Cough&Hemoptysis_ppt Sept202122

[Audio] HEMOPTYSIS BY: KATTHULA NISHANTH KUMAR 18- 1080- 545 [ Group -2].

[Audio] ❏ Hemoptysis is the expectoration of blood from the respiratory tract. The first step in evaluation is to ascertain whether the bleeding is coming from the respiratory tree or instead originating from the nasal cavities (i.e., epistaxis) or the gastrointestinal tract (i.e., hematemesis) ❏ Hemoptysis can arise from anywhere in the respiratory tract; from the glottis to the alveolus. Most commonly, bleeding arises from the bronchi or medium sized airways ❏ A unique feature of the lung that predisposes to hemoptysis of varied severity is its dual blood supply—the pulmonary and bronchial circulations. ❏ Hemoptysis commonly results from infection, malignancy, or vascular disease; however, the differential for bleeding from the respiratory tree is varied and broad. HEMOPTYSIS?.

[Audio] IDENTIFYING INFORMATION Patient name : Jose Rodriguez Age : 35 years old Gender : male Occupation : laborer , currently working for cash on a new home construction project Location : United states Marital status : Married.

[Audio] CHIEF COMPLAINT " coughing up blood for the past 3 days.".

[Audio] HISTORY OF PRESENT ILLNESS Several weeks PTC Along with cough patient also complains subjective fever , chills, night sweats , dyspnea, pleuritic chest pain, fatigue, and an unintentional 10-lb weight loss. 3- 4 Weeks PTC productive cough , originally accompanied of yellow sputum 3 days PTC Blood in the sputum.

[Audio] PAST MEDICAL HISTORY ❏ NONE FAMILY HISTORY ❏ Father with Myocardial Infarction ❏ Mother with Diabetes mellitus and Hypertension.

[Audio] SOCIAL HISTORY ❏ Patient has a 10 pack-year history of smoking but quit several weeks ago when the current illness started . ❏ The patient denies illicit drug use, but does report drinking alcohol on weekends. ❏ patient is a laborer and is currently working for cash on a new home construction project in close contact with other workers.

[Audio] REVIEW OF SYSTEMS EYES HEAD SKIN (-) Rashes, lumps, sores, itching, dryness changes in color ; changes in hair or nails ; changes in size and color of moles GENERAL : (+) Weight loss; (-) weakness,(+) fatigue, (+) cills (+), night sweats SKIN (-) Headache, head injury, dizziness , lightheadedness (-) Pain, redness, excessive tearing, double or blurred vision, spots, specks, flashing lights, glaucoma, cataracts.

[Audio] (-) tinnitus, vertigo, earaches, infection discharge. EARS NOSE & SINUSES : (-) Frequent colds, nasal stuffiness discharge or itching, hay fever, nose bleeds, sinus trouble BREAST NECK THROAT (-) Sore tongue, dry mouth, frequent sore throats, hoarseness (-) " swollen glands," goiter, lumps, pain or stiffness in the neck (-) Lumps, pain or discomfort, nipple discharge.

[Audio] (+) Cough,(+) shortness of breath ( dyspnea ), (+) sputum ,(+) pleuritic pain (-) wheezing RESPIRATO RY CARDIOVASCUL AR (-) Chest pain or discomfort , palpitation, heart murmur , edema. PERIPHERAL VASCULAR ; (-) Claudication ; leg cramps : varicose veins ; swelling in calves, legs or feet ; color change in fingertips or toes during cold weather ; swelling with redness / tenderness (-) Trouble swallowing, heartburn, nausea, pain with defecation, jaundice, constipation, diarrhea, food intolerance, liver or gall bladder trouble, hepatitis.

[Audio] (-) Frequency of urination, polyuria, nocturia, urgency, burning or pain during urination, hematuria, urinary infections, kidney or flank pain, incontinence ; reduced caliber or force of the urinary stream, hesitancy, dribbling. URINARY MUSCULO -SKELETAL (-) Muscle or joint pain, arthritis gout, back ache, neck or low back pain. HEMATOLOGIC (-) Anemia, easy bruising or bleeding, past transfusions, transfusion reactions. (-) Changes in mood, attention or speech ; changes in orientation, memory, insight or judgement ; headache, dizziness, vertigo, fainting, blackouts ; weakness, paralysis, numbness or loss of sensation, tingling or " pins and needles", tremors or other involuntary movements, seizures..

