The most typical complaints of the patient with respiratory pathology dyspnoea cough

1. Sympoms in diseases of respiratory organs based on the results of inquiry of a patient, palpation and percussion of a chest

2. The most typical complaints of the patient with respiratory pathology dyspnoea cough bloody expectorations pain in the chest Fever, asthenia, sweating

3. Dyspnoea can be subjective, objective, or mixed. Subjective dyspnoea is the subjective feeling of difficult or laboured breathing (in hysteria, thoracic radiculitis) Objective dyspnoea is determined by objective examination and is characterized by changes in the respiration rate, depth, or rhythm, and also the duration of the inspiration or expiration (in pulmonary emphysema or pleural obliteration). Mixed dyspnoea (i.e. subjective and objective).

4. Inspiratory dyspnoea - inspiration become difficult (mechanical obstruction in the upper respiratory ducts) Expiratory dyspnoea - expiration become difficult (narrowed lumen in the fine bronchi and bronchioles due to inflammatory oedema and swelling of their mucosa, or else in spasms in the smooth muscles) Mixed dyspnoea both expiration and inspiration become difficult (most respiratory pathology)

5. Physiological dyspnoea is caused by heavy exercise Pathological dyspnoea is associated with pathology of the respiratory organs, diseases of the cardiovascular and haemopoietic systems, and poisoning). Paroxysmal attacks of dyspnoea are called asthma.

6. Coughis a complicated reflex act which is actually a defence reaction aimed at clearing the larynx, trachea, or bronchi from mucus or foreign material.

7. Cough may be dry, without sputum, and moist whith expectoration of sputum Dry cough – laryngitis, dry pleurisy or compression of the main bronchi by the lymph nodes. Moist - bronchitis, pulmonary tuberculosis, abscess, bronchiectatic disease, pneumoia, lung cancer.

8. Morning cough is characteristic of patients with chronic bronchitis, bronchiectasis, lung abscess, and cavernous tuberculosis of the lungs. The sputum accumulates during the night sleep in the lungs and the bronchi, but as the patient gets up, the sputum moves to the neighbouring parts of the bronchi to stimulate the reflexogenic zones of the bronchial mucosa. This causes cough and expectoration of the sputum.

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

10. Cough may be permanent and periodic. Permanent cough is rarer and occurs in laryngitis, bronchitis, cancer of the lungs, and in certain forms of pulmonary tuberculosis. Periodic cough occurs more frequently.

11. Haemoptysis is expectoration of blood with sputum during cough. Pulmonary tuberculosis and cancer, virus pneumonia, bronchiectasis, abscess and gangrene of the lung, thrombosis or embolism of the pulmonary arteries.

12. Degrees of haemoptysis: • blood streaks in sputum • diffuse bloody colouration to the sputum, which can be jelly-like or foamy. • lung haemorrhage (cavernous tuberculosis, bronchiectases, degrading tumor and pulmonary infarction Blood expectorated with sputum can be fresh (scarlet) or altered. Scarlet (fresh) blood in the sputum is characteristic of pulmonary tuberculosis, lung bleeding, cancer of the lung, bronchiectasis. Altered blood: in acute lobar pneumonia (second stage) has the colour of rust (rusty sputum) due to decomposition of the red blood cells and formation of the pigment haemosiderin.

13. Painin the chest • is classified by its location (upper, medial or lower parts of a chest), origin (heart, lungs, pleura), character (dull, acute, stubbing, pressing), intensity, duration, and irradiation. • Pleural pain is connected with the respiratory movements and cough.

14. Pain in the chest may be caused by affection of pleura, the chest wall (trauma, neuralgia) and heart.

15. Objective examination of the patients with respiratory pathology. Inspection – position of a patient, consciousness, skin, configuration of the chest (position of the clavicles, supra- and subclavicular fossae, shoulder blades), type, rhythm and frequency of breathing, involvement of the accessory respiratory muscles in the breathing act. Palpation – vocal fremitus, pain, resistance of the chest. Percussion – comparative and topographic. Auscultation – main and adventitious respiratory sounds.

16. The shape of the chest may be normal or pathological. A normal chest may be asthenic, normosthenia and hypersthenic. Pathological shape of the chest may be the result of congenital bone defects and of various chronic diseases (emphysema of the lungs, rickets, tuberculosis).

18. Normal form of the chest. 1.Normosthenic (conical) chest resembles a truncated cone. The anteroposterior (sterno vertebral) diameter of the chest is smaller than the lateral (transverse) one, and the supraclavicular fossae are slightly pronounced. Тhe epigastric angle nears 90°. The ribs are moderately inclined as viewed from the side; the shoulder blades closely fit to the chest and are at the same level; the chest is about the same height as the abdominal part of the trunk.

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

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

21. Pathological chest. 1. Emphysematous (barrel-like) chest resembles a hypersthenic chest in its shape, but has a barrel-like configuration, the intercostal spaces are enlarged. Active participation of accessory respiratory muscles in the respiratory act (especially m. sternocleidomastoideus and m. trapezius). This type of chest is found in chronic emphysema of the lungs.

22. 2. Paralytic chest resembles the asthenic chest. Marked atrophy of the chest muscles and asymmetry of the clavicles and dissimilar depression of the supraclavicular fossae can be observed. The shoulder blades are not at one level either, and their movements during breathing are asynchronous. It is found in emaciated patients, in general asthenia and constitutional underdevelopment; it often occurs in grave chronic diseases, more commonly in pulmonary tuberculosis and pneumosclerosis.

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

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

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

27. The shape of the chest can readily change due to enlargement or diminution of one half of the chest (asymmetry of the chest). These changes can be transient or permanent. The enlargement of the volume of one half of the chest can be due to escape of considerable amounts of fluid as the result of accumulation of fluid in the pleural cavity, or due to penetration of air inside the chest in injuries (pneumothorax).

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

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

30. Thoracic (costal) respiratio. Respiratory movements are carried out mainly by the contraction of the intercostal muscles. This type of breathing is known as costal and is mostly characteristic of women. Abdominal respiration. Breathing is mainly accomplished by the diaphragmatic muscles. This type of respiration is also called diaphragmatic and is mostly characteristic of men.

31. Respiration rate in norm is within 16-20 breathing movements a min. It is increased in dyspnea and rises in the case of inhibition of respiratory center.

33. Palpation of the chest • 1. Vocal fremitus. A doctor puts his palms on the symmetrical parts of patient’s chest and asks him to say wards with letter “R”. Vocal fremitus must be of equal intensity on symmetrical points of the chest. • Resistance of the chest. A doctor presses the chest in lateral and anerior-posterior directions. • Pain

34. Percussion o the chest • You must know topographic lines on the chest. • Comparative percussion • Topographic percussion (lower lung borders, respiratory mobility of the lower lung border, high of lungs apexes and width of Kroenig’s area)