| A | B |
|---|
| Clear or mucoid Sputum | Excess secretion from bronchial mucous glands |
| Purulent Sputum | Inflammatory exudate from respiratory tract infection |
| blood in Sputum | Ulceration of airways or damage to pulmonary vasculature in lung tumors pulmonary infarcts bronchiectasis aspergilloma |
| Cough | Physiological reflex response to presence of mucus |
| Wheezing on inspiration (stridor) | Narrowing of larynx |
| Wheezing on expiration | Distal bronchial narrowing in asthma |
| Dyspnea | Decreased oxygen in the blood from impaired alveolar gas exchange left heart failure or anemia |
| Cyanosis | Increased non-oxygenated blood in circulatory bypassing of lungs in congenital heart diseases or impaired alveolar gas exchange |
| Pleuritic pain | Irritation of the pleura due to pulmonary inflammation infarction or tumor |
| Pleural effusion with transudate | Cardiac failure Hypoalbuminemia |
| Pleural effusion with exudate | Pleural inflammation or tumor |
| Finger clubbingFrequently accompanies | carcinoma of lung bronchiectasis and pulmonary fibrosis |
| Weight loss | Protein catabolic state induced by chronic inflammatory disease or tumors |
| Auscultation of Crackles | Sudden inspirational opening of small airways resisted by fluid or fibrosis |
| Auscultation of Wheezes | Generalized or localized airway narrowing |
| Auscultation of Pleural rub | Pleural surface roughened by exudate |
| Percussion of dullness of the lung | Consolidation of lung by exudate or pleural effusion |
| Percussion of Hyper-resonance of the lung | Increased gas content of thorax due to pneumothorax or emphysema |
| Peak expiratory flow rate (PEFR) | Reduced with obstructed airways or muscle weakness |
| Forced expiratory volume in 1 second (FEV1) | Reduced with obstructed airways pulmonary fibrosis or oedema or muscle weakness |
| Vital capacity (VC) | Reduced with reduction in effective lung volume in fibrosis or edema chest wall deformity in kyphoscoliosis or muscle weakness - Increased in emphysema |
| Forced expiratory ratio (FEV1:VC) | Low in obstructive defects Normal or high in restrictive defects |
| Carbon monoxide transfer (TCO) | Reduced in pulmonary fibrosis emphysema |
| Respiratory failure | leads to |
| Type I respiratory failure is characterized by | hypoxia and a low level of CO2 in the blood secondary to hyperventilation |
| Type II respiratory failure the hypoxia is associated with | hypoventilation resulting in impaired clearance of CO2 and hypercapnia |
| In acute type II respiratory failure there is respiratory | acidosis due to an increased [H]+ |
| In chronic respiratory failure is buffered by | increased bicarbonate retention by the kidneys compensatory metabolic alkalosis |
| Dyspnea | Difficulty with breathing |
| Cough with a normal chest x-ray | postnasal discharge is the most common |
| Drugs causing cough include | ACE inhibitors & Aspirin |
| Hemoptysis is | Coughing up blood-tinged sputum |
| Tracheal shift | due to pressure in contralateral lung or decreased volume in ipsilateral lung |
| Vocal tactile fremitus | Palpable thrill (vibration) transmitted through chest when patient says “E” or “1 |
| Decreased vocal tactile fremitus occurs in | emphysema or asthma |
| Absent vocal tactile fremitus occurs in | atelectasis effusion or pneumothorax |
| Increased tactile fremitus occurs in | alveolar consolidation like in lobar pneumonia |
| Dull percussion note is discovered in | pleural effusion lung consolidation atelectasis |
| Hyperresonant percussion is discovered in | pneumothorax asthma & emphysema |
| The origin for normal breath sounds | air velocity and turbulence induce vibrations in airway walls of the trachea |
| Sounds heard with the stethoscope are produced in more central (hilar) regions and are altered in intensity and tonal quality as they pass through | pulmonary tissue to the periphery. |
| The site for normal airway resistance | segmental bronchi (turbulent air flow) |
| The site for laminar airflow | the bronchioles—“small airway” |
| Parallel branching pattern results from | increases cross-sectional area of airways; converts turbulence into laminar airflow |
| Effects of inflammation of small airways | air trapping wheezing increased airway resistance |
| Tubular breath sounds | Sound is like blowing air through a tube |
| Tracheal breath sound | normal sound over lateral neck or suprasternal notch |
| Bronchial breath sounds | always an abnormal sound loud high-pitched sound with a peculiar hollow or tubular quality |
| Significance of expiratory sounds longer than inspiratory | consolidation |
| Normal Inspiratory/expiratory ratio is | 3:1 |
| Bronchovesicular breath sounds | Crackles |
| Early and mid inspiratory crackles occur due to | secretions in proximal large to medium-sized airways in chronic bronchitis clear with coughing |
| Late inspiratory crackles due to | reopening of distal airways partially occluded by increased interstitial pressure do not clear with coughing vary from fine to coarse |
| Wheezing | high-pitched musical sound usually heard in expiration |
| Rhonchi | low-pitched snoring sound heard during inspiration or expiration Due to secretions in large airways |
| Inspiratory stridor | high-pitched inspiratory sound sign of upper airway obstruction in epiglottitis |
| Inspiratory and expiratory stridor | sign of fixed upper airway obstruction in cancer |
| Pleural friction rub | two inflamed surfaces pleural and parietal rubbing against each other |
| Grunting in newborns | always abnormal after 24 hours Common finding in RDS respiratory distress syndrome |
| Bronchophony | sound of bronchi |
| Bronchophony in normal lung | spoken syllables or numbers (“99”) are indistinctly heard |
| Bronchophony in alveolar consolidation | syllables numbers heard louder and more distinctly |
| In Egophony patient saying “E” sounds like | “A" |