[Audio] MEDICATIONS ❏ OTC antitussives, which did not provide any relief ALLERGIES No known drug allergies.

[Audio] PHYSICAL EXAMINATION GENERAL: Somewhat thin-appearing Hispanic male in mild respiratory distress VITAL SIGNS: BP 131/70, P 94, R24, T t 38.8°C; Weight 68 kg, Height 5' 9'' SKIN: No lesions HEENT: Pupils equal, round, and reactive to light and accommodation, EOM intact, no scleral icterus NECK: Supple CHEST : Bronchial breath sounds in RUL CARDIOVASCULAR: Slightly tachycardic, no murmur, rub or gallop ABDOMEN: Soft Nontender nondistended; (+) bowel sounds; no hepatosplenomegaly or tenderness EXTREMITIES: No clubbing, cyanosis, edema, pulses 2+ throughout; full ROM NEURO: Alert & Oriented × 3; CN II–XII intact; reflexes 2+, sensory and motor levels intact.

[Audio] SALIENT FEATURES ❏ Patient thin-appearing Hispanic male ❏ (+) Fever (+) Chills (+) fatigue , (+) dyspnea (+) Night sweats (+) pleuritic chest pain ❏ (+)productive cough ,(+) yellow sputum , (+) hemoptysis ❏ (+) unintentional 10-lb weight loss(+) Bronchial breath sounds in right upper lobe ❏ Reports use of alcohol on weekends ❏ History of smoking 10-packs per -year ❏ Respiratory rate 24 breaths per minute ❏ Patient is a laborer and is currently working for cash on a new home construction project in close contact with other workers ❏ CC : Coughing up blood for past 3 days.

[Audio] INITIAL IMPRESSION PULMONARY TUBERCULOSIS.

[Audio] DIFFERENTIAL DIAGNOSIS ❏ Lung cancer ❏ Pneumonia ❏ Acute bronchitis ❏ Bronchiectasis ❏ Lung Abscess.

[Audio] ➢ Also known As lung carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. ➢ This growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body. ➢ Signs and symptoms of lung cancer include: ▪ Coughing up blood, even a small amount ▪ Shortness of breath ▪ Chest pain ▪ Hoarseness ▪ Losing weight ▪ Bone pain ▪ Headache LUNG CANCER.

[Audio] RULE IN RULE OUT Cough with blood Frequent respiratory infection Dyspnea Wheezing Fatigue Swollen lymph nodes Chest pain hoarseness Weight loss Loss of appetite.

[Audio] PNEUMONIA Pneumonia is an infection in one or both lungs. Bacteria, viruses, and fungi cause it. The infection causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. ➢ Common symptoms include: • Chest pain when you breathe or cough • Cough that produces phlegm or mucus • Fatigue and loss of appetite • Fever, sweating, and chills • Nausea, vomiting, and diarrhea • Shortness of breath.

[Audio] RULE IN RULE OUT Weight loss Headache Fever and chills Diarrhea Night sweats Wheezing Fatigue Pleural effusion Hemoptysis Rapid shallow breathing.

[Audio] ACUTE BRONCHITIS Acute bronchitis, also known as a chest cold, is short-term bronchitis . Inflammation of the bronchi (large and medium sized airways) of the lungs. ➢ symptoms include: • runny nose • sore throat • tiredness • sneezing • wheezing • feeling cold easily • back and muscle aches • fever.

[Audio] RULE IN RULE OUT Fever Wheezing Shortness of breath Soreness in the chest Cough Sore throat Fatigue Mild head and body aches.

[Audio] Bronchiectasis is a chronic condition where the walls of the bronchi are thickened from inflammation and infection. Some common symptoms include : Coughing that results in a lot of mucus Coughing up mucus that has blood in it ( known as hemoptysis) Chest pain or tightness because it is harder to breathe Wheezing or making whistling noises when breathing Clubbing of nails Loss of weight Fatigue Fever / chills Increased shortness of breath Night sweats BRONCHIECTASIS.

[Audio] RULE IN RULE OUT Fever / chills Coughing that results in a lot of mucus Fatigue Clubbing of nails Weight loss Wheezing Chest pain hemoptysis Shortness of breath.

[Audio] Lung abscess is defined as necrosis of the pulmonary tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection Symptoms include : Chest pain ( especially when you breath in ) Cough Fatigue Fever Loss of appetite Night sweats Sputum ( a mixture of saliva and mucus )with pus that always sore tasting , foul- smelling ,or streaked with blood Weight loss LUNG ABSCESS.

