The Main Respiratory Features .

1- cough

*Dry or productive:
Dry bronchitis
Productive smoker, chronic bronchitis
*Painful or painless:
change in the pattern of cough example from normal to
bovine and the patient has horsiness of voice
.
If the cough persists for more time 2-3weeks the patient should be send to the chest x-ray (CXR).

2- sputum:- expectorated secretions which are produced out by coughing.

*quantity: small or large.
*quality: thin or thick(purulent).
*color: white , yellow (mean there is infection) or green (must serious one).
If the sputum mixed with blood called Haemoptysis.
How we deal with sputum?
1.Gross examination.
2. Microscopical examination.

Investigation:

1. Gram stain: for bacterial examination.
2.AFB(acid fast bacillus) :for tuberculosis.
3.Cytology: for bronchiogenic carcinoma.

3-Haemoptysis:- it is coughing of blood whether mixed with the sputum or pure. It may be small in amounts or large in amounts.
The causes of large amounts of haemoptysis:
1. Bronchiectasis.
2. Lung abscess.
3. Tuberculosis.


CHEST PAIN Chest pain is a frequent manifestation of both cardiac and respiratory disease and is considered in detail on. Pleural or chest wall involvement by lung disease gives rise to peripheral chest pain which is exacerbated by deep breathing or coughing). Central chest pain suggests heart disease but occurs with tumours affecting the mediastinum, oesophageal disease) or disease of the thoracic aorta).

Massive pulmonary embolus may cause ischaemic cardiac pain as well as severe breathlessness. Tracheitis produces raw upper retrosternal pain which is worse on coughing. Musculoskeletal chest wall pain is usually exacerbated by movement and associated with local tenderness

Chest pain :

Cardiac
Lung
Esophagus
Aorta
Central :angina pectoris
Peripheral :pneumonia

Cardiac

Myocardial ischaemia (angina)
Myocardial infarction
Myocarditis
Pericarditis
Mitral valve prolapse syndrome
Aortic
Aortic dissection
Aortic aneurysm

Oesophageal

Oesophagitis
Oesophageal spasm
Mallory-Weiss syndrome
Massive pulmonary embolus
Mediastinal
Tracheitis
Malignancy

Lungs/pleura

Pulmonary infarct
Pneumonia
Pneumothorax
Malignancy
Tuberculosis
Connective tissue disorders

Musculoskeletal2

Osteoarthritis
Costochondritis (Tietze's
Rib fracture/injury syndrome)
Intercostal muscle injury
Epidemic myalgia (Bornholm disease)
Neurological
Prolapsed intervertebral disc
Herpes zoster
Thoracic outlet syndrome

Breathlessness or dyspnoea can be defined as the feeling of an uncomfortable need to breathe. It is unusual among sensations in having no defined receptors, no localised representation in the brain, and multiple causes both in health (e.g. exercise) and in diseases of the lungs, heart or muscles.


Pathophysiology Physiological stimuli to breathing are summarised in. Respiratory diseases can stimulate breathing and dyspnoea by stimulating intrapulmonary sensory nerves (e.g. pneumothorax, interstitial inflammation and pulmonary embolus), by increasing the mechanical load on the respiratory muscles (e.g. airflow obstruction or pulmonary fibrosis) or by causing hypoxia, hypercapnia or acidosis, stimulating chemoreceptors. In cardiac failure, pulmonary congestion reduces lung compliance and can obstruct the small airways.

Dysponea : shortness of breathHeart failureRespiratory failurePneumoniaAsthmaMetabolic :diabetic ketoacidosis –renal failure

Asthma

Dyspnoea in asthma is associated with episodes of wheeze or chest tightness, varying in severity over time, but usually worse in the morning and often waking the patient overnight. There may be a history of childhood wheeze, or of wheeze or rhinitis provoked by pollens, dusts, household pets or occupational allergens. In exercise-induced asthma, wheeze and chest tightness typically come on immediately after exercise.

Heart disease Impaired left ventricular function can cause exertional dyspnoea. Orthopnoea, cough and wheeze may also be present, as in lung disease. A history of angina or hypertension may be useful in implicating a cardiac cause. On examination, an increase in heart size as judged by a displaced apex beat, a raised JVP and cardiac murmurs may indicate cardiac disease (although these signs can occur in severe cor pulmonale). The chest X-ray may show cardiomegaly


Cyanosis is an abnormal bluish discoloration of the skin resulting from an increase in the level of reduced hemoglobin in the blood, and, in general, reflects an arterial oxygen saturation of 85% or less (normal arterial oxygen saturation ≥95%). Central cyanosis presents as cyanosis of the lips or trunk and reflects right-to-left shunting of blood owing to structural cardiac abnormalities (e.g., atrial or ventricular septal defects) or pulmonary parenchymal or vascular disease (e.g., chronic obstructive pulmonary disease, pulmonary embolism, pulmonary arteriovenous fistula).

Peripheral cyanosis may occur because of systemic vasoconstriction in the setting of poor cardiac output or may be a localized phenomenon resulting from venous or arterial occlusive or vasospastic disease (e.g., venous or arterial thrombosis, arterial embolic disease, Raynaud's disease). When cyanosis presents in childhood, it usually reflects congenital heart disease with right-to-left shunting of blood.

clubbing:- loss of the angle between the nail and nail bed.

normally the angle 175 (less than 180 ) and becomes 180 and more in clubbing. So clubbing characterized by :
1. Increase curvature of the nail.
2. Swelling of the terminal phalanges (drumstick).
Causes of the clubbing:
1. Lung abscess.
2. Fibrosing alveoli.
3. Bronchiogenic carcinoma.