairwayAcutelaryngealedema

ChestpainInfectionPneumothoraxPulmoembolismLungcancerAcutemyocardialinfarct

Dyspnea:accompanysigns(1)RhDyspnea:accompanysigns(2)FeverInfectionCoughandsputum

COPDInfectionLeftheartfailureUnconsciousness

CNSdisorderUremiadiabeticketoacidosisDyspnea:accompanysigns(2)FeCyanosisCyanosisCyanosisreferstoabluishcoloroftheskinandmucousmembranesresultingfromanincreasedquantityofreducedhemoglobinorofhemoglobinderivativesinthesmallbloodvesselsofthoseareas.Itisusuallymostmarkedinthelips,nailbeds,ears,andmalareminences.CyanosisreferstoabluishcoanincreaseinthequantityofvenousbloodasaresultofdilationofthevenulesandvenousendsofthecapillariesorbyareductionintheSaO2inthecapillaryblood.anincreaseinthequantityofCentralCyanosisPeripheralCyanosisCentralCyanosisCyanosisinPulmonaryDiseaseCyanosisDuetoVenousAdmixtureCyanosisDuetoAbnormalPigmentsinBloodCyanosisinPulmonaryDiseaseDecreasedarterialoxygensaturationDecreasedatmosphericpressure—highaltitudeImpairedpulmonaryfunctionAlveolarhypoventilationUnevenrelationshipsbetweenpulmonaryventilationandperfusion(perfusionofhypoventilatedalveoli)ImpairedoxygendiffusionAnatomicshuntsCertaintypesofcongenitalheartdiseasePulmonaryarteriovenousfistulasMultiplesmallintrapulmonaryshuntsHemoglobinwithlowaffinityforoxygenDecreasedarterialoxygensatuCentralCyanosisDecreasedarterialoxygensaturation:respiratory;cardiacHemoglobinabnormalitiesCentralCyanosisDecreasedartePeripheralCyanosisColdexposureRedistributionofbloodflowfromextremitiesArterialobstructionVenousobstructionPeripheralCyanosisColdexposuRESPIRATORYSYPTOMSRESPIRATORYSYPTOMSSymptomsofRespiratoryDiseasesSymptomsofRespiratoryDiseasCoughandSputumCoughandSputumCoughCoughisadeepinspirationfollowedbyastrongexpirationagainstaclosedglottis,whichthenopenswithanexpulsiveflowofair,followedbyarestorativeinspiration;thesearetheinspiratory,compressive,expulsive(expiratoryorexplosive),andrecoveryphasesofcoughCoughCoughisadeepinspiratiThestimulithatcanelicitacoughinhaledparticles,Mucusontheliningoftheairways,Inflammatoryexudateinairwaysorparenchyma,anewgrowthorforeignbodyinanairway,pressureontheexternalwallofthebronchus.ThestimulithatcanelicitaCOUGHItisaprotectivereflexwhichremovessecretionsorinhaledsolidmaterial,provokedbyphysicalorchemicalstimulationofirritantreceptorsinthelarynx,tracheaorbronchialtree.COUGHItisaprotectivereflexClassificationAcute<3wksSubacute:3-8wksChronic:>8wksdryorproductive(sputumproduction)ClassificationAcute<3wksCough(aprotectivereflex):causesRespiratorydiseases___themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleuraCardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitisCough(aprotectivereflex):cCough:accompanysignsFever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess)Cough:accompanysignsFever(iSputum:consistency

MucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSeroussputumPulmoedemaPussputumAnybacterialinfectionBloodysputumSputum:consistencyMucoidspuCoughrhythm

咳嗽的節(jié)律Paroxysm發(fā)作性咳嗽急性咽喉炎、異物、百日咳、哮喘、支氣管內(nèi)膜結(jié)核等Chronic慢性咳嗽慢支、支擴(kuò)、肺膿腫、肺結(jié)核等Coughrhythm

咳嗽的節(jié)律Paroxysm急性咽喉ToneQuality

咳嗽的音色Hoarseness嘶啞聲帶炎、喉結(jié)核、喉癌、喉返神經(jīng)麻痹等Brassy金屬音調(diào)縱隔腫瘤、主動(dòng)脈瘤、支氣管癌等壓迫氣管Highpitch雞鳴樣咳嗽百日咳，會(huì)咽、喉部疾患及氣管受壓Weak低微或無(wú)聲極度衰弱、嚴(yán)重肺氣腫、聲帶麻痹等ToneQuality

