Sympoms in Sympoms in diseases of diseases of respiratory respiratory

organs based on organs based on the results of the results of inquiry of a inquiry of a

patient, patient, palpation and palpation and

percussion of a percussion of a chestchest

The most typical complaints The most typical complaints of the patient with of the patient with respiratory pathologyrespiratory pathology

dyspnoeadyspnoea coughcoughbloody expectorationsbloody expectorations pain in the chestpain in the chest Fever, asthenia, sweatingFever, asthenia, sweating

DyspnoeaDyspnoea can be can be subjectivesubjective, , objectiveobjective, or , or mixedmixed..

SubjectiveSubjective dyspnoea is the subjective dyspnoea is the subjective feeling of difficult or laboured breathing feeling of difficult or laboured breathing (in hysteria, thoracic radiculitis)(in hysteria, thoracic radiculitis)

ObjectiveObjective dyspnoea is determined by dyspnoea is determined by objective examination and is characterized objective examination and is characterized by changes in the respiration rate, depth, by changes in the respiration rate, depth, or rhythm, and also the duration of the or rhythm, and also the duration of the inspiration or expiration (in pulmonary inspiration or expiration (in pulmonary emphysema or pleural obliteration). emphysema or pleural obliteration).

MixedMixed dyspnoea (i.e. subjective and dyspnoea (i.e. subjective and objective). objective).

Inspiratory dyspnoea - Inspiratory dyspnoea - inspiration inspiration become difficult (mechanical obstruction become difficult (mechanical obstruction in the upper respiratory ducts)in the upper respiratory ducts)

Expiratory dyspnoea - Expiratory dyspnoea - expiration expiration become difficult (narrowed lumen in the become difficult (narrowed lumen in the fine bronchi and bronchioles due to fine bronchi and bronchioles due to inflammatory oedema and swelling of inflammatory oedema and swelling of their mucosa, or else in spasms in the their mucosa, or else in spasms in the smooth muscles) smooth muscles)

Mixed dyspnoeaMixed dyspnoea both expiration and both expiration and inspiration become difficult (most inspiration become difficult (most respiratory pathology)respiratory pathology)

PhysiologicalPhysiological dyspnoea is caused dyspnoea is caused by heavy exercise by heavy exercise

Pathological Pathological dyspnoea is dyspnoea is associated with pathology of the associated with pathology of the respiratory organs, diseases of the respiratory organs, diseases of the cardiovascular and haemopoietic cardiovascular and haemopoietic systems, and poisoning).systems, and poisoning).

Paroxysmal attacks of dyspnoea are Paroxysmal attacks of dyspnoea are called called asthmaasthma..

CoughCough is a complicated is a complicated reflex act which is reflex act which is actually a defence actually a defence

reaction aimed at clearing reaction aimed at clearing the larynx, trachea, or the larynx, trachea, or bronchi from mucus or bronchi from mucus or

foreign material. foreign material.

Cough may be Cough may be drydry, without sputum, , without sputum, and and moist moist whith expectoration of whith expectoration of sputum sputum

Dry cough – laryngitis, dry pleurisy Dry cough – laryngitis, dry pleurisy or compression of the main or compression of the main bronchi by the lymph nodes. bronchi by the lymph nodes.

Moist - bronchitis, pulmonary Moist - bronchitis, pulmonary tuberculosis, abscess, tuberculosis, abscess, bronchiectatic disease, pneumoia, bronchiectatic disease, pneumoia, lung cancer.lung cancer.

MorningMorning cough is characteristic of cough is characteristic of patients with chronic bronchitis, patients with chronic bronchitis, bronchiectasis, lung abscess, and bronchiectasis, lung abscess, and cavernous tuberculosis of the lungs. cavernous tuberculosis of the lungs.

The sputum accumulates during the The sputum accumulates during the night sleep in the lungs and the night sleep in the lungs and the bronchi, but as the patient gets up, the bronchi, but as the patient gets up, the sputum moves to the neighbouring sputum moves to the neighbouring parts of the bronchi to stimulate the parts of the bronchi to stimulate the reflexogenic zones of the bronchial reflexogenic zones of the bronchial mucosa. This causes cough and mucosa. This causes cough and expectoration of the sputum. expectoration of the sputum.

