Symptomatology of Respiratory Disorders
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Symptomatology of Respiratory Disorders
- 1. Symptomatology of Respiratory Disorders Department ofMedicine ACMS
- 2. Female, 45 years, Nurse, • Fever and weight loss X 2 months • Productive cough X 2 months • Blood in sputum X 2 days
- 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. 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. Female, 50 years, Army wife • Dry, distressing cough X 15 days • Recently started on treatment for high BP Tab Indapamide and Tab Enalapril
- 6. Why do patients consult ? –Discomfort –Interference with normal life –Fear/ concern
- 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. Cough Triggers • Exogenous- Fumes, smoke, dust, Foreign body • Endogenous- Secretions, gastric contents • Initiate inflammation- persistence of cough • Constriction • Infiltration • Compression
- 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. 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. Questions ? • Duration- Acute/ Chronic (3 weeks) • Associated infection • Seasonal • Wheezing • Post nasal drip/ GERD • Sputum • Associated conditions (smoking, HIV, occupation) • Drug therapy
- 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. 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. • 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. 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. 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. 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. 3. Hemoptysis ALWAYS ALARMING Differentiate from • nasopharyngeal bleed • Epistaxis • Hematemesis Quantity- • Streaking • Rusty, Mixed • Massive (> 100 ml / > 600 ml/ 24 hrs)
- 19. 45 year old male, Smoker • Change of voice X 1 month • Worsening cough X I month • Blood in sputum X 2 days
- 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. Questions ? • Where from • How much • Single episode/ multiple • Other sites • Other complaints • Pre existing disease • Age group • Occupation • Injury • Drugs
- 22. 4. Breathlessness Mechanism is complex • Sensory endings stimulation • Work of breathing (muscles) • Small airway obstruction • Chemoreceptor stimulation (acidosis)
- 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. 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. 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. 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. 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. Questions ? • Symptom Scale • Precipitating event • Associated complaints • Pre existing disease • Age group • Occupation
- 29. 5. Chest Pain Central Peripheral Cardiac Lungs Aortic Pleura Esophageal Muscular Massive Pulmonary Embolism Skeletal Tracheitis Neurological Mediastinitis
- 30. Respiratory causes • Raw upper sternal- Tracheitis • Pleuritic- associated with breathing • Shoulder - lower lobes/ diaphragm • Neurologic- invasion of nerves
- 31. 40 year old smoker • Hoarseness of voice X 3 weeks • Dry irritative cough X 3 weeks • Blood in sputum X 1 day
- 32. A R Rehman, Musician • Weakness of voice after tour 10 concerts in 2 weeks
- 33. 6. Voice Change (Dysphonia) Structural Problems Neurological Problems • Hoarseness • Weakness • Aphonia
- 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. Questions • Quality • Time course • Onset and other associations • Other diseases • Waxing and waning • Level of discomfort • Smoker
- 36. 7. Hiccups • Diaphragmatic irritation Causes • Respiratory- Basal pneumonia, Pleurisy • CVS • Upper GI • Metabolic