Marshell Tendean. MD.

DPCP
Dept of Internal Medicine
Faculty of Medicine
UKRIDA Jakarta-Indonesia.
 Review of the main respiratory system
Determined formulation of proper diagnosis
Patophysiology of cough and dyspnea
Review common disease related in
respiratory system
 Properhistory.
Good physical examination.
Accurate diangostic workup :
General.
Respiratory specific.
 Obstructive lung disease.
Restrictive patophysiology
(parenchymal disease).
Restrictive patophysiology
(neuromuscular weakness).
Pulmonary vascular disease
Malignancy.
Infectious diasease.
 Dyspnea and Cough
Main symptoms ?
Air hunger
Chest tightness
Duration ?
Onset ? Acute, chronic
Acute, waxing weaning

Dyspnea with Sputum production

excertion ? ?
Productive / non productive

Incite or relieving
factor ?
Reproduced from : Adalberto Pacheco, Arch Bronconeumol.2013;49:151-7
 Wheezing
Hemoptysis
Chestpain
Symptoms of cor pulmonale
 Inspection.
Palpation.
Percussion.
Auscultation.
 Chest PA/ Lateral

CT-Scan
 Infection :
Bacterial :
Atypical bacteria.
Typical bacteria.
Virus
RSV, coronavirus, SARS, influenzavirus.
Fungal.
Aspergilosis, histoplasmosis, candidiosis.
Mycobacterium
Pneumocystis jirovei
 Mycobacterium tuberculosis
Worldwide health problems.
Droplet related infection.
Must be treated completely.

Pneumocystis jirovei.
Classified as non fungal, non bacterial.
Hiv related.
 Obstruction : Smoke related.
Ireversible airflow
Asthma
obstruction.
Commonly in child.
B2 Agonist responsive
Atopic history.
Reversible airflow
obstruction.
Steroid responsive.

COPD
Commonly in elderly.
 Determine obstruction vs restrictive
condition
May represents some physiologic condition of
the lung
FVC, FEV1, FCV/FEV1 ratio

Ascertainreversibility
Done in patient with stable lung condition
 Malignancy (Smoke related)
Small cell
Oat cell carcinoma.

Non small cell :

Squamous, adenocarcinoma, large cell.
 Pulmonary vascular change :
DVT and Pulmonary embolism
Virchow triad :
Hypercoagulation state

Stasis

Endothelial injury
 General(Non pharmacologic).
Pharmacologic.
Antibiotic
Steroid
B2 Agonist
Chemotherapeutic agent
Special procedure / intervention.
 Imunization :
Active
Pasive
Physiotherapy.
Medications.
Misc.
Thank you for your kind
consideration.

UKRIDA 2014