This document summarizes common respiratory symptoms including cough, expectoration, breathlessness, chest pain, and wheeze. It provides guidance on evaluating each symptom, including important questions to ask patients and potential differential diagnoses depending on symptom characteristics and clinical context. Example patient cases are presented to demonstrate how to reach a diagnosis based on reported symptoms.

1. Cardinal Symptoms of the
Respiratory System…
Dr. Saswat

2. ???????

3. Commonly
reported
respiratory
symptoms…
Cough
Expectoration
Breathlessness
Chest pain
Wheeze.

4. Cough…
• Protective reflex????
• Acute cough?
• Chronic cough?
• < 3 weeks
• >8 weeks

6. • Onset: sudden/ gradual?
• Duration?
• Dry/ associated with expectoration?
• Diurnal variation?
• Postural variation?
• Associated hemoptysis?
Aggravating factors?

7. • Dry cough??
- Pleurisy.
- Acute trachea-bronchitis.
- ILD
• Brassy cough?
• Bovine cough?
• Nocturnal cough?
Ca larynx
RLN palsy
Bronchial
asthma,
LVF.

8. • Hemoptysis is expectoration of blood from the respiratory tract.
• D/d: bleeding from upper respiratory tract or GIT.
• Ask about:
- Appearance
- Amount
- Duration
- Associated with cough/food particles/epistaxis/
• Massive hemoptysis: 400ml in a day or 100-150ml at one time.

11. Expectoration.
Amount.
Appearance (character/ color)
Smell
Postural variation

12. • Profuse expectoration??
• Mucoid/purulent/muco-purulent.
• Color: yellow/red/green/black/anchovy sauce.
• Postural variation?
>100ml
per day
-Bronchiectasis
- Lung abscess
- Empyema thoracis
rupturing into
bronchus.
- Resolving stages of
pneumonia

13. Dyspnea.
• Breathlessness inappropriate
to the level of exertion or
occurring at rest.
• Ask about:
- Duration.
- Progression.
- Aggravating and relieving
factors.
- Postural variation.

14. • mMRC???
Modified Medical Research
Council

15. Chest pain.
• Location.
• Type: pricking/dull
aching/stabbing
• Radiation.
• Aggravating and relieving
factors.

16. Reaching a diagnosis
of the origin of the
pain.

17. • A typical pleuritic chest pain:
- Sharp/ stabbing in nature.
- Non-radiating
- Increased by cough and deep breathing.

18. Wheeze
It is a continuous
musical sound
produced by flow
through narrowed
airways.
Produced when air is
forced past a point at
which opposing walls
are just touching.

19. • OAD
• Intra-bronchial mass
lesion/foreign body/lymph
node.
• Wheeze vs stridor??

20. Case 1:
• A 50 year old female presents with increased cough since 10
days, which is associated with copious amounts of yellowish
expectoration with foul smell. The cough and expectoration are
more in left lateral position.
• What are your differential diagnosis?
- Bronchiectasis
- Lung abscess

21. Case 2:
• A 23 year old male with a height of 6’8” presents with a sudden
onset of chest pain and dyspnea. The pain is localised to the
right hemithorax with no radiation and increased on deep
inspiration.
• What are the differentials?
- Pneumothorax.
- Pulmonary
embolism

22. Case 3:
• A 60 year old male, smoker presents with cough and dyspnea
since 1 month. The dyspnea is gradually progressive and the
patient is now unable to walk 100 yards on a level road. He also
complaints of a wheeze.
1. What is the grade of
dyspnea?
2. What is the most probable
diagnosis?
OAD, most
probably COPD