Understanding Cough, Sputum, and Hemoptysis

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Questions and Answers

Which of the following is a common cause of chronic cough with a normal chest X-ray?

Upper airway cough syndrome (correct)

Pneumonia

Pulmonary embolism

Lung abscess

What characterizes acute cough in terms of duration?

Between 3 to 8 weeks

More than 8 weeks

Less than 3 weeks (correct)

Less than 1 week

Which condition is most likely associated with chronic bronchitis?

Bronchiectasis

Lung cancer

Chronic obstructive pulmonary disease (correct)

Gastroesophageal reflux disease

Which type of cough is typically seen post-infection of the upper or lower respiratory tract?

Subacute cough Signup and view all the answers

Which of the following is NOT a non-respiratory cause of cough?

Chronic bronchitis Signup and view all the answers

What is the most common cause of hemoptysis?

Acute exacerbation of COPD Signup and view all the answers

Which of the following conditions can lead to instantaneous onset of dyspnea?

Pulmonary embolism Signup and view all the answers

What type of sputum is typically associated with lobar pneumonia?

Rusty sputum Signup and view all the answers

Which symptom is NOT typically included in the category of respiratory causes of chest pain?

Myocardial infarction Signup and view all the answers

What is a non-respiratory cause of hemoptysis that should be excluded during evaluation?

Goodpasture's syndrome Signup and view all the answers

What is a symptom that may accompany tuberculosis, pneumonia, or mesothelioma?

Nocturnal fever Signup and view all the answers

Which condition is associated with subacute onset of dyspnea lasting several days?

Pleural effusion Signup and view all the answers

Wheezing is characterized by what type of sound?

A continuous whistling sound Signup and view all the answers

Which symptom is commonly associated with laryngitis or lung cancer?

Hoarseness Signup and view all the answers

What common symptom can indicate corpulmonale?

Abdominal and ankle swelling Signup and view all the answers

Which examination finding indicates a potential obstruction in the large airways?

Stridor Signup and view all the answers

What is an important factor to assess in the history of a patient presenting with respiratory symptoms?

Smoking history Signup and view all the answers

Which of the following examinations is NOT typically included in a general system examination for respiratory distress?

Palpation of the abdomen Signup and view all the answers

Which condition may be suggested by a prominent neck vein during examination?

SVC obstruction Signup and view all the answers

What does the presence of a barrel chest indicate?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

Which abnormal finding in hands may indicate a respiratory cause?

Clubbing Signup and view all the answers

What does a tracheal tug indicate in terms of chest condition?

Distance between sternal notch and cricoid cartilage is less than 3-4 finger breadths Signup and view all the answers

In percussion, what does a resonant note below the upper edge starting at the 6th rib midclavicular line indicate?

Hyper-inflation Signup and view all the answers

What characterizes bronchial breath sounds during auscultation?

Louder and longer on expiration with a gap between phases Signup and view all the answers

Which added sound is characterized by continuous musical polyphonic sounds heard louder on expiration?

Wheezes Signup and view all the answers

Which of the following conditions may cause high-pitched wheezes?

Asthma Signup and view all the answers

What finding indicates vocal resonance during auscultation?

Transmission of voice sounds through the chest wall Signup and view all the answers

Late or pan-inspiratory crackles might indicate which condition?

Pulmonary fibrosis Signup and view all the answers

What is a characteristic sign of friction rub during lung auscultation?

Intermittent grating sound Signup and view all the answers

Study Notes

Cough

Cough is a reflex that can last for less than 3 weeks (acute), 3-8 weeks (subacute), or more than 8 weeks (chronic)
Acute cough is often caused by upper or lower respiratory tract infections, acute exacerbation of chronic pulmonary diseases, or pulmonary embolism
Subacute cough is often caused by post-infection of upper or lower respiratory tract or by angiotensin converting enzyme inhibitors (ACEIs)
Chronic cough is often caused by upper airway cough syndrome, bronchial asthma, or gastroesophageal reflux disease

Sputum

Normal sputum is clear and white, less than 100 ml per day, and not smelly
Large amounts of purulent sputum may indicate bronchiectasis (chronic) or lobar pneumonia (acute)
Foul-smelling purulent sputum may indicate a lung abscess with anaerobic infection
Pink frothy secretions occur in pulmonary edema

Hemoptysis

Hemoptysis is blood-stained sputum
The amount of blood can range from streaks to massive bleeding (over 100-600 ml in 24 hours)
The most common cause is an acute infection, such as an exacerbation of COPD, but other serious causes should be ruled out
Other causes include pulmonary embolism, bronchogenic cancer, pulmonary tuberculosis, bronchiectasis, lung abscess, pulmonary hemorrhage, and non-respiratory causes like severe mitral stenosis and acute left ventricular failure

Dyspnea

Dyspnea is the experience of discomfort in breathing or awareness of respiratory distress
Onset can be instantaneous (pneumothorax, PE), minutes to hours (airway disease, parenchymal disease, pulmonary vascular disease, cardiac disease, metabolic acidosis, hyperventilation syndrome), subacute (days, many causes of acute dyspnea plus pleural effusion, lobar collapse, acute interstitial pneumonia, superior vena cava obstruction, pulmonary vasculitis), or chronic (months to years, COPD & BA, diffuse parenchymal disease, hypoventilation, anemia, thyrotoxicosis)
Dyspnea can be graded from I-IV based on the NYHA classification

Chest Pain

Pulmonary causes of chest pain include pulmonary vasculature (acute PE, pulmonary hypertension, cor pulmonale), lung parenchyma (pneumonia, cancer, sarcoidosis, pleuritis and serositis), pleura and pleural spaces (pneumothorax, pleural effusion), and psychogenic/psychosomatic

Wheezing

Wheezing is a continuous whistling sound that is not diagnostic for asthma and can occur in other respiratory diseases such as COPD

Other Symptoms

Runny, blocked nose and sneezing can occur in both common cold and allergic rhinitis
Nocturnal fever may accompany TB, pneumonia, and mesothelioma
Nocturnal sweating can occur in TB, lymphoma, and lung abscess
Hoarseness may be secondary to laryngitis, vocal cord tumor, and recurrent laryngeal nerve palsy in apical lung cancer
Symptoms of cor pulmonale include abdominal and ankle swelling, etc.

History

Details should be collected about the onset, duration, character, radiation, severity, frequency, aggravating and relieving factors, and associated symptoms of respiratory system symptoms.
Previous medical history of respiratory disease, smoking history, drug history (including IV drug abuse and alcohol consumption), occupational history, pets history

Clinical Examination

General Appearance: look for respiratory distress (tachypnea, hyperapnea, accessory muscle use), coughing, sputum, abnormal sounds (stridor, wheezing), abnormal voice (hoarseness), and surroundings
General System Examination:
- Hands: clubbing, tar staining, weakness of hand’s small muscles
- Wrist: pulse (rate and character), flapping tremors (asterixis), blood pressure (pulsus paradoxus, hypotension)
- Neck: jugular venous pressure (elevated in cor pulmonale and SVC obstruction but not pulsatile), lymph nodes (enlargement in bronchogenic cancer or metastases)
- Face: eyes (Horner’s syndrome in bronchogenic cancer), tongue (central cyanosis), SVC obstruction (plethoric and cyanosed, periorbital edema, injected conjunctivae, positive Pