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Symptomatology of Respiratory
Disorders
Department ofMedicine
ACMS
Female, 45 years, Nurse,
• Fever and weight loss X 2 months
• Productive cough X 2 months
• Blood in sputum X 2 days
Male, 18 year, Medical student
• Fever X 2 days
• Sore throat and running nose X 1 day
• Dry and painful cough X 1 day
55 year old soldier, Smoker
• Breathlessness and wheezing
• Productive Cough- more in the mornings
• Yellow sputum, approx...
Female, 50 years, Army wife
• Dry, distressing cough X 15 days
• Recently started on treatment for high BP
Tab Indapamide ...
Why do patients consult ?
–Discomfort
–Interference with normal life
–Fear/ concern
1. Cough
• Explosive expiration against a closed glottis-
Purpose- clearance of airways
Protective Superficial Reflex
• Af...
Cough Triggers
• Exogenous- Fumes, smoke, dust, Foreign body
• Endogenous- Secretions, gastric contents
• Initiate inflamm...
Cough Causes
Inflammation Infections, Post nasal drip,
GERD
Constriction Asthma, scarring, tumors
Infiltration Granulomato...
Cough Associations
Origin Common Cause Clinical Features
Pharynx Post nasal drip H/O chronic rhinitis
Larynx Laryngitis
Tu...
Questions ?
• Duration- Acute/ Chronic (3 weeks)
• Associated infection
• Seasonal
• Wheezing
• Post nasal drip/ GERD
• Sp...
60 year old female in C4 ward
• Progressive neurological illness X 2 months
• Weakness all 4 limbs
• Difficulty in swallow...
Baby boy, 2 years
• Breathlessness and cough 1 hour ago
• Loud and noisy breathing since then
• Blue discoloration of skin...
• Ineffective Cough- Muscle disease/ paralysis
• Bovine Cough -single vocal cord paralysis
Noisy Breathing
• Stridor- Insp...
Male, 35 years, Alcoholic
• Low grade fever and weight loss X 1 Month
• Cough X 1 month
• sputum production X 15 days
• Sp...
2. Sputum Production
• Quantity- nil, scanty, moderate (qty) copious
• Quality-
– Mucoid
– Muco-purulent
– Purulent
– Curr...
45 year old diabetic
• Diarrheal illness 4 days ago
• Fever and chest pain X 2 days
• Cough X 1 day
• Current Jelly like b...
3. Hemoptysis
ALWAYS ALARMING
Differentiate from
• nasopharyngeal bleed
• Epistaxis
• Hematemesis
Quantity-
• Streaking
• ...
45 year old male, Smoker
• Change of voice X 1 month
• Worsening cough X I month
• Blood in sputum X 2 days
Causes of Hemoptysis
Site Common Causes Rare Causes
Tracheo bronchial Carcinoma
Bronchitis
Bronchiectasis
Adenoma
Foreign ...
Questions ?
• Where from
• How much
• Single episode/ multiple
• Other sites
• Other complaints
• Pre existing disease
• A...
4. Breathlessness
Mechanism is complex
• Sensory endings stimulation
• Work of breathing (muscles)
• Small airway obstruct...
70 year old male, non smoker
• Previously an employee of Union Carbide
factory in Bhopal
• Progressively worsening breathl...
30 year old HIV Positive,
• Dry Cough X 3 weeks
• Progressive Breathlessness X 2 weeks
• Moderate Fever and weight loss X ...
Chronic Exertional Breathlessness
• COPD
• Asthma
• Heart disease
• Interstitial or Alveolar disease
• Chest wall / Respir...
40 year old postman, cycling every
day, non smoker
• Sudden onset and worsening by the minute-
Breathlessness and Chest pa...
Acute Severe Breathlessness
• Pulmonary Edema
• Massive Pulmonary Embolism
• Acute Severe Asthma
• Acute Exacerbation of C...
Questions ?
• Symptom Scale
• Precipitating event
• Associated complaints
• Pre existing disease
• Age group
• Occupation
5. Chest Pain
Central Peripheral
Cardiac Lungs
Aortic Pleura
Esophageal Muscular
Massive Pulmonary Embolism Skeletal
Trach...
Respiratory causes
• Raw upper sternal- Tracheitis
• Pleuritic- associated with breathing
• Shoulder - lower lobes/ diaphr...
