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
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
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
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
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