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

Signs and Symptoms of Signs and Symptoms of Respiratory DisRespiratory Dis

easeseases

Signs and Symptoms of Signs and Symptoms of Respiratory DiseasesRespiratory Diseases

Omer Alamoudi, Professor, Omer Alamoudi, Professor, consultant Pulmonologistconsultant Pulmonologist

MD, FRCP, FACP, FCCPMD, FRCP, FACP, FCCP


Cardinal SymptomsCardinal Symptoms– CoughCough– SputumSputum– HemoptysisHemoptysis– DyspneaDyspnea– WheezesWheezes– Chest painChest pain


Other presenting symptomsOther presenting symptoms– ApneaApnea– HoarsenessHoarseness– StridorStridor– Snoring Snoring – FeverFever– Night sweatingNight sweating– Weight lossWeight loss


Acute coughAcute cough– Acute bronchitisAcute bronchitis– PneumoniaPneumonia– Pulmonary Pulmonary

EmbolismEmbolism– Left ventricular Left ventricular

failurefailure


Chronic cough (>2 weeks)Chronic cough (>2 weeks)– Bronchial asthmaBronchial asthma– Chronic bronchitisChronic bronchitis– Pulmonary fibrosisPulmonary fibrosis– Lung cancerLung cancer– Drugs ( ACE inhibitors)Drugs ( ACE inhibitors)– BronchiectasisBronchiectasis


SputumSputum– Bronchiectasis (yellow, green, Bronchiectasis (yellow, green,

large amount, more in the large amount, more in the morning)morning)

– Lung abscess ( Foul smelling, Lung abscess ( Foul smelling, more on lying on more on lying on

the the other side of lesion)other side of lesion)

– PneumoniaPneumonia ( yellowish, ( yellowish, streaks of blood)streaks of blood)

– Pulmonary edema ( Pink Pulmonary edema ( Pink frothy)frothy)


HemoptysisHemoptysis– Massive >200 ml/episodeMassive >200 ml/episode– Frank (fresh, bright red, Frank (fresh, bright red,

no sputum)no sputum)– CausesCauses

Lung cancer ( clots)Lung cancer ( clots) Tuberculosis, Tuberculosis,

Bronchiectasis ( brisk & Bronchiectasis ( brisk & brief)brief)

Pulmonary infarctionPulmonary infarction Pneumonia Pneumonia A/V malformationA/V malformation


DyspneaDyspnea– Sudden ( seconds)Sudden ( seconds)

Pneumothorax Pneumothorax ( Male, COPD, or ( Male, COPD, or Tall, thin)Tall, thin)

Pulmonary Pulmonary embolism embolism ( Female, Pills)( Female, Pills)


DyspneaDyspnea– Acute dyspnea Acute dyspnea

(hours to days)(hours to days) Bronchial Bronchial

asthmaasthma PneumoniaPneumonia Massive pleural Massive pleural

effusioneffusion Pulmonary Pulmonary

edema (LVF, MS)edema (LVF, MS)


Chronic dyspnea Chronic dyspnea (months to (months to Years)Years)– Chronic bronchitisChronic bronchitis– EmphysemaEmphysema– Pulmonary Pulmonary

fibrosisfibrosis– Chronic Chronic

thromboembolisthromboembolismm


Types of dyspneaTypes of dyspnea– Paroxysmal dyspneaParoxysmal dyspnea

Bronchial asthmaBronchial asthma (wheezes, no crackles)(wheezes, no crackles) Left ventricular failure (crackles, Left ventricular failure (crackles,

cardiomegaly)cardiomegaly)

– Nocturnal dyspneaNocturnal dyspnea Bronchial asthmaBronchial asthma GERDGERD LVFLVF


Wheezes (Rhonchi)Wheezes (Rhonchi)– Bronchial asthmaBronchial asthma– COPDCOPD– Pulmonary embolismPulmonary embolism– Lung cancerLung cancer– BronchiectasisBronchiectasis– LVFLVF


Chest painChest pain– Pulmonary infarctionPulmonary infarction– PneumoniaPneumonia– Acute pleurisyAcute pleurisy– Tiet’z syndromeTiet’z syndrome– Angina pectorisAngina pectoris


General examinationGeneral examination– SputumSputum

White mucoidWhite mucoid Chronic Chronic bronchitisbronchitis

Purulent, yellow, greenPurulent, yellow, green Suppurative Suppurative lung lung syndromesyndrome

RedRed TB, Ca TB, Ca lung, PElung, PE

Frothy pinkFrothy pink Pulmonary Pulmonary edemaedema


General examinationGeneral examination– SputumSputum

White mucoidWhite mucoid– Chronic bronchitisChronic bronchitis

Purulent, yellow, greenPurulent, yellow, green– Suppurative lung Suppurative lung

syndromesyndrome RedRed

– TB, Ca lung, PETB, Ca lung, PE Frothy pinkFrothy pink

– Pulmonary edemaPulmonary edema


General examinationGeneral examination– Respiratory rate (n=14±2)Respiratory rate (n=14±2)– Cyanosis (>5gm% of Hb Cyanosis (>5gm% of Hb

deoxygenated)deoxygenated) Central (blue hands & tongue)Central (blue hands & tongue) Peripheral (blue hands & red tongue)Peripheral (blue hands & red tongue)