40 year old smoker
• Hoarseness of voice X 3 weeks
• Dry irritative cough X 3 weeks
• Blood in sputum X 1 day
A R Rehman, Musician
• Weakness of voice after tour 10 concerts in 2
weeks
6. Voice Change (Dysphonia)
Structural Problems
Neurological Problems
• Hoarseness
• Weakness
• Aphonia
Causes
Inflammatory Acute and chronic laryngitis
Smoke inhalation
Neoplastic Carcinoma
Laryngeal Papillomatosis
Recurrent ...
Questions
• Quality
• Time course
• Onset and other associations
• Other diseases
• Waxing and waning
• Level of discomfor...
7. Hiccups
• Diaphragmatic irritation
Causes
• Respiratory- Basal pneumonia, Pleurisy
• CVS
• Upper GI
• Metabolic
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Symptomatology of Respiratory Disorders

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Symptomatology of Respiratory Disorders

  1. 1. Symptomatology of Respiratory Disorders Department ofMedicine ACMS
  2. 2. Female, 45 years, Nurse, • Fever and weight loss X 2 months • Productive cough X 2 months • Blood in sputum X 2 days
  3. 3. Male, 18 year, Medical student • Fever X 2 days • Sore throat and running nose X 1 day • Dry and painful cough X 1 day
  4. 4. 55 year old soldier, Smoker • Breathlessness and wheezing • Productive Cough- more in the mornings • Yellow sputum, approx 1 cupful X 1 week • Similar problem every winter for over 15 years that takes months to clear up. • Mild symptoms persist throughout the year
  5. 5. Female, 50 years, Army wife • Dry, distressing cough X 15 days • Recently started on treatment for high BP Tab Indapamide and Tab Enalapril
  6. 6. Why do patients consult ? –Discomfort –Interference with normal life –Fear/ concern
  7. 7. 1. Cough • Explosive expiration against a closed glottis- Purpose- clearance of airways Protective Superficial Reflex • Afferent- Trigeminal, Glossopharyngeal, Sup Laryngeal (Vagus) • Efferent- Recurrent Laryngeal (Vagus) and Spinal nerves
  8. 8. Cough Triggers • Exogenous- Fumes, smoke, dust, Foreign body • Endogenous- Secretions, gastric contents • Initiate inflammation- persistence of cough • Constriction • Infiltration • Compression
  9. 9. Cough Causes Inflammation Infections, Post nasal drip, GERD Constriction Asthma, scarring, tumors Infiltration Granulomatous diseases, Malignancy Compression Lymph nodes, Mediastinal tumors, Aortic aneurysm Other ACE Inhibitors
  10. 10. Cough Associations Origin Common Cause Clinical Features Pharynx Post nasal drip H/O chronic rhinitis Larynx Laryngitis Tumor Whooping cough Croup Voice change, odynophagia, painful, harsh Longer duration Paroxysms of cough Associated stridor Trachea Tracheitis Retrosternal pain Bronchi Acute Bronchitis COPD Asthma Carcinoma Dry/ productive; Associated fever; Short duration Productive; morning worsening ; long duration Usually dry, worse at night Persistent (with hemoptysis) Parenchyma TB Pneumonia Bronchiectasis abscess Pulmonary edema Interstitial fibrosis Productive (with hemoptysis) Initially dry, later productive Productive (postural change) Postural Nocturnal (pink frothy sputum) Dry, irritant & distressing Pleura Parietal pleura Pleurisy/ during aspiration
  11. 11. Questions ? • Duration- Acute/ Chronic (3 weeks) • Associated infection • Seasonal • Wheezing • Post nasal drip/ GERD • Sputum • Associated conditions (smoking, HIV, occupation) • Drug therapy
  12. 12. 60 year old female in C4 ward • Progressive neurological illness X 2 months • Weakness all 4 limbs • Difficulty in swallowing • Weakness of trunkal muscles • Ineffective cough
  13. 13. Baby boy, 2 years • Breathlessness and cough 1 hour ago • Loud and noisy breathing since then • Blue discoloration of skin X 10 minutes • Was playing with toys unattended when this happened
  14. 14. • Ineffective Cough- Muscle disease/ paralysis • Bovine Cough -single vocal cord paralysis Noisy Breathing • Stridor- Inspiratory sound (partial obstruction of large airway) Laryngeal level • Stertor- Oropharyngeal level • Rattling – Tracheal level • Wheezing – Bronchial level
