The authors would like to acknowledge David A. Miller for his contributions that remain unchanged from the first edition.
SYMPTOM POSSIBILITIES AND ORIGINS
I. Major symptoms suggesting a pulmonary disorder
A. Dyspnea
1. Air flow obstruction and/or altered ventilation/perfusion relationship
2. Altered pulmonary compliance
3. Respiratory muscle weakness
B. Cough
1. Mucus
2. Foreign body
3. Exposure to noxious stimuli
4. Bronchospasm
C. Production of sputum or blood—hemoptysis: below the vocal cords
D. Chest pain
1. Cardiac
2. Pleural
3. Pericardial
4. Esophageal
5. Vascular
F. Altered mental status or daytime functioning
II. Potential origins of symptoms (pathophysiologic alterations) in the thorax
A. Pulmonary parenchyma—altered ventilation and/or perfusion
B. Pulmonary vasculature—altered perfusion
C. Trachea and bronchi—altered secretion and/or air flow
D. Chest wall, pleura, and pericardium
1. Altered perfusion and/or ventilation
2. Altered sense of comfort in breathing
E. Great vessels—altered comfort
F. Esophagus—altered comfort
G. Hemoglobin
1. Altered perfusion
2. Altered systemic oxygen distribution
H. Heart and cardiac valves—altered sense of comfort in breathing
I. Constitutional changes:
1. Altered body temperature
2. Altered appetite and/or weight
3. Altered sweating/chills
III. Special considerations
A. Lung parenchyma—absent pain fibers below the glottis
B. Chest wall and pleura—pain with ventilation and/or with movement of the chest
C. Changes in sputum
1. Color
2. Amount
3. Production
4. Expectoration
D. Hemoptysis
1. Lung infection
2. Tumor
3. Anticoagulation
a. Medical therapy
b. Severe intrinsic liver disease
c. Thrombocytopenia
4. A source of bleeding above the vocal cords is not considered hemoptysis but, rather, is believed to be related to the upper airway or gastrointestinal tract.
E. Circadian variation in symptoms
1. Usual increase in airway resistance between 2 am and 6 am
2. Aggravation of symptoms during periods of recumbency
G. Chest pain 3 to 4 hours after rising—usually cardiac in origin
H. Chest pain after meals—usually of esophageal and/or cardiac origin
IV. Detailing symptoms referable to breathing in differential diagnosis of breathing problems
A. About what is the patient complaining?
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
