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Cough
Explosive expiration to clear
tracheobronchial tree
Mechanism
 Voluntary or reflexive
 Phases-
 Deep inspiration
 Glottic closure & muscle contraction
 Glottis opens cau...
Evaluation of cough
 Acute <3 wks. or Chronic >8 wks.
Ac.- RTI; Ch.- postnasal drip, asthma, GERD
 Fever- present or abs...
Evaluation- contd.
 Examination- oral cavity, larynx,
rhonchi or crepts
 Investigation- need based
 Eosinophilia
 Sput...
Investigation mandatory
 Hemoptysis
 Recurrent cough
 Rhonchi or crepts
 Any change in ‘smoker’s cough’
Complications of cough
 Syncope
 Insomnia
 Vomiting
 Subconjunctival hemorrhage
 Costochondritis
 Rib fracture
 Pne...
Treatment
 Etiology based
 Stop ACEI
 Antacids/H2RB/PPI
 Antibiotics- bacterial infection
 Inhaled bronchodilators/st...
Hemoptysis
Blood in sputum
streaking or gross
Hemoptysis- causes
 RTI- commonest
 TB
 Lung cancer
 Bronchiectasis
 Lung abscess
 Mitral stenosis
 Heart failure
...
Hemoptysis- evaluation
 A.B.C.- massive hemoptysis
 History
 Examination
 CxR- AP & lateral
 CT scan ± HRCT
 Broncho...
Treatment
 Majority stops spontaneously
 Cough suppressants, if required
 Treat underlying pathology
 If massive or un...
Cyanosis
Bluish color of skin/mucous
membranes, due to
>5 gm./dl. deoxygenated Hb.
Cyanosis- types
 Central
 Skin & mucous
membranes
 Caused by decreased
arterial oxygen sat. or
abnormal hemoglobin
 Ex...
Cyanosis- causes
 Central-
 High altitude- decreased atmospheric pressure
 Bronchospasm, hypoventilation
 Congenital h...
Cyanosis- treatment
Oxygen
Etiology based
Clubbing
Drumstick finger
Cause- vasodilation, PDGF,
PGE2
Stages of clubbing
 1- nail bed fluctuation
 2- loss of angle between nailbed & fold
 3- increased convexity of nail fo...
Clubbing- causes
 Lung
 Cancer
 ILD
 TB
 Abscess
 Bronchiectasis
 Empyema
 Mesothelioma
 Cyanotic heart dis.
 SA...
Management
 History
 Examination
 Investigation
 CxR
 CT scan
 ECHO
 Treatment- of underlying etiology
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Cough & hemoptysis & cyanosis & clubbing

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Cough & hemoptysis & cyanosis & clubbing

  1. 1. Cough Explosive expiration to clear tracheobronchial tree
  2. 2. Mechanism  Voluntary or reflexive  Phases-  Deep inspiration  Glottic closure & muscle contraction  Glottis opens causing forced exhalation  Stimuli-  Inflammatory- infection, postnasal drip, GERD  Mechanical- dust, tumors, edema, interstitial fibrosis  Chemical- smoke, fumes  Thermal- cold/hot air
  3. 3. Evaluation of cough  Acute <3 wks. or Chronic >8 wks. Ac.- RTI; Ch.- postnasal drip, asthma, GERD  Fever- present or absent  Dry or productive; character of sputum  Hemoptysis +/-  Postural or diurnal or seasonal variation  Associated symptoms- SOB/DOE, heartburn  Past history of episodes of cough  Personal history- smoking etc.
  4. 4. Evaluation- contd.  Examination- oral cavity, larynx, rhonchi or crepts  Investigation- need based  Eosinophilia  Sputum exam. ± culture, ± cytology  CxR  Spirometry  CT scan  Bronchoscopy
  5. 5. Investigation mandatory  Hemoptysis  Recurrent cough  Rhonchi or crepts  Any change in ‘smoker’s cough’
  6. 6. Complications of cough  Syncope  Insomnia  Vomiting  Subconjunctival hemorrhage  Costochondritis  Rib fracture  Pneumothorax  Hernia/Prolapse
  7. 7. Treatment  Etiology based  Stop ACEI  Antacids/H2RB/PPI  Antibiotics- bacterial infection  Inhaled bronchodilators/steroids  Symptomatic- dry cough only  Cough suppressant- codeine/dextromethorphan  Humidification & expectorants
  8. 8. Hemoptysis Blood in sputum streaking or gross
  9. 9. Hemoptysis- causes  RTI- commonest  TB  Lung cancer  Bronchiectasis  Lung abscess  Mitral stenosis  Heart failure  Pulmonary embolism  Foreign body  Trauma  Wegener’s  Goodpasture’s syn.  Bleeding diathesis
  10. 10. Hemoptysis- evaluation  A.B.C.- massive hemoptysis  History  Examination  CxR- AP & lateral  CT scan ± HRCT  Bronchoscopy  Echocardiography
  11. 11. Treatment  Majority stops spontaneously  Cough suppressants, if required  Treat underlying pathology  If massive or unresolving  Angiography  arterial embolization  Bronchoscopy  Surgery
  12. 12. Cyanosis Bluish color of skin/mucous membranes, due to >5 gm./dl. deoxygenated Hb.
  13. 13. Cyanosis- types  Central  Skin & mucous membranes  Caused by decreased arterial oxygen sat. or abnormal hemoglobin  Exposed areas warm  Clubbing may be present  Peripheral  Peripheral exposed skin only  Caused by vasoconstriction or decreased blood flow  Exposed areas cold, massage/warming helps  No clubbing
  14. 14. Cyanosis- causes  Central-  High altitude- decreased atmospheric pressure  Bronchospasm, hypoventilation  Congenital heart disease- TOF  Intrapulmonary fistula/shunts  Met/Sulf-hemoglobinemia  Peripheral-  low cardiac output  cold exposure  arterial/venous obstruction
  15. 15. Cyanosis- treatment Oxygen Etiology based
  16. 16. Clubbing Drumstick finger Cause- vasodilation, PDGF, PGE2
  17. 17. Stages of clubbing  1- nail bed fluctuation  2- loss of angle between nailbed & fold  3- increased convexity of nail fold  4- thickened distal phalanx  5- hypertrophic osteoarthropathy Schamroth’s window test
  18. 18. Clubbing- causes  Lung  Cancer  ILD  TB  Abscess  Bronchiectasis  Empyema  Mesothelioma  Cyanotic heart dis.  SABE  Atrial myxoma  IBD  PBC  Hyperthyroidism  Idiopathic
  19. 19. Management  History  Examination  Investigation  CxR  CT scan  ECHO  Treatment- of underlying etiology

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