Signs and Symptoms of Respiratory Diseases
A sudden audible expulsion of air from the lungs. Coughing is proceeded by inspiration, the glottis is partially closed and the accessory muscles of expiration contract to expel the air forcibly from the respiratory passages. Coughing is a essential protective response that serves to clear the lungs.Bronchi or trachea of irritants and secretions or to prevent aspiration of foreign material into the lungs. Material coughed up from the lungs and expectorated through the mouth. It contains mucus, cellular derbis or microorganisms and it may content blood or pus.The amount, colour and constituents of the sputum are important in the diagnose of many illness.
Dry Cough – Pleuritis, ILD
Productive Cough -Chronic bronchitis ,Suppurative lung disease, Tuberculosis.
Brassy Cough – Trachea 1 compression
Bovine Cough -Recurrent laryngeal palsy, laryngitis
Nocturenal Cough -Chronic bronchitis, Bronchial asthma,Aspiration, Tropical eosinophilia, Left sided heart failure.
It is due to raised intrathoracic pressure with reduced venous return to heart, reduced cardiac output and cerebral ischaemia.
1. In resp. tract
Pharyngeal (and Laryngeal): Infection
Pulmonary : Pneumonia , TB, etc.
Pleural effusion: Pneumothorax
Pressure : Mediastinal growth, aneurysm
2. Outside respiratory tract
Auditory : Wax or inflammation
Abscess: Liver, subphrenic
Asthmatic: Mostly nocturnal
Bovine : Vocal cord paralysis
Croupy: Laryngeal infection
Dry : TB
Expectorant: Bronchitis, brotichiectasis
Foetid: Anaerobic infection
Gander (metallic): Mediastinal compression
Hacking: Postnasal drip
Intermittent (Staccato): Whooping cough
Cyanotic congenital heart disease
Endocrine: Thyroid acropachy
Familial or idiopathic
Gastro-intestinal disease: Crohn’s disease
Hepatic disease: Cirrhosis
Yellow thick/Green thick – Bacterial infections
Rusty – Pneumococcal pneumonia
Red currant jelly – sticky – Klebsiella pneumonia
Pink frothy – Pulmonary edema
Blood tinged – Bronchitis, bronehiectasis, bronchial adenoma, tuberculosis, malignancy
Ancovy sauce -Ruptured amoebic liver abscess
Copious colourless -Alveolar cell carcinoma
Copious-purulent – Lung abscess, bronchiectasis necrotising pneumonia.
Foul smelling sputum
Abscess, Anaerobic lung abscess
Carcinoma (breaking down)
Diaphragmatic abscess (bursting into lung)
Empyema (bursting into lung)
Difficulty in Breathing
It is defined as undue awareness of respiratory effort or of the need to increase the effort as in thickened pleura, pleural effusion, pneumothorax, hypoxia, anaemia, acidosis etc. J receptors in alveoli stretch receptors of thoracic cage, chemoreceptors in carotid arteries are all involved.
Within minutes, Pneumothorax, Pulmonary edema, Pulmonary embolism, Laryngeal edema, Foreign body,
Within hours-days, Asthma, Pneumonia, Allergic alveolitis. Massive consolidation, ARDS collapse
Within weeks-months, Pleural effusion, Fibrosing alveolitis,Emphysema,Pneumoconiosis, Pleural fibrosis, Anaemia.
Orthopnoea defines dyspnoea on recumbency.
Causes of orthopnoea
LV failure, pericardial effusion.
Bronchial asthma, bilateral diaphragmatic palsy.
Large ascites, GERD, obstructive sleep apnoea.
It is dyspnoea worse on upright position, commonly due to a-v malformation at lung bases.
I. Regular abnormal
Cheyne Stokes – hyperpnoea followed by apnoeic as in cardiac failure, narcotic over dose, raised ICP
Kussmaul’s – Increase in rate and depth as in metabolic acidosis and pontine lesions.
II. Irregular abnormal
Biot’s – Shallow or deep breaths with apneic spells as in meningitis.
Ataxic – Deep and shallow breaths occurring randomly as in brain stem lesion.
Apneustic – Pause after inspiration and expiration as in pontine lesions.
Cogwheel – Interrupted breathing in anxiety
Pursed lip – Emphysema.
Normal 5-8 cm
General restriction – Emphysema, ankylosing spondylitis, interstitial lung disease
Asymmetrical restriction – Fibrosis, collapse, pneumothorax, pleural effusion, pneumonia
Tympanitis – Hollow viscus
Skodiac – Above level of pleural effusion
Hyper resonant – Pneumothorax
Resonant – Normal lung
Impaired – Pulmonary fibrosis, thick walled cavity
Dull – Consolidation, collapse, thickened pleura
Stony dull – Pleural effusion
Impaired or Dull note
Diaphragm raised (uncommon)
Effusion (and thickened pleura)
Obliteration of Traube’s space occurs in left sided pleural effusion, massive splenomegaly, massive percicardial effusion,
Upward shift ofTraube’s space, occurs in left lower lobe fibrosis, left diaphragmatic palsy.
Distension of stomach
Diminished - Thickened pleura, emphysema, collapsed lung with occluded bronchus, tumor.
Absent - Massive pleural effusion, pneumothorax, severe asthma.
Bronchial Breathing Sounds
Tubular breathing is high pitched heard over consolidation, collapsed lung with patent bronchus and above level of pleural effusion (a partially collapsed lung with patent bronchus).
Amphoric breathing is of low pitched metallic quality heard over large superficial cavity, tension pneumothorax, bronchopleural fistula
Cavernous breathing is low pitched heard over thick walled cavity with a communicating bronchus.
Decreased : Air in pleural cavity
Fine crackles are high pitched, short duration and arise from alveoli. Coarse crackles are low pitched and arise from bronchus and bronchioles. Early inspiratory crackles occur in chronic bronchitis, mid inspiratory in bronchiectasis and late inspiratory in pneumonitis, ILD, pulmonary edema, pulmonary fibrosis. Expiratory crackles occur in chronic bronchitis and pulmonary edema.
Bronchi ectas is
More expiratory Insp. or expiratory
Large number Single or few
Not widely heard Wide conduction
Loud. Can be heard with Cannot be heard with unaided car (except stridor)
Congestion or thickening of mucous lining
Constriction of smooth ms. of bronchi
Chronic bronchitis, emphysema
If single wheeze on inspiration – Stenosis or FB or lymphnode or
Ca obstructing principalbronchus.
Audible during both phases of respiration
Better heard on increased pressure of stethoscope.
Cough does not change rub
Defined area (Localised)
Eliminated by holding breath
Frequently associated with localised pain and tenderness
Grating in character
Differentiation between pleural rub and crackle
Superficial loud Deep
Usually localised May be diffuse
Unaffected by cough Intensified or abolished by cough
Pressure with stethoscope No effect Increased intensity
Pain and tenderness No pain or tenderness
Obstruction of the Pyloric outlet can be checked by succussion splash.Simultaneously listening in the epigastrium and shaking the upper abdomen from side to side.
Herniation of stomach or colon into thorax
Huge cavity with fluid and air