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Ebook Hutchison’s clinical methods (24/E): Part 2

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(BQ) Part 2 book "Hutchison’s clinical methods" has contents: Cardiovascular system, respiratory system, locomotor system, gastrointestinal system, urogenital system, skin, nails and hair, endocrine and metabolic disorders,. and other contents. | SECTION 3 Basic systems 12. Respiratory system 13. Cardiovascular system 14. Gastrointestinal system 15. Locomotor system 16. Nervous system 17. Urogenital system 18. Endocrine and metabolic disorders 19. Skin, nails and hair 20. Eyes 21. Ear, nose and throat This page intentionally left blank SECTION THREE BASIC SYSTEMS Respiratory system 12  Veronica L.C. White Introduction Diseases of the respiratory system account for up to a third of deaths in most countries and for a major proportion of visits to the doctor and time away from work or school. As with every aspect of diagnosis in medicine, the key to success is a clear and carefully recorded history; symptoms may be trivial or extremely distressing, but either may indicate serious and lifethreatening disease. The history Most patients with respiratory disease will present with breathlessness, cough, excess sputum, haemoptysis, wheeze or chest pain. Breathlessness Everyone becomes breathless on strenuous exertion. Breathlessness inappropriate to the level of physical exertion, or even occurring at rest, is called dyspnoea. Its mechanisms are complex and not fully understood. It is not due simply to a lowered blood oxygen tension (hypoxia) or to a raised blood carbon dioxide tension (hypercapnia), although these may play a significant part. People with cardiac disease (see Ch. 13) and even non-cardiorespiratory conditions such as anaemia, thyrotoxicosis or metabolic acidosis may become dyspnoeic as well as those with primarily respiratory problems (Box 12.1). An important assessment is whether the dyspnoea is related only to exertion and how far the patient can walk at a normal pace on the level (exercise tolerance). This may take some skill to elicit, as few people note their symptoms in this form, but a brief discussion about what they can do in their daily lives usually gives a good estimate of their mobility (Box 12.2). Other clarifications will include whether there is variability in the