I. When patient presents with Cough :
The cough reflex mainly evolved to clear the foreign materials and fluids from the central airways, and it can be triggered by bronchial tree diseases at any level.
Normally the reason behind acute coughing is the viral infections, but sometimes the coughing can remain for longer time period which is known as chronic cough.
Causes of chronic cough :
- Lung cancer
- Adverse effects of drugs – If the patient is on angiotensin-converting enzyme inhibitors
- Oesophageal reflux
- Rhinitis(Rhinitis is a condition in which the mucous membrane of the nose becomes inflamed and swollen.)
II. When the patient comes complaining Chest Pain / Discomforts :
A dull aching, a crushing or burning sensation, a quick stabbing pain, and pain that extends to the neck or shoulder are all symptoms of chest discomfort.
Chest pain can originate from several sites, they are :
- Chest wall,
- Parietal pleura,
- Mediastinal structures,
- Tracheobronchial tree,
- Oesophagus, and
- Subdiaphragmatic organs like liver and gallbladder
- Myocardial ischaemia
Because they only have an autonomic nerve supply, pain does not originate in the lung parenchyma or visceral pleura.
What are the diseases which causes chest pain :
- Pulmonary Infarcts
- And Lung cancer
Sometimes Herpes zoster infection can cause burning pain and superficial itching in a thoracic dermatome.
III. When a patient presents with Breathlessness :
Breathlessness is a condition marked by the difficulty in breathing.
What are the most common causes behind the Breathlessness condition :
- Pneumonia – Here the clinical findings are Fever, cough and Green Sputum.
- Pneumothorax – During Percussion, there will be absent of unilateral breath sound.
- Pulmonary embolus – The patient complains about haemoptysis and swollen leg.
- Acute Inflammation including asthma – The patient comes with complaint of Wheezing.
- New interstitial diseases – Here on Auscultation, Fine inspiratory crackles can be heard.
- Interstitial lung diseases – Here also on Auscultation, Fine inspiratory crackles can be heard.
- Tumours – Patient present with pain and discomfort
- Myocardial infarction with pulmonary oedema – Crackles in the chest can be heard.
- Tuberculosis – Carckles and night sweat are the features.
|In this condition, the patient wakes up during sleeping at night.||Here the patient feels comfortable at rest and during sleeping, but starts to feel discomfort when he/she tries to put physical or mental efforts.|
IV. If Patient diagnosed with Haemoptysis :
This condition is known by a vigorous cough that brings up small amounts of blood mixed with sputum (or, more critically, significant amounts of bright red blood).
These symptoms are most commonly associated with acute or chronic respiratory tract infections.
—> There is a huge chance of getting malignancy and pulmonary embolism also.
What are the clinical features of each disease related with Haemoptysis :
- Tuberculosis – Over the weeks, here recurrent blood streaks are present in purulent sputum.
- Bronchiectasis – Over the years , here recurrent blood streaks are present in purulent sputum.
- Pulmonary Embolism – Sudden loss of a tiny amount of blood, accompanied by pleuritic pain and shortness of breath
- Aute Bronchitis – A brief history of blood streaks and purulent sputum
When the patient is diagnosed with haemoptysis greater than 20mL
Then there are other chances of diseases like :
- Pulmonary vasculitis
- Cystic fibrosis
- When lung cancer erodes a pulmonary vessel
- Cavitatory disease (Indise the lung there is formation of an abnormal, thick-walled and air-filled space)
V. Patient comes with abnormal Sputum presentation :
Here, the patient can present with mainly five types of sputum colours.
- Mucoid & Clear – Most probable causes are COPD or Bronchiectasis
- Pinkish and mucoid – Left ventricular failure
- Purulent & Green – Recent infections
- Frothy & pink – Acute pulmonary oedema
- Mucopurulent & Yellow – Infection of the acute lower respiratory tract like in Asthma
- Rusty & Red – Pneumococcal Pneumonia
VI. Patient comes with complaining of Wheezing :
In this condition during breathing, a high-pitched whistling sound is produced.
Mainly this is the characteristic features of COPD and Asthma.
|In this case wheezing occurs during exercise or working in the day time, specially in the morning.||In Asthma, the wheezing occurs during night time.|
VII. Patient comes with Stridor :
This occur when the patient takes a breath in, and will hear a high-pitched whistling sound by the vibration of the walls of the trachea air major bronchi.
This situation occurs during the narrowing of the large airway at the thoracic inlet.
VIII. Patient having Sleepiness during day time :
This is a condition where the person gets the feeling of excessive sleepiness during day time and this occurs due having unable to sleep during the night time for having an obstructive sleep apnoea
—> Mainly seen in Asthma patients, who gets unable to sleep during the night time because of respiratory tract obstruction.
IX. Patient has Fever with night sweat :
FEVER – These are mainly caused by the acute & chronic infections and also in malignancies.
SWEAT – Mainly associated with chronic infections and malignancies.
X. Patient arriving with complaining Weight Loss :
This can occur in :
- COPD and Interstitial lung diseases
- Lung cancers
- Tuberculosis and bronchiectasis