"Night""Night" cough is characteristic of cough is characteristic of tuberculosis, lymphogranulomatosis, tuberculosis, lymphogranulomatosis, or cancer. Enlarged mediastinal lymph or cancer. Enlarged mediastinal lymph nodes in these diseases stimulate the nodes in these diseases stimulate the reflexogenic zone of the bifurcation, reflexogenic zone of the bifurcation, especially during night when the tone especially during night when the tone of the vagus nerve increases, to of the vagus nerve increases, to produce the coughing reflex.produce the coughing reflex.

Cough may be Cough may be permanentpermanent and and periodicperiodic..

Permanent coughPermanent cough is rarer is rarer and occurs in laryngitis, and occurs in laryngitis, bronchitis, cancer of the bronchitis, cancer of the

lungs, and in certain forms of lungs, and in certain forms of pulmonary tuberculosis. pulmonary tuberculosis.

Periodic coughPeriodic cough occurs more occurs more frequently.frequently.

HaemoptysisHaemoptysis is is expectoration of blood with expectoration of blood with

sputum during cough. sputum during cough. Pulmonary tuberculosis and Pulmonary tuberculosis and

cancer, virus pneumonia, cancer, virus pneumonia, bronchiectasis, abscess and bronchiectasis, abscess and

gangrene of the lung, gangrene of the lung, thrombosis or embolism of the thrombosis or embolism of the

pulmonary arteries.pulmonary arteries.

Degrees of haemoptysis:Degrees of haemoptysis:1.1. blood streaks in sputumblood streaks in sputum2.2. diffuse bloody colouration to the sputum, diffuse bloody colouration to the sputum,

which can be jelly-like or foamy.which can be jelly-like or foamy.3.3. lung haemorrhage (cavernous tuberculosis, lung haemorrhage (cavernous tuberculosis,

bronchiectases, degrading tumor and bronchiectases, degrading tumor and pulmonary infarction pulmonary infarction

Blood expectorated with sputum can be Blood expectorated with sputum can be freshfresh ( (scarlet) scarlet) or alteredor altered. .

Scarlet (fresh) blood in the sputum is characteristic of Scarlet (fresh) blood in the sputum is characteristic of pulmonary tuberculosis, lung bleeding, cancer of the pulmonary tuberculosis, lung bleeding, cancer of the

lung, bronchiectasis. lung, bronchiectasis. Altered blood: in acute lobar pneumonia (second stage) Altered blood: in acute lobar pneumonia (second stage)

has the colour of has the colour of rust (rusty sputum)rust (rusty sputum) due to due to decomposition of the red blood cells and formation of decomposition of the red blood cells and formation of

the pigment haemosiderin. the pigment haemosiderin.

PainPain inin the chest the chest is classified by its location (upper, is classified by its location (upper,

medial or lower parts of a chest), medial or lower parts of a chest), origin (heart, lungs, pleura), origin (heart, lungs, pleura), character (dull, acute, stubbing, character (dull, acute, stubbing, pressing), intensity, duration, and pressing), intensity, duration, and irradiation. irradiation.

Pleural pain is connected with the Pleural pain is connected with the respiratory movements and cough.respiratory movements and cough.

Pain in the chest may Pain in the chest may be caused by be caused by

affection of pleura, affection of pleura, the chest wall the chest wall

(trauma, neuralgia) (trauma, neuralgia) and heart.and heart.

Objective examination of the patients with Objective examination of the patients with respiratory pathology.respiratory pathology.

Inspection – position of a patient, consciousness, skin, Inspection – position of a patient, consciousness, skin, configuration of the chest (position of the clavicles, configuration of the chest (position of the clavicles, supra- and subclavicular fossae, shoulder blades), supra- and subclavicular fossae, shoulder blades), type, rhythm and frequency of breathing, type, rhythm and frequency of breathing, involvement of the accessory respiratory muscles in involvement of the accessory respiratory muscles in the breathing act.the breathing act.

Palpation – vocal fremitus, pain, resistance of the Palpation – vocal fremitus, pain, resistance of the chest.chest.

Percussion – comparative and topographic.Percussion – comparative and topographic.Auscultation – main and adventitious respiratory Auscultation – main and adventitious respiratory

sounds.sounds.

The shape of the chest may be The shape of the chest may be normal normal or or pathologicalpathological. .

A A normalnormal chest may be asthenic, chest may be asthenic, normosthenia and hypersthenic.normosthenia and hypersthenic.

Pathological Pathological shape of the chest may shape of the chest may be the result of congenital bone be the result of congenital bone defects and of various chronic defects and of various chronic diseases (emphysema of the lungs, diseases (emphysema of the lungs, rickets, tuberculosis).rickets, tuberculosis).