咳嗽的音色Hoarseness嘶啞CharacterofCoughDrycoughNon-sputumProductivecoughSputum:infectious,edemaCharacterofCoughDrycoughNon

(sputum:Quantity,traits)

痰量及性狀量quantity多：肺泡細(xì)胞癌(alveolarcellcarcinoma)少:性狀traits粘：真菌(fungi)臭：厭氧(Anaerobicbacteria)韌：纖維性支氣管炎

(sputum:Quantity,traits)

痰量Sputum:ColorWhiteMucoidorserofluidsputumYellowGeneralbacterialinfectionGreenAeruginosus-bacillusinfectionGreyorblackDustinhalationRustyLobarpneumoniaPinkCardiacedemaRedHemoptysisSputum:ColorWhiteMucoidorsSYMPTOMSANDSIGNS--sputumColor,quantity,consistencyandunusualodorColorlessandtransparent:mildinflammationandnormalProductiveandpurulent-bacterialinfectionasbronchitispneumonia,lungabscess,bronchiectasisBloodstreaked-cancer,tuberculosis,lunginfarctionBloodfoamy-congestiveheartfailureRust-colored–pneumococalpneumoniaLargequantity-lungabscess,bronchiectasis,lungcancerPurulentwithfoulodor-streptococcusandanaerobeinlungabscessSYMPTOMSANDSIGNS--sputumColoAcuteCoughViralinfectionsRhinoviruses,coronaviruses,andrespiratorysyncytialvirusinfluenza,parainfluenza,andadenovirusesAllergicrhinitisExacerbationsofCOPDStreptococcuspneumoniae,Haemophilusinfluenzae,andMoraxellacatarrhalisBordetellapertussisinfectionAcuteCoughViralinfectionsChronicCoughUpperairwaycoughsyndrome(Postnasaldrip)AsthmaGastroesophagealreflux(GERD)EosinophilicbronchitisACEinhibitorsChronicbronchitisBronchiectasisInterstitialLungDiseaseLungCancerCongestiveHeartFailurePsychogenicCoughChronicCoughUpperairwaycougComplicationsofcoughpainfromintercostalmusclestraincoughfracturecoughsyncopecough-inducedincontinencepneumothorax,pneumomediastiniumComplicationsofcoughpainfroHaemoptysisHaemoptysisSYMPTOMSANDSIGNS--haemoptysisThecoughupofbloodistermedhaemoptysisBloodtingedsputumtopurebloodDifferentiation:upperairway,uppergastrointestinaltract(hematemesis-vomitingblood)Haemoptysis—bloodisbrightredmixedwithfrothysputum,alkalineHematemesis—dark,acidic,foodparticleSYMPTOMSANDSIGNS--haemoptysiBronchialcirculationmassivePulmonarycirculationairwaysPulmonaryparenchyma.VasculardisordersOriginanddisordersBronchialcirculationmassivHemoptysisBleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:>500ml/d,or100-500/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesisHemoptysisBleedingfromlowerDistinguishedhemoptysisfromhematemesisDistinguishedhemoptysisfromCommonCausesBronchialDisordersBronchiectasisBronchogeniccarcinomaEndobronchialTBChronicBronchitisPulmoDiscordersPulmoTBPeumoniaLungabscessPulmoembolismTumorOthersHematologicdisease,),leptospirosis(鉤端螺旋體病EpidemicHemorrhagicfever,endometriosisCardiovascularDisordersAcuteleftheartfailureMitralstenosis:capillaries,veinsPulmonaryhypertensionPulembolismCommonCausesBronchialDisordeAccompanySignsFeverInfectionChestpainInfectionPulmoembolismCarcinomaPussputumBronchie-ctasisLungabscessClubbingfingersBronchi-ectasisLungabscessCarcinomaHemorrha-gicspotsHematologicdiseaseLeptospirosisEpidemicHemorrhagicfeverJaundicepneumoniaLeptospiro-sis(鉤端螺旋體病PulmoinfarctAccompanySignsFeverInfectionCSYMPTOMSANDSIGNS--haemoptysisTuberculosis,bronchiectasis,lungcancerParallelsymptoms-intermittent,purulent—bronchiectasisParallelsymptoms-older,longhistoryofsmoking,chestpain—lungcancerParallelsymptoms-suddenonset,chestpain,dyspnea—pulmonaryembolismParallelsymptoms-menstrationcycle—endometriosisParallelsymptoms-oliguria—GoodpastersyndromeParallelsymptoms-epidemiologicalhistory—parasiteinfectionSYMPTOMSANDSIGNS--haemoptysiSomeCommonCausesofHemoptysisInfectionsBronchitisTuberculosisFungalinfectionsPneumoniaLungabscessBronchiectasisNeoplasmsBronchogeniccarcinomaBronchialadenomaCardiovasculardisordersPulmonaryinfarctionfromthromboembolismMitralstenosisTraumaForeignbodyHematologic/immunologicBlooddyscrasiaGoodpasture’ssyndromeSomeCommonCausesofHemoptysDIFFERENTIALDIAGNOSISTracheobronchialsourceNeoplasm(bronchogeniccarcinoma,endobronchialmetastatictumor,Kaposi’ssarcoma,bronchialcarcinoid)Bronchitis(acuteorchronic)BronchiectasisBroncholithiasisAirwaytraumaForeignbodyPulmonaryparenchymalsourceLungabscessPneumoniaTuberculosisMycetoma(“fungusball”)Goodpasture’ssyndromeIdiopathicpulmonaryhemosiderosisWegener’sgranulomatosisLupuspneumonitisLungcontusionPrimaryvascularsourceArteriovenousmalformationPulmonaryembolismElevatedpulmonaryvenouspressure(especiallymitralstenosis)Pulmonaryarteryrupturesecondarytoballoon-tippulmonaryarterycathetermanipulationMiscellaneousandrarecausesPulmonaryendometriosis(catamenialhemoptysis)SystemiccoagulopathyoruseofanticoagulantsorthrombolyticagentsDIFFERENTIALDIAGNOSISTracheoNeoplasm40-60ageLonghistoryofsmokingTroublesomecoughandchestpainthatprecedeandacompanyhemoptysisNeoplasm40-60ageInfectionStaphylococcus—rusty-looking,grosslybloodStaphylococcus—bloodmixedwithpusKlebsiella—currantjellyBrisk(濃味道)bleeding—bloodmixedwithcopiousamountoffoul-smellingpusInfectionStaphylococcus—rusty-2022/12/1697Investigation

