Pulmão

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)


Sintomas

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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
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
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
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
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
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


Videoaulas

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