[Audio] RULE IN RULE OUT Chest pain Sputum cough Loss of appetite fatigue Bad breath Fever Weight loss Night sweats Shortness of breath.

[Audio] DIAGNOSTIC TEST OR LABORATORY WORKOUT ❖ Patient history ❖ Physical examination ❖ Blood test ❖ Sputum test ❖ Chest X-ray ❖ Bronchoscopy ❖ CT scan ❖ ventilation - perfusion scanning.

[Audio] FINAL DIAGNOSIS Pulmonary tuberculosis. .

[Audio] Pulmonary Tuberculosis is an infectious disease usually caused by Mycobacterium tuberculosis ( MTB) bacteria. it is a bacterial infection of the lungs. can be life threatening if person does not receive treatment. ➢ The main symptoms of pulmonary TB include: ▪ a bad cough that lasts for at least 3 weeks ▪ chest pain ▪ coughing up blood or phlegm from the lungs ▪ breathlessness.

[Audio] ➢ More general symptoms of TB can include: ▪ weight loss ▪ a loss of appetite ▪ fatigue ▪ fever and chills ▪ night sweats.

[Audio] DIAGNOSTIC TEST FOR PULMONARY TUBERCULOSIS ❖ Bronchoscopy ❖ Chest CT scan ❖ Chest X- ray ❖ Interferon - gamma release blood test , Quantiferon QFT-Gold test for TB infection ( active or infection in the past) ❖ Sputum examination and cultures ❖ Thoracentesis ❖ Tuberculin skin test ❖ Biopsy of affected tissue ( done rarely ).

[Audio] MANAGEMENT PHARMACOLOGICAL ➢ The most common medications used to treat tuberculosis include: Isoniazid Rifampin ( Rifadin, Rimactane) Ethambutol ( Myambutol) Pyrazinamide.

[Audio] NON-PHARMACOLOGICAL ❖ Isolation ❖ Ventilate the room ❖ Cover the mouth ❖ Wear mask ❖ Finish entire course of medication ❖ Vaccinations.

[Audio] Discuss the COUGH REFLEX ARC ➢ Pulmonary irritant receptors in the epithelium of the respiratory tract are sensitive to both mechanical and chemical stimuli. ➢ The bronchi and trachea are sensitive to light touch that slight amounts of foreign matter or other causes of irritation initiate the cough reflex. The larynx and carina are especially sensitive ➢ Rapidly moving air usually carries with it any forely matter that is present in the bronchi or trachea ➢ Stimulation of the cough receptors by dust or other foreign particles produces a cough, which is necessary to remove the foreign material from the respiratory tract before it reaches the lungs.

[Audio] ➢ Each cough occurs through the stimulation of a complex reflex arc. This is initiated by initiation of cough receptors which are found in the trachea bronchi, main carina, and branching points of large airways and most distal airways. ➢ Impulses from stimulated cough receptors traverse an afferent pathway via the vagus nerve to a ' cough center in the medulla. ➢ The cough center then generates an efferent signal that travels down through the vagus phrenic and spinal motor nerves to expiratory musculature that produces the cough.

[Audio] ACUTE CHRONIC SUBACUTE COUGH < 3 WEEKS 3- 8 WEEKS > 8 WEEKS Foreign body Bacterial / viral respiratory infections Removal Antibiotics Symptomatic treatment Pertussis Post viral [bronchial hyperreactivity] CXR - PA view Abnormal Normal Tuberculosis COPD ILD Carcinoma lung bronchiectasis Bronchial asthma Drug induced cough ( ACE inhibitor) Post nasal drip GERD DISCUSS TO APPROACH TO ACUTE , SUBACUTE , CHRONIC COUGH.

[Audio] How would you work-up the patient considering the following scenarios? Scenario A: CXR: No significant chest findings ❏ After considering the scenario , diagnose the patient with Mantoux tuberculin skin test( TB skin test) TB blood tests.

[Audio] Scenario B: CXR: Multifocal patchy opacities in the right upper lobe with thickening and upward shift of the minor fissure. ❏ These findings are consistent with and confirmed to be Pulmonary Tuberculosis.

[Audio] CREDITS: This presentation template was created by Slideshow, including icons by Flaticon, and infographics & images by Freepik. REPORTING & PPT BY : KATTHULA NISHANTH KUMAR 18- 1080- 545 THANK YOU.