最近工作比较忙，因此有些延后。今天开始进入呼吸系统的病史采集及体格检查相关内容了。今天从病史采集开始。
HistoryAge,race,occupation(thelatterisessentialforrespiratorydisease).
Presenting
symptoms
DirectquestionsCoughDuration?Character(egbarking/hollow/dry)?Nocturnal夜间发生的(≈asthma,askaboutotheratopicsymptoms特应性敏性症状,ieeczema湿疹,hayfever花粉过敏；枯草热)?Exacerbatingfactors?Sputum痰(colour?Howmuch?)Anyblood/haemoptysis血液/咯血?Coughingisrelativelynon-specific,resultingfromirritationanywherefromthepharynxtothelungs咳嗽是相对非特异性表现，从咽喉部到肺部的刺激都会引起咳嗽，因此需要注意咳嗽的一些常见性质特点.Thecharacterofacoughmay,however,givecluesastotheunderlyingcause:?Loud,brassycoughing刺耳的咳嗽suggestspressureonthetrachea气管，气道,egbyatumour.?Hollow空的,‘bovine’coughing牛样咳isassociatedwithrecurrentlaryngealnervepalsy喉返神经麻痹.?Barkingcoughsoccurincroup.哮吼(见下面的图示)?Chroniccough:Thinkofpertussis百日咳,TB,foreignbody,asthma(egnocturnal).?Dry,chroniccoughingmayoccurfollowingacidirritationofthelungsinoesophagealreflux胃食管反流,andasaside-effectofACEinhibitorsACEI药物副作用.Donotignoreachangeincharacterofachroniccough;itmaysignifyanewproblem,eginfection,malignancy.HaemoptysisAlwaysthinkaboutTB(recentforeigntravel?)andmalignancy(weightloss?).Mixedwithsputum?(Bloodnotmixedwithsputumsuggestspulmonaryembolism肺栓塞,trauma,orbleedingintoalungcavity.)Melaena黑边?(Occursifenoughcoughed-upbloodisswallowed.)DyspnoeaDuration?Stepsclimbed/distancewalkedbeforeonset?NYHAclassification?Diurnalvariation(≈asthma)?Askspecificallyaboutcircumstancesinwhichdyspnoeaoccurs(egoccupationalallergenexposure).HoarsenessEgduetolaryngitis,recurrentlaryngealnervepalsy,Singer’snodules,orlaryngealtumour.WheezeFever/nightsweatsChestpainSOCRATES（见心血管检查相关内容）,usually‘pleuritic’ifrespiratory(ieworseoninspiration?).Stridor喘鸣Inspiratorysoundduetopartialobstructionofupperairways.吸入性喘鸣音是由于上呼吸道部分受阻导致。Obstructionmaybeduetosomethingwithinthelumen气管腔内(egforeignbody,tumour,bilateralvocalcordpalsy双边声带麻痹),withinthewall气管壁(egedemafromanaphylaxis过敏性,laryngospasm喉痉挛,tumour,croup,acuteepiglottitis,amyloidosis),orextrinsic(eggoitre,oesophagus,lymphadenopathy,post-opstridor,afternecksurgery).It’sanemergencyifgasexchangeis
2.湿性咳嗽：咳嗽伴有痰液称为湿性咳嗽，见医学教`育网搜集整理于慢性支气管炎、肺炎、肺脓肿、支气管扩张症、空洞型肺结核、肺囊肿合并感染、支气管胸膜瘘等。
咳嗽的时间与规律突发性咳嗽常由于吸入刺激性气体或异物、淋巴结或肿瘤压迫气管或支气管分叉处所引起。发作性咳嗽可见于百日咳、支气管内膜结核以及以咳嗽为主要症状的支气管哮喘(变异性哮喘)等。长期慢性咳嗽，多见于慢性支气管炎、支气管扩张、肺脓肿及肺结核。夜间咳嗽常见于左心衰竭和肺结核患者，引起夜间咳嗽的原因，可能与夜间肺淤血加重及迷走神经兴奋性增高有关。
咳嗽的音色指咳嗽声音的特点。如①咳嗽声音嘶哑，多为声带的炎症或肿瘤压迫喉返神经所致;②鸡鸣样咳嗽，表现为连续阵发性剧咳伴有高调吸气回声，多见于百日咳、会厌、喉部疾患或气管受压;③金属音咳嗽，常见于因纵隔肿瘤、主动脉瘤或支气管癌直接压迫气管所致的咳嗽;④咳嗽声音低微或无力，见于严重肺气肿、声带麻痹及极度衰弱者。
(Screenforpresentingsymptomsbeforeproceedingtopasthistory.)
Pasthistory
Askabout:pneumonia/bronchitis;TB;atopy特异反应(asthma/eczema/hay
fever);previousCXRabnormalities既往胸片的异常;lungsurgery;myopathy肌病;neurologicaldisorders.Connectivetissuedisorders,egrheumatoid,SLE.
注：
Atopyimpliespredispositionto,orconcurrenceof,asthma,hayfeverandeczemawithproductionofspecificIgEonexposureto