Respiratory disease

by: Dr. Ezyan

Introduction
Respiratory diseases are quite
common in day to day practise
and are significant causes of
morbidity and mortality all
over the world.
It may present in the form of
symptoms or as an
abnormality on the chest
radiograph
Cardiac failure
Physical signs of right
ventricular hypertrophy:
Left parasternal
heave,thirdheart sound over
the rt. Ventricle,enlarged JVP
with V waves,hepatomegaly
and dependent oedema.

General symptoms
Hypoxemia and Hypercapnia
Hyperventilation
Cardiac failure
Infection and Malignancy
Finger clubbing and
Osteoarthropathy

Clubbing and Pulmonary

osteoarthropathy
Asoociated with Broncogenic
carcinoma, fibrosing
alveolitis,pulmonary

Approach to respiratory diseases

Hyperventilation
Leads to respiratory alkalosis
and producing paraesthesiae
in the lips and
extremities,tetanic cramps in
the hands and variety of
discomfort in the chest

Hypoxia and Hypercapnia

Hypoxia:
Cyanosis
Tacchycardia/Bradycardia,
irritablity,and mental confusion
Hypercapnia:
Headache ,confusion,flapping
tremors,warm moist skin,full
volume pulse,suffused
conjunctiva and papilloedema
Effect of Infection and
Malignancy
Fever and loss of weight
Effects of metastasis:lymoh node,
brain,bone , liver or other organs
Secretion of hormones by tumours
leadind to Cushings
syndrome,SIADH etc
Mediastinal
obstruction,compression of
SVC(non pulsatile JVP),chest
oedema etc
Horners syndrome
DYSPNEA

Sympto
m
Chief
complaints

Past

Dyspnea

TB

Cough with

Asthma

Sputum

Diabetes

BREATHLESSNESS

Personal
history
Smoking

ACUTE

SUBACUTE

CHRONIC

Ac.Asthma

COPD

COPD

Pneumothora
x

Pleural
disease

ILD

Pulmonary
embo

PCP
pneumonia

Fibrosis

Occupation
Promiscuity

CCF

fibrosis,empyema,lung
abscess, bronchiectasis.
Increased periosteal growth of
long bones give rise to
hypertrophic pulmonary
osteoarthropathy producing
painfull tender swelling around
ankles,knees and wrists

Cough with expectoration

Suggests airway disease or
parenchymal diseases.
With mild sputumAsthma,Pneumonia
With moderate amt.Chr.Bronchitis
With large amountBronchiectasis,lung
abscess(ask for odour?)
Dry cough- Pleurisy,early stage of
pneumonia and atypical
pneumonia
Additional history
Smoking:Active/Passive

HEMOPTYSIS
HEMOPTYSI

AIRWAYS

PARENCHYMA

Ac/chr.Bronc

Pneumonia

Bronchiectasi
s

Lung abscess
Tuberculosis

Cystic fibrosis
Aspergillosis

VASCULATUR
E
Pulm.thromb
oembo.

CHEST PAIN
Causes:
Pleurisy
Pneumonia
Pulmonary infarction
Invasive malignancy

AV
malformatio
ns

Systemic examination

Exposure to inhaled agents

Exposure to infectious agents
H/O systemic disorderseg:Rheumatic diseases
Risk factors for AIDS
Treatment
history:Immunosuppression,radioth
erapy,intake of drugs like beta
blockers,ACE inhibitors and
Amiodarone.
Family history: Cystic
fibrosis,asthma,1 antitrypsin
defficiency
Breath sounds

Breathing

Vesicular

Bronchial

Insp.Exp

Insp.Exp

No gap

Has gap

Normally

Abnormal
Tubular

Physical examination
Enlarged cervical and
supraclavicular lymph nodes
Disturbance of
mentation/coma
Nicotine stains on the fingers
Infected teeth and gums
Clubbing
Oedema,cyanosis,enlarged JVP
Evidence of mediastinal
compression

Adventitious sounds
Crackles(rales)
Eg:ILD,microatelectasis,pneum
onia
,pulmonary edema
Wheezes
Eg:Bronchospasm,airway
edema or collapse,intraluminal
obstruction
Ronchii

Inspection
Palpation
Percussion
Auscultation: Breath
soundsIntensity,Character,adven
titious sounds
Pleural friction rub

Diagnosis
Is it a problem of Pulmonary
Parenchyma
Eg:Pneumonia,Interstitial lung
disease,TB
Is it a problem of Pulmonary
vasculature
Pulmonary embolism,Pulmonary
infarction etc

Is it a disease of the airway

Eg:COPD,Br.asthama
Is it a disease of the pleura
Eg: Pleural disease, Pneumothorax
etc