Hands examinationHands examination Central CyanosisCentral Cyanosis

– COPD, AsthmaCOPD, Asthma– Pulmonary fibrosisPulmonary fibrosis– Pneumonia, PEPneumonia, PE– A/V malformationA/V malformation– Cardiac Rt to Lt Cardiac Rt to Lt

shuntsshunts Peripheral cyanosisPeripheral cyanosis

– Cold weatherCold weather– Low COPLow COP


Clubbing of the Clubbing of the fingers and toesfingers and toes– BronchiectasisBronchiectasis– Ca lungCa lung– Lung abscessLung abscess– Pulmonary fibrosisPulmonary fibrosis– AsbestosisAsbestosis– Cystic fibrosisCystic fibrosis


Hands Hands examinationexamination

Hypertrophic Hypertrophic pulmonary pulmonary osteoarthropathyosteoarthropathy

– Ca lungCa lung


Hands examinationHands examination TremorsTremors

– FineFine B2 agonistB2 agonist– FlappingFlapping CO2 retentionCO2 retention


Head & neckHead & neck Horner's Horner's

syndromesyndrome– PtosisPtosis– EnophthalmosEnophthalmos– MiosisMiosis– AnhydrousisAnhydrousis


Head and neckHead and neck FaceFace

– SLESLE (Butterfly (Butterfly rash)rash)

– SarcoidosisSarcoidosis(Lupus (Lupus

pernio)pernio)


Head and NeckHead and Neck JVPJVP

– CHFCHF (Pulsatile)(Pulsatile)– SVOSVO (Non (Non

pulsatile)pulsatile)


Chest Chest examinationexamination– Skin (scar)Skin (scar)– ThoracotomyThoracotomy


Chest Chest examinationexamination

ShapeShape– Barrel shapeBarrel shape

(COPD)(COPD)



ShapeShape– KyphoscoliosisKyphoscoliosis



ShapeShape– Pectus Pectus

excavatumexcavatum


Head and NeckHead and Neck FundiFundi

– PapilledemaPapilledema


Lymph nodesLymph nodes


Chest examination Chest examination – Position of the Position of the

tracheatrachea Shifted to the side Shifted to the side

of the lesionof the lesion– FibrosisFibrosis– CollapseCollapse

Shifted awayShifted away– Pleural effusionPleural effusion– Tension Tension

PneumothoraxPneumothorax


Chest examinationChest examination– Cardiac apexCardiac apex

(dextrocardia)(dextrocardia)– Chest expansionChest expansion

(n=3-5cm)(n=3-5cm)– Tactile Vocal fremitusTactile Vocal fremitus

IncreasedIncreased– ConsolidationConsolidation

DecreasedDecreased– Pleural effusionPleural effusion– CollapseCollapse


Chest examinationChest examination– PercussionPercussion

DecreasedDecreased– Pleural effusionPleural effusion

(stony dull)(stony dull)– ConsolidationConsolidation (dull)(dull)– CollapseCollapse– FibrosisFibrosis

IncreasedIncreased– Pneumothorax & Pneumothorax &

emphysemaemphysema


AuscultationAuscultation– Breathing soundsBreathing sounds

VesicularVesicular BronchialBronchial AegophonyAegophony Whispering pectrologyWhispering pectrology


AuscultationAuscultation– Decreased breath soundDecreased breath sound

Pleural effusionPleural effusion Collapse/AtelectasisCollapse/Atelectasis Pneumothorax & ObesityPneumothorax & Obesity

– Increased breath soundIncreased breath sound ConsolidationConsolidation CavityCavity Top of pleural effusionTop of pleural effusion


AuscultationAuscultation– Wheeze (Rhonchi)Wheeze (Rhonchi)– BilateralBilateral

Asthma, COPD, LVFAsthma, COPD, LVF

– UnilateralUnilateral FBFB Lung cancerLung cancer Mucous plugMucous plug


AuscultationAuscultation– Crackles Crackles

(crepitations)(crepitations) Fine Fine

– Pulmonary Pulmonary fibrosisfibrosis

CoarseCoarse– BronchiectasisBronchiectasis– PneumoniaPneumonia– Pulmonary Pulmonary

edemaedema Friction rubFriction rub

– Infection, Infection, Infarction, tumorInfarction, tumor


Examination of Examination of systems related to systems related to respiratory diseaserespiratory disease

– CVSCVS P2, Corpulmonale, P2, Corpulmonale,

CHFCHF

– AbdomenAbdomen HepatosplenomegaHepatosplenomega

lyly

– RenalRenal Goodpastures Goodpastures

syndromesyndrome


Examination of Examination of systems related to systems related to respiratory respiratory diseasedisease LocomotorLocomotor

Rheumatoid Rheumatoid arthritis, SLE, PAN, arthritis, SLE, PAN, Bone painBone pain

– CNSCNS CO2 retentionCO2 retention EpilepsyEpilepsy Cranial nerve palsyCranial nerve palsy


Examination of Examination of systems related systems related to respiratory to respiratory diseasedisease

Skin erythema nodosum,vasuclitisheliotropic rash


QuizzesQuizzes– 11– 22– 33– 44– 55

Signs and Symptoms Signs and Symptoms of Respiratory of Respiratory DiseasesDiseases

Thank youThank you

Signs and Symptoms Signs and Symptoms of Respiratory of Respiratory DiseasesDiseases Suggested Text book to readSuggested Text book to read

– McLeod's sing and symptoms McLeod's sing and symptoms

Documents

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