Ifcoughedoutorvomittedout[文本】Age,sex,colourVolume:howmuchTimedurationAnyaccompaniedappearances2022/12/1132Investigation

IfcChestPainChestPainSYMPTOMSANDSIGNS—chestpainPleuritis,lunginfection,lungtumor,lunginfarctionarethemajorcauses.Pleuriticchestpain—respirationSuddenonsetwithdyspnae–pneomothorax,lunginfarctionSuperficialpainofchestwall—intercostalneuropathy,viralinfectionPericardialandpoststernal-myocardialinfarction--substernal"pressure,""constriction,"or"squeezing",neckorbotharms.

SYMPTOMSANDSIGNS—chestpainPPleuriticPainPulmonaryPainChestWallPainCardiacPainPleuriticPainCommonCausesChestwallHerpeszosterRibfractureCardiovas-cularAngina(心絞痛）

MyocardialinfarctionPericarditisDissectinganeurysmRespirato-ryPleuraldisordersPneumotho-raxCarcinomaPneumoniaMediastin-alMediastinitisMediastinalemphysemaMediastinaltumorEsophageallesionsHiatalhernia(食管裂孔疝OthersLivercarcinomaLiverabscessSubdiaph-ragmaticabsessSpleeninfartCommonCausesChestwallHerpesChestwallpainPersistentcoughorbreathlessnessMuscularstrainsIntercostalmyositisThoracicherpeszosterCoxsackieBinfectionThoracicdisclesionornervecompressionIntercostalnervecompressionorinfiltrationRibfractureRibtumour:primaryormetastaticTietze’ssyndromeSlippingribsyndromePleuralpainInfectivepleurisyPneumothoraxAutoimmunediseaseAsbestospleuralfibrosisMesotheliomaMetastatictumourAirwaypainTracheitisInhalationofirritantgasIntubationCentralbronchialcarcinomaMediastinalpainCardiacischaemia/infarctionMassivepulmonaryembolismOesophagit