A ausculta dos sons respiratórios com um cilindro (estetoscópio) produz sinais auditivos facilmente interpretados, capazes de indicar a presença e a extensão da maioria dos órgãos da cavidade torácica.
René Laennec (1781-1826)
Semiologia
Sintomas
Dx Diferenciais
Tosse Aguda
• Viral URI or postviral cough (most common)
• Bacterial URI
• Postnasal drip (allergic rhinitis)
• Pneumonia
• Pulmonary edema, e.g., CHF
• Asthma
• Pulmonary embolism
• Aspiration pneumonia
• Bacterial URI
• Postnasal drip (allergic rhinitis)
• Pneumonia
• Pulmonary edema, e.g., CHF
• Asthma
• Pulmonary embolism
• Aspiration pneumonia
Tosse Crônica
Top 3 causes: postnasal drip, asthma, gastroesophageal reflux disease (GERD)
Don’t miss
• Pertussis
Pulmonary infectious
• Postviral
• Bronchitis, especially in smokers
• Bronchiectasis
• Tuberculosis
• Cystic fibrosis
• Mycobacterium avium complex (MAC)
• Pertussis
• Mycoplasma
• Chlamydia
• Respiratory syncytial virus (RSV)
• Parasites, eg, ascariasis, paragonimiasis
Pulmonary noninfectious
• Asthma (cough-variant asthma)
• Beta-blockers causing asthma
• Chronic obstructive pulmonary disease (COPD)
• ACE inhibitors
• Irritant inhalation, eg, smoking
• Endobronchial lesion, eg, tumor
• Interstitial lung disease
• Sarcoidosis
• Chronic microaspiration
Nonpulmonary
• Gastroesophageal reflux disease (GERD)
• Postnasal drip (allergic rhinitis)
• Sinusitis
• Congestive heart failure (CHF)
• Laryngitis
• Ear canal or tympanic membrane irritation
• Psychogenic or habit cough
Don’t miss
• Pertussis
Pulmonary infectious
• Postviral
• Bronchitis, especially in smokers
• Bronchiectasis
• Tuberculosis
• Cystic fibrosis
• Mycobacterium avium complex (MAC)
• Pertussis
• Mycoplasma
• Chlamydia
• Respiratory syncytial virus (RSV)
• Parasites, eg, ascariasis, paragonimiasis
Pulmonary noninfectious
• Asthma (cough-variant asthma)
• Beta-blockers causing asthma
• Chronic obstructive pulmonary disease (COPD)
• ACE inhibitors
• Irritant inhalation, eg, smoking
• Endobronchial lesion, eg, tumor
• Interstitial lung disease
• Sarcoidosis
• Chronic microaspiration
Nonpulmonary
• Gastroesophageal reflux disease (GERD)
• Postnasal drip (allergic rhinitis)
• Sinusitis
• Congestive heart failure (CHF)
• Laryngitis
• Ear canal or tympanic membrane irritation
• Psychogenic or habit cough
Hemoptise
Airways
• Bronchitis
• Bronchiectasis
• Bronchogenic carcinoma
Pulmonary vasculature
• Left ventricular failure
• Mitral stenosis
• Pulmonary embolism
• Arteriovenous malformation
Pulmonary parenchyma
• Pneumonia
• Abscess
• Tuberculosis
• Aspergilloma
• Parasites, eg, paragonimiasis, ascariasis, hookworm, strongyloidiasis
• Goodpasture’s syndrome
• Wegener’s granulomatosis
• Systemic lupus erythematosus (SLE)
• Crack cocaine inhalation
• Idiopathic pulmonary hemosiderosis
• Leukemia
Iatrogenic
• Transbronchial lung biopsy
• Anticoagulation
• Pulmonary artery rupture by PA line
• Bronchitis
• Bronchiectasis
• Bronchogenic carcinoma
Pulmonary vasculature
• Left ventricular failure
• Mitral stenosis
• Pulmonary embolism
• Arteriovenous malformation
Pulmonary parenchyma
• Pneumonia
• Abscess
• Tuberculosis
• Aspergilloma
• Parasites, eg, paragonimiasis, ascariasis, hookworm, strongyloidiasis
• Goodpasture’s syndrome
• Wegener’s granulomatosis
• Systemic lupus erythematosus (SLE)
• Crack cocaine inhalation
• Idiopathic pulmonary hemosiderosis
• Leukemia
Iatrogenic
• Transbronchial lung biopsy
• Anticoagulation
• Pulmonary artery rupture by PA line
Sibilos
• Asthma
• Chronic obstructive pulmonary disease
• Congestive heart failure (cardiac asthma)
• Acute bronchitis
• Pneumonia
• Gastroesophageal reflux disease
• Airway obstruction (eg, tumor, goiter)
• Foreign-body aspiration
• Aspiration pneumonia
• Interstitial lung disease
• Pulmonary embolism
• Angioedema or anaphylaxis
• Carcinoid syndrome
• Vocal cord dysfunction
