RespiratorySymptomsZhaoLi,M.D.(鉤端螺旋體病)CommonsymptomsCoughExpectorationHemoptysisChestpainCyanosisDyspnea(鉤端螺旋體病)Cough(aprotectivereflex):causesRespiratorydiseases___themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleura(鉤端螺旋體病)Cough(aprotectivereflex):causesCardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitis(鉤端螺旋體病)Cough:manifestationsCharacteristicsDrycough(non-sputum)Productivecough(sputum:infectious,edema)AttackTime(morning,midnight,earlymorning)Season(spring,summer,falland/orwinter)Motivation(fumeinhalation,exertion)ToneHoarsenessHighpitchWeakBrassy(鉤端螺旋體病)Cough:accompanysignsFever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess)(鉤端螺旋體病)Sputum:amountBulkfrothysputumPulmoedemaBulkserofluidsputumAlveolarcellcarcinomaBulkpussputumBronchiectasisLungabscessLayeringupper:frothy,middle:mucoidormucopus,lower:necrosissubstance(鉤端螺旋體病)Sputum:consistency

MucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSerofluidsputumPulmoedemaPussputumAnybacterialinfection

Bloodysputum(鉤端螺旋體病)Sputum:colorWhitemucoidorserofluidsputumYellow

generalbacterialinfectionGreen

aeruginosusBacillusinfectionGreyorblackdustinhalationRusty

LobarpneumoniaPink

cardiacedemaRedhemoptysisGreyorblack(鉤端螺旋體病)Sputum:foulodoranaerobicbacteriuminfection(鉤端螺旋體病)HemoptysisBleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:>500ml/d,or100-500ml/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesis(鉤端螺旋體病)DistinguishedhemoptysisfromhematemesisHemoptysisHematemesisCausesPulmoorcardiacdigestivesystemPrevioussymptomsCough,chesttightnessNausea,vomitingSpitupCoughupVomitedColorBrightredDarkredMixtureSputum,frothyGastriccontentspHalkalityacidityTarrystools-or++Post-bleedingSputumwithbloodNosputum(鉤端螺旋體病)Hemoptysis:causesBronchialdisordersBronchiectasisBronchogeniccarcinomaendobronchialTBChronicbronchitisPulmoDisordersPulmoTBPeumoniaLungabscessPulmoembolism(鉤端螺旋體病)Hemoptysis:causesCardiovasculardisordersAcuteleftheartfailureMitralstenosisOthersHematologicdisease,leptospirosis（鉤端螺旋體病），epidemichemorrhagicfever，endometriosis（子宮內(nèi)膜異位癥）(鉤端螺旋體病)Hemoptysis:accompanysignsFeverInfectionorcarcinomaChestpainInfection，PulmoEmbolism，CarcinomaPussputumBronchiectasis，LungabscessClubbingfingersBronchiectasis，Lungabscess，CarcinomaHemorrhagicspotsHematologicdisease,leptospirosis,epidemichemorrhagicfever(鉤端螺旋體病)Chestpain:causesChestwallherpeszoster,ribfractureCardiovascularanginapectoris,myocardialinfarction,pericarditis,dissectinganeurysm（夾層動(dòng)脈瘤）RespiratoryPleuraldisorders,pneumothorax,carcinomaMediastinalMediastinitis,mediastinalemphysema,mediastinaltumorOthersesophagealcarcinoma,liverabscess,subdiaphragmaticabscess,hiatalhernia（食道裂孔疝）(鉤端螺旋體病)Chestpain:characteristics

locationReferredpain

featureBurningpain,pressingpain,burstingpain,prickingpainDurationInfluentialfactorsExertional,respiration,foodintake,administration(鉤端螺旋體病)Chestpain:accompanysignsCough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumonia,pneumothorax,pleurisy,pulmoembolismHemoptysisCarcinoma,pulmoembolismShock

myocardialinfarction,dissectinganeurysm(rupture),largeareapulmoembolismDysphagia(吞咽困難)Esophagealdisease(鉤端螺旋體病)CyanosisAnexcessofdesaturatedhemoglobincausesabluecolorationoftheskinormucosae.methemoglobinemia(高鐵血紅蛋白血癥）Poisoningbynitrite(鉤端螺旋體病)Cyanosis:classificationCentral(warm)DeficientoxygenationRight-to-leftshuntPeripheral(cold)ReducedcardiacoutputLocalvasoconstrictionMixedHeartfailure(鉤端螺旋體病)Cyanosis:accompanysignsDyspneaSeverecardiacorrespiratorydisorderClubbingfingersCongenitalheartdiseaseChronicrespiratorydiseaseUnconsciousness

Poisoning,shock,Severecardiacorrespiratorydisorder(鉤端螺旋體病)Dyspnea:causesRespiratorysystemObstruction:asthma,COPD,tumor

PulmoDiseases:pneumonia,interstitiallungdisease,Chestwallorpleura:pleurisy,pneumothorax,trauma

neuro-muscles:poliomyelitis(脊髓灰質(zhì)炎),myastheniagravis(重癥肌無(wú)力)Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavity(鉤端螺旋體病)Dyspnea:causesCardiovascularsystemHeartfailurePulmoembolismPoisoningketoacidosisCentralnervoussystemcerebraltumor,trauma,abscess,hemorrhage,encephalitis,meningitishematologicalsystem

Severeanemia(鉤端螺旋體病)RespiratoryDyspneaInspiratorydyspnea____obstructioninlargeairwayThreedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea____obstructioninsmallairwayoralveolarelasticitydecreasedProlongedexpiratorytimeExpiratoryrhonchiMixeddyspnea____deficientgasexchangeRespiratoryrateincreasedShallowbreathing(鉤端螺旋體病)Cardiacdyspnea____HeartfailureMechanismofleftheartfailurePulmoedemadiffusioncapacitydecreasedAlveolartensionincreasedstimulatingstretchreceptorexcitationofvagusnerveexcitationofrespiratorycenterAlveolarelasticitydecreasedvitalcapacitydecreasedIncreasedpressureofpulmocirculationstimulatingrespiratorycenter

(鉤端螺旋體病)Featuresofleftheartfailure

UnderlyingdiseasesMixeddyspneaPositionrelateddyspneaMoistcracklesorrhonchiinbothlungsReliefofsymptomsafterdigitalis,diuretic,vasodilatoragentused

(鉤端螺旋體病)NocturnalparoxysmaldyspneaCharacteristicsAwokenduetochesttightnessordyspneaForcedsittingpositionororthopneaSeveresweatTachycardiaMoistcracklesorrhonchiinbothlungsPinkfrothysputum

(鉤端螺旋體病)NocturnalparoxysmaldyspneaMechanismElevatedexcitationofvagusnerveContractionofcoronaryarterymyocardiumischemiaContractionofbronchioledecreasedalveolarventilationVitalcapacitydecreasedins