Signs and Symptoms of Respiratory Diseases Omer Alamoudi

Signs and Symptoms of Respiratory Diseases Omer Alamoudi, Professor, consultant Pulmonologist MD, FRCP, FACP, FCCP

Signs and Symptoms of Respiratory Diseases n Cardinal Symptoms – Cough – Sputum – Hemoptysis – Dyspnea – Wheezes – Chest pain

Signs and Symptoms of Respiratory Diseases n Other presenting symptoms – Apnea – Hoarseness – Stridor – Snoring – Fever – Night sweating – Weight loss

Signs and Symptoms of Respiratory Diseases n Acute cough – Acute bronchitis – Pneumonia – Pulmonary Embolism – Left ventricular failure

Signs and Symptoms of Respiratory Diseases n Chronic cough (>2 weeks) – Bronchial asthma – Chronic bronchitis – Pulmonary fibrosis – Lung cancer – Drugs ( ACE inhibitors) – Bronchiectasis

Signs and Symptoms of Respiratory Diseases n Sputum – Bronchiectasis (yellow, green, large amount, more in the morning) – Lung abscess ( Foul smelling, more on lying on – – the other side of lesion) Pneumonia ( yellowish, streaks of blood) Pulmonary edema ( Pink frothy)

Signs and Symptoms of Respiratory Diseases n Hemoptysis – Massive >200 ml/episode – Frank (fresh, bright red, no sputum) – Causes n n n Lung cancer ( clots) Tuberculosis, Bronchiectasis ( brisk & brief) Pulmonary infarction Pneumonia A/V malformation

Signs and Symptoms of Respiratory Diseases n Dyspnea – Sudden ( seconds) n Pneumothorax ( Male, COPD, or Tall, thin) n Pulmonary embolism ( Female, Pills)

Signs and Symptoms of Respiratory Diseases n Dyspnea – Acute dyspnea (hours to days) n Bronchial asthma n Pneumonia n Massive pleural effusion n Pulmonary edema (LVF, MS)

Signs and Symptoms of Respiratory Diseases n Chronic dyspnea (months to Years) – – Chronic bronchitis Emphysema Pulmonary fibrosis Chronic thromboembolism

Signs and Symptoms of Respiratory Diseases n Types of dyspnea – Paroxysmal dyspnea n Bronchial asthma (wheezes, no crackles) n Left ventricular failure (crackles, cardiomegaly) – Nocturnal dyspnea n Bronchial n GERD n LVF asthma

Signs and Symptoms of Respiratory Diseases n Wheezes (Rhonchi) – Bronchial asthma – COPD – Pulmonary embolism – Lung cancer – Bronchiectasis – LVF

Signs and Symptoms of Respiratory Diseases n Chest pain – Pulmonary infarction – Pneumonia – Acute pleurisy – Tiet’z syndrome – Angina pectoris

Signs and Symptoms of Respiratory Diseases n General examination – Sputum n White mucoid bronchitis n Purulent, yellow, green lung n Red PE n Frothy pink edema Chronic Suppurative syndrome TB, Ca lung, Pulmonary

Signs and Symptoms of Respiratory Diseases n General examination – Sputum n White mucoid n Purulent, yellow, green n Red n Frothy pink – Chronic bronchitis – Suppurative lung syndrome – TB, Ca lung, PE – Pulmonary edema

Signs and Symptoms of Respiratory Diseases n General examination – Respiratory rate (n=14± 2) – Cyanosis (>5 gm% of Hb deoxygenated) n Central (blue hands & tongue) n Peripheral (blue hands & red tongue)

Signs and Symptoms of Respiratory Diseases n n n Hands examination Central Cyanosis – COPD, Asthma – Pulmonary fibrosis – Pneumonia, PE – A/V malformation – Cardiac Rt to Lt shunts Peripheral cyanosis – Cold weather – Low COP