  15. 15. Male, 35 years, Alcoholic • Low grade fever and weight loss X 1 Month • Cough X 1 month • sputum production X 15 days • Sputum is purulent, blood tinged, foul smelling. More while lying on the left side
  16. 16. 2. Sputum Production • Quantity- nil, scanty, moderate (qty) copious • Quality- – Mucoid – Muco-purulent – Purulent – Current Jelly – Greenish – Granules – yellow/ black – Hydatid cysts – Anchovy sauce (brown) • Odour (smell)
  17. 17. 45 year old diabetic • Diarrheal illness 4 days ago • Fever and chest pain X 2 days • Cough X 1 day • Current Jelly like blood in sputum
  18. 18. 3. Hemoptysis ALWAYS ALARMING Differentiate from • nasopharyngeal bleed • Epistaxis • Hematemesis Quantity- • Streaking • Rusty, Mixed • Massive (> 100 ml / > 600 ml/ 24 hrs)
  19. 19. 45 year old male, Smoker • Change of voice X 1 month • Worsening cough X I month • Blood in sputum X 2 days
  20. 20. Causes of Hemoptysis Site Common Causes Rare Causes Tracheo bronchial Carcinoma Bronchitis Bronchiectasis Adenoma Foreign body Parenchyma TB & Chronic Pneumonia Acute Pneumonia Lung abscess Parasites Trauma Actinomycetes Mycetoma Lung Vasculature Infarction PAN Good Pasteur’s syndrome Idiopathic pulmonary hemosiderosis CVS Disease Ac LVF MS Aortic Aneurysm Blood Disorders Leukemia Hemophilia Anticoagulants
  21. 21. Questions ? • Where from • How much • Single episode/ multiple • Other sites • Other complaints • Pre existing disease • Age group • Occupation • Injury • Drugs
  22. 22. 4. Breathlessness Mechanism is complex • Sensory endings stimulation • Work of breathing (muscles) • Small airway obstruction • Chemoreceptor stimulation (acidosis)
  23. 23. 70 year old male, non smoker • Previously an employee of Union Carbide factory in Bhopal • Progressively worsening breathlessness for 29 years • Intermittent respiratory infections
  24. 24. 30 year old HIV Positive, • Dry Cough X 3 weeks • Progressive Breathlessness X 2 weeks • Moderate Fever and weight loss X 2 weeks • Last CD4 200 cells
  25. 25. Chronic Exertional Breathlessness • COPD • Asthma • Heart disease • Interstitial or Alveolar disease • Chest wall / Respiratory muscle disease • Chronic Pulmonary Thrombo- embolism • Psychogenic hyperventilation Dry Cough
  26. 26. 40 year old postman, cycling every day, non smoker • Sudden onset and worsening by the minute- Breathlessness and Chest pain X 1 hour • Cyanosed • Percussion-
  27. 27. Acute Severe Breathlessness • Pulmonary Edema • Massive Pulmonary Embolism • Acute Severe Asthma • Acute Exacerbation of COPD • Severe Pneumonia • Tension Pneumothorax • Foreign body/ mucous plug • Epiglottitis (children) • Metabolic Acidosis • Psychogenic
  28. 28. Questions ? • Symptom Scale • Precipitating event • Associated complaints • Pre existing disease • Age group • Occupation
  29. 29. 5. Chest Pain Central Peripheral Cardiac Lungs Aortic Pleura Esophageal Muscular Massive Pulmonary Embolism Skeletal Tracheitis Neurological Mediastinitis
  30. 30. Respiratory causes • Raw upper sternal- Tracheitis • Pleuritic- associated with breathing • Shoulder - lower lobes/ diaphragm • Neurologic- invasion of nerves
  31. 31. 40 year old smoker • Hoarseness of voice X 3 weeks • Dry irritative cough X 3 weeks • Blood in sputum X 1 day
  32. 32. A R Rehman, Musician • Weakness of voice after tour 10 concerts in 2 weeks
  33. 33. 6. Voice Change (Dysphonia) Structural Problems Neurological Problems • Hoarseness • Weakness • Aphonia
  34. 34. Causes Inflammatory Acute and chronic laryngitis Smoke inhalation Neoplastic Carcinoma Laryngeal Papillomatosis Recurrent Laryngeal Nerve Post Thyroidectomy Carcinoma of lung/ breast Neurological Myasthenia gravis Hypothyroidism, Rheumatoid Arthritis Habitual Dysphonias Renke’s Dysphonia, Singer’s nodules Vocal cord polyps, GERD Reflux Psychogenic Musculoskeletal tension,Dysphonia Conversion Disorders
  35. 35. Questions • Quality • Time course • Onset and other associations • Other diseases • Waxing and waning • Level of discomfort • Smoker
  36. 36. 7. Hiccups • Diaphragmatic irritation Causes • Respiratory- Basal pneumonia, Pleurisy • CVS • Upper GI • Metabolic

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