Normal form of the chest.Normal form of the chest. 1.1. Normosthenic (conical) chestNormosthenic (conical) chest

resembles a truncated cone. The resembles a truncated cone. The anteroposterior (sterno vertebral) anteroposterior (sterno vertebral) diameter of the chest is smaller than the diameter of the chest is smaller than the lateral (transverse) one, and the lateral (transverse) one, and the supraclavicular fossae are slightly supraclavicular fossae are slightly pronounced. pronounced. ТТhe epigastric angle nears he epigastric angle nears 90°. The ribs are moderately inclined as 90°. The ribs are moderately inclined as viewed from the side; the shoulder blades viewed from the side; the shoulder blades closely fit to the chest and are at the closely fit to the chest and are at the same level; the chest is about the same same level; the chest is about the same height as the abdominal part of the trunk.height as the abdominal part of the trunk.

2. 2. Hypersthenic chestHypersthenic chest has the shape of has the shape of a cylinder. The anteroposterior diameter a cylinder. The anteroposterior diameter is about the same as the transverse one; is about the same as the transverse one; the supraclavicular fossae are absent the supraclavicular fossae are absent (level with the chest). The epigastric (level with the chest). The epigastric angle exceeds 90°; the ribs in the lateral angle exceeds 90°; the ribs in the lateral parts of the chest are nearly horizontal, parts of the chest are nearly horizontal, the intercostal space is narrow, the the intercostal space is narrow, the shoulder blades closely fit to the chest, shoulder blades closely fit to the chest, the thoracic part of the trunk is smaller the thoracic part of the trunk is smaller than the abdominal one.than the abdominal one.

3. 3. Asthenic chestAsthenic chest is elongated, is elongated, narrow (both the narrow (both the anteroposterior and transverse anteroposterior and transverse diameters are smaller than diameters are smaller than normal); the chest is flat. The normal); the chest is flat. The supra- and subclavicular fossae supra- and subclavicular fossae are distinctly pronounced. The are distinctly pronounced. The epigastric angle is less than epigastric angle is less than 90°. The ribs are more vertical 90°. The ribs are more vertical at the sides; the intercostal at the sides; the intercostal spaces are wide, the shoulder spaces are wide, the shoulder blades are winged (separated blades are winged (separated from the chest), the muscles of from the chest), the muscles of the shoulder girdle are the shoulder girdle are underdeveloped, the chest is underdeveloped, the chest is longer than the abdominal part longer than the abdominal part of the trunk.of the trunk.

Pathological chest.Pathological chest. 11. . Emphysematous (barrel-like) Emphysematous (barrel-like)

chestchest resembles a hypersthenic resembles a hypersthenic chest in its shape, but has a barrel-chest in its shape, but has a barrel-like configuration, the intercostal like configuration, the intercostal spaces are enlarged. Active spaces are enlarged. Active participation of accessory participation of accessory respiratory muscles in the respiratory muscles in the respiratory act (especially m. respiratory act (especially m. sternocleidomastoideus and m. sternocleidomastoideus and m. trapezius).trapezius).

This type of chest is found in chronic This type of chest is found in chronic emphysema of the lungs. emphysema of the lungs.

2. 2. Paralytic chestParalytic chest resembles the asthenic resembles the asthenic chest. Marked atrophy of the chest chest. Marked atrophy of the chest muscles and asymmetry of the clavicles muscles and asymmetry of the clavicles and dissimilar depression of the and dissimilar depression of the supraclavicular fossae can be observed. supraclavicular fossae can be observed. The shoulder blades are not at one level The shoulder blades are not at one level either, and their movements during either, and their movements during breathing are asynchronous.breathing are asynchronous.

It is found in emaciated patients, in general It is found in emaciated patients, in general asthenia and constitutional asthenia and constitutional underdevelopment; it often occurs in underdevelopment; it often occurs in grave chronic diseases, more commonly in grave chronic diseases, more commonly in pulmonary tuberculosis and pulmonary tuberculosis and pneumosclerosis. pneumosclerosis.

3. 3. Rachitic chest (keeled or pigeon Rachitic chest (keeled or pigeon chest).chest). It is characterized by a markedly It is characterized by a markedly greater anterioposterior diameter greater anterioposterior diameter (compared with the transverse diameter) (compared with the transverse diameter) due to the prominence of the sternum due to the prominence of the sternum (which resembles the keel of a boat.) The (which resembles the keel of a boat.) The anterolateral surfaces of the chest are as anterolateral surfaces of the chest are as if pressed on both sides and therefore if pressed on both sides and therefore the ribs meet at an acute angle at the the ribs meet at an acute angle at the sternal bone, while the costal cartilages sternal bone, while the costal cartilages thicken like beads at points of their thicken like beads at points of their transition to bones (rachitic beads). transition to bones (rachitic beads).