Signs and Symptoms of Respiratory Diseases n Clubbing of the fingers and toes – – – Bronchiectasis Ca lung Lung abscess Pulmonary fibrosis Asbestosis Cystic fibrosis

Signs and Symptoms of Respiratory Diseases n n Hands examination Hypertrophic pulmonary osteoarthropathy – Ca lung

Signs and Symptoms of Respiratory Diseases Hands examination n Tremors n – Fine – Flapping B 2 agonist CO 2 retention

Signs and Symptoms of Respiratory Diseases n n Head & neck Horner's syndrome – – Ptosis Enophthalmos Miosis Anhydrousis

Signs and Symptoms of Respiratory Diseases n n Head and neck Face – SLE (Butterfly rash) – Sarcoidosis (Lupus pernio)

Signs and Symptoms of Respiratory Diseases n n Head and Neck JVP – CHF (Pulsatile) – SVO (Non pulsatile)

Signs and Symptoms of Respiratory Diseases n Chest examination – Skin (scar) – Thoracotomy

Signs and Symptoms of Respiratory Diseases n n Chest examination Shape – Barrel shape (COPD)

Signs and Symptoms of Respiratory Diseases n n Chest examination Shape – Kyphoscoliosis

Signs and Symptoms of Respiratory Diseases n n Chest examination Shape – Pectus excavatum

Signs and Symptoms of Respiratory Diseases n n Head and Neck Fundi – Papilledema

Signs and Symptoms of Respiratory Diseases n Lymph nodes

Signs and Symptoms of Respiratory Diseases n Chest examination – Position of the trachea n n Shifted to the side of the lesion – Fibrosis – Collapse Shifted away – Pleural effusion – Tension Pneumothorax

Signs and Symptoms of Respiratory Diseases n Chest examination – Cardiac apex (dextrocardia) – Chest expansion (n=3 -5 cm) – Tactile Vocal fremitus n n Increased – Consolidation Decreased – Pleural effusion – Collapse

Signs and Symptoms of Respiratory Diseases n Chest examination – Percussion n n Decreased – Pleural effusion (stony dull) – Consolidation (dull) – Collapse – Fibrosis Increased – Pneumothorax & emphysema

Signs and Symptoms of Respiratory Diseases n Auscultation – Breathing sounds n Vesicular n Bronchial n Aegophony n Whispering pectrology

Signs and Symptoms of Respiratory Diseases n Auscultation – Decreased breath sound n Pleural effusion n Collapse/Atelectasis n Pneumothorax & Obesity – Increased breath sound n Consolidation n Cavity n Top of pleural effusion

Signs and Symptoms of Respiratory Diseases n Auscultation – Wheeze (Rhonchi) – Bilateral n Asthma, COPD, LVF – Unilateral n FB n Lung cancer n Mucous plug

Signs and Symptoms of Respiratory Diseases n Auscultation – Crackles (crepitations) n n n Fine – Pulmonary fibrosis Coarse – Bronchiectasis – Pneumonia – Pulmonary edema Friction rub – Infection, Infarction, tumor

Signs and Symptoms of Respiratory Diseases n Examination of systems related to respiratory disease – CVS n P 2, Corpulmonale, CHF – Abdomen n Hepatosplenomegaly – Renal n Goodpastures syndrome

Signs and Symptoms of Respiratory Diseases Examination of systems related to respiratory disease Locomotor n Rheumatoid arthritis, SLE, PAN, Bone pain – CNS CO 2 retention n Epilepsy n Cranial nerve palsy n

Signs and Symptoms of Respiratory Diseases n n Examination of systems related to respiratory disease Skin n erythema nodosum, nvasuclitis nheliotropic rash

Signs and Symptoms of Respiratory Diseases n Quizzes – 1 – 2 – 3 – 4 – 5

Signs and Symptoms of Respiratory Diseases Thank you

Signs and Symptoms of Respiratory Diseases n Suggested Text book to read – Mc. Leod's sing and symptoms