• Ascariasis
• Chronic obstructive pulmonary disease
• Congestive heart failure (cardiac asthma)
• Acute bronchitis
• Pneumonia
• Gastroesophageal reflux disease
• Airway obstruction (eg, tumor, goiter)
• Foreign-body aspiration
• Aspiration pneumonia
• Interstitial lung disease
• Pulmonary embolism
• Angioedema or anaphylaxis
• Carcinoid syndrome
• Vocal cord dysfunction
• Ascariasis
Dor torácica
Don’t miss
• Myocardial ischemia, pericarditis, aortic dissection, pulmonary embolism, tension pneumothorax, esophageal rupture
Cardiovascular
• Myocardial ischemia (angina, myocardial infarction), pericarditis, aortic stenosis, aortic dissection, pulmonary embolism, cardiomyopathy, myocarditis, mitral valve prolapse, pulmonary hypertension, hypertrophic obstructive cardiomyopathy (HOCM), carditis (eg, acute rheumatic fever), aortic insufficiency, right ventricular hypertrophy
Pulmonary
• Pneumonia, pleuritis, bronchitis, pneumothorax, tumor
Gastrointestinal
• Esophageal rupture, gastroesophageal reflux disease (GERD), esophageal spasm, Mallory-Weiss syndrome, peptic ulcer disease, biliary disease, pancreatitis, functional gastrointestinal pain
Musculoskeletal
• Cervical or thoracic disk disease or arthritis, shoulder arthritis, costochondritis (anterior chest wall syndrome or Tietze’s syndrome), subacromial bursitis
Other
• Anxiety or panic attack, herpes zoster, breast disorders, chest wall tumors, thoracic outlet syndrome, mediastinitis
• Myocardial ischemia, pericarditis, aortic dissection, pulmonary embolism, tension pneumothorax, esophageal rupture
Cardiovascular
• Myocardial ischemia (angina, myocardial infarction), pericarditis, aortic stenosis, aortic dissection, pulmonary embolism, cardiomyopathy, myocarditis, mitral valve prolapse, pulmonary hypertension, hypertrophic obstructive cardiomyopathy (HOCM), carditis (eg, acute rheumatic fever), aortic insufficiency, right ventricular hypertrophy
Pulmonary
• Pneumonia, pleuritis, bronchitis, pneumothorax, tumor
Gastrointestinal
• Esophageal rupture, gastroesophageal reflux disease (GERD), esophageal spasm, Mallory-Weiss syndrome, peptic ulcer disease, biliary disease, pancreatitis, functional gastrointestinal pain
Musculoskeletal
• Cervical or thoracic disk disease or arthritis, shoulder arthritis, costochondritis (anterior chest wall syndrome or Tietze’s syndrome), subacromial bursitis
Other
• Anxiety or panic attack, herpes zoster, breast disorders, chest wall tumors, thoracic outlet syndrome, mediastinitis
Dispnéia
Acute
• Asthma, pneumonia, pulmonary edema, pneumothorax, pulmonary embolus, metabolic acidosis, acute respiratory distress syndrome, panic attack
Pulmonary
• Airflow obstruction (asthma, chronic obstructive pulmonary disease, upper airway obstruction), restrictive lung disease (interstitial lung disease, pleural thickening or effusion, respiratory muscle weakness, obesity), pneumonia, pneumothorax, pulmonary embolism, aspiration, acute respiratory distress syndrome
Cardiac
• Myocardial ischemia, congestive heart failure, valvular obstruction, arrhythmia, cardiac tamponade
Metabolic
• Acidosis, hypercapnia, sepsis
Hematologic
• Anemia, methemoglobinemia
Psychiatric
• Anxiety
• Asthma, pneumonia, pulmonary edema, pneumothorax, pulmonary embolus, metabolic acidosis, acute respiratory distress syndrome, panic attack
Pulmonary
• Airflow obstruction (asthma, chronic obstructive pulmonary disease, upper airway obstruction), restrictive lung disease (interstitial lung disease, pleural thickening or effusion, respiratory muscle weakness, obesity), pneumonia, pneumothorax, pulmonary embolism, aspiration, acute respiratory distress syndrome
Cardiac
• Myocardial ischemia, congestive heart failure, valvular obstruction, arrhythmia, cardiac tamponade
Metabolic
• Acidosis, hypercapnia, sepsis
Hematologic
• Anemia, methemoglobinemia
Psychiatric
• Anxiety