4. Funnel chest4. Funnel chest has a funnel- has a funnel-shaped depression in the lower shaped depression in the lower part of the sternum. This part of the sternum. This deformity can be regarded as a deformity can be regarded as a result of abnormal development result of abnormal development of the sternum or prolonged of the sternum or prolonged compressing effect. In older compressing effect. In older times this chest would be found times this chest would be found in shoemaker adolescents.in shoemaker adolescents.

5. 5. Foveated chestFoveated chest is almost is almost the same as the funnel chest the same as the funnel chest except that the depression is except that the depression is found mostly in the upper found mostly in the upper and the middle parts of the and the middle parts of the anterior surface of the chest. anterior surface of the chest. This abnormality occurs in This abnormality occurs in syringomyelia, a rare disease syringomyelia, a rare disease of the spinal cord.of the spinal cord.

The shape of the chest can readily The shape of the chest can readily change due to enlargement or diminution change due to enlargement or diminution of one half of the chest (asymmetry of the of one half of the chest (asymmetry of the chest). These changes can be transient or chest). These changes can be transient or permanent.permanent.

The enlargement of the volume of one The enlargement of the volume of one half of the chest can be due to escape of half of the chest can be due to escape of considerable amounts of fluid as the considerable amounts of fluid as the result of result of accumulation of accumulation of fluid in the fluid in the pleural cavity, or due to penetration of air pleural cavity, or due to penetration of air inside the chest in injuries inside the chest in injuries (pneumothorax). (pneumothorax).

Respiratory movements of Respiratory movements of the chest should be examined the chest should be examined during inspection of the during inspection of the patient. During examinaion a patient. During examinaion a doctor puts one hand on doctor puts one hand on patient’s pulse and other hand patient’s pulse and other hand on patient’s chest and on patient’s chest and calculate respiratory rate (to calculate respiratory rate (to take patient aware of the take patient aware of the procedure).procedure).

The type, The type, frequency, depth frequency, depth and rhythm of and rhythm of respiration can be respiration can be determined by determined by carefully observing carefully observing the chest and the the chest and the abdomen. abdomen. Respiration can be Respiration can be costal (thoracic), costal (thoracic), abdominal, or abdominal, or mixed typemixed type..

Thoracic (costal) respiratioThoracic (costal) respiratio. . Respiratory movements are carried Respiratory movements are carried out mainly by the contraction of the out mainly by the contraction of the intercostal muscles. This type of intercostal muscles. This type of breathing is known as costal and is breathing is known as costal and is mostly characteristic of women.mostly characteristic of women.

Abdominal respiration.Abdominal respiration. Breathing is mainly accomplished Breathing is mainly accomplished by the diaphragmatic muscles. This by the diaphragmatic muscles. This type of respiration is also called type of respiration is also called diaphragmatic and is mostly diaphragmatic and is mostly characteristic of men.characteristic of men.

Respiration rateRespiration rate in in norm is within 16-20 norm is within 16-20

breathing movements a breathing movements a min. It is increased in min. It is increased in

dyspnea and rises in the dyspnea and rises in the case of inhibition of case of inhibition of respiratory center. respiratory center.

Palpation of the chestPalpation of the chest 1. Vocal fremitus. A doctor puts his palms 1. Vocal fremitus. A doctor puts his palms

on the symmetrical parts of patient’s chest on the symmetrical parts of patient’s chest and asks him to say wards with letter “R”. and asks him to say wards with letter “R”. Vocal fremitus must be of equal intensity Vocal fremitus must be of equal intensity on symmetrical points of the chest.on symmetrical points of the chest.

Resistance of the chest. A doctor presses Resistance of the chest. A doctor presses the chest in lateral and anerior-posterior the chest in lateral and anerior-posterior directions. directions.

PainPain

Percussion o the chestPercussion o the chest You must know topographic lines on You must know topographic lines on

the chest.the chest. Comparative percussion Comparative percussion Topographic percussion (lower lung Topographic percussion (lower lung

borders, respiratory mobility of the borders, respiratory mobility of the lower lung border, high of lungs lower lung border, high of lungs apexes and width of Kroenig’s area)apexes and width of Kroenig’s area)