INTRODUCTORY MEDICINE

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RESPIRATORY/CARDIOVASCULAR

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By

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Dr. Danjuma Sulai, OON

MBBS, MSc. Com Hlth (Lon), FRCP (Lon) FMCP (Nig)

email: danjumasulai@yahoo.com

Anatomical Basis of Symptom and Signs

UPPER RESPITORY TRACTS

Nose

• Para-nasal sinuses linked
• Empties to naso-pharynx
• Nasal turbinates
• Highly vascular, innervated mucous

ciliated epithelium

• Hairy.

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Pharynx

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• Partial separated into Naso and oro- pharynx by soft & hard palate
• Richly lined with lymphoid tissue (Adenoids), and the tonsils
• Eustachian tube connection to M/Ear.

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Larynx

• Cricoid bone/cartilage
• Vocal cords, Glottis, Epiglottis
• Recurrent Laryngeal Nerve (vagus N)

Trachea

• Tube – ringed with cartilage
• Ciliated mucous epitheluim
• Bifurcates. Right (more vertical) & Lt Bronchi.

* Can be pulled or pushed

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LOWER RESPIRATORY TRACT

1. Pleural – space; Parietal visceral the
2. Lungs Parenchyma/ Interstitium in Lobes
3. Bronchi – RT vertical LT- slanted
4. Bronchioles - segmental
5. Respiratory Bronchioles, alveoli, and pulmonary arteries/arterioles and veins form respiratory acina for gas-exchange.
6. Diaphragm – Rt and Lt Domes and central.

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SYMPTOMS

• Complaint(s) delivered by patient

directly. Relation(s) especially in children

or amplified by self, the spouse, other relations – at home, work-place etc.

• Often not straight forward

eg I just don’t feel myself,

I feel heat inside me

Things as if are moving this side to

this site etc.

. Specific symptoms/complaints

eg. I have chest pain; my Lt leg swells

. However though “specific” requires you to

define- where (site); when – time, and when the part is moving ;

aggravating or remitting factors; Onset-

acute or insidious; or when the part put on its normal role eg. “Abdo Pain”

Is it when eaten food? or when hungry?

• “ Heart Pain, Palpitation (feel) heart beating”

is it at rest, exertion e.g climbing upstairs, running? Could ask about effect of symptom

eg “abdo pains” – Nausea, vomiting, appetite generally relates to what food etc.

“Chest Pain”

Difficulty in breathing,

coughing –sputum, site of comfort/worsening when deep breathing etc.

Note concurrence or divergence

eg. “ I cannot walk on this leg” – you see him walk in

Radiation: ie where the pain spread to.

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COMMON IMPORTANT RESPIRATORY SYMPTOMS

1. Nasal Complaints

- Nose block – “ Cannot suck” in babies

- Recurrent sneezing

- Nasal watery discharge (Rhinitis)

- Nasal Bleed ( Epistaxis)

- Snoring (Nasal and Obstructive Sleep Apnea)

- Frontal Headaches/maxiallary pains

Recurrent sneezing, Nasal Discharges

(Parasinusitis)

PHARYNX---Sore Throat, Tonsils, Uvula, Adenoids

2. Chest Pain

a) Rib Cage –Skin, Muscle, Cartilage,

Ribs, Sternum. Pleura – Parietal inflamed/

effusion.

b) Pericardium

- Inflamed

- Effusion

c) Cardiac (Heart) pains only due to

ischaemia, which could be severe

enough to cause Myocardial Necrosis

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3. Cough

Productive – sputum: colour, volume (wet) consistency, haemoptysis

Dry – Wheeze, croup. ( trigger factors)

4. Difficulty in breathing

- Rapid shallow breaths

- Deep long breaths

- Gets short of breath with exertion

- posture related (orthopnea, PND)

Central cyanosis-Anatomical shunt, poor gas exchange

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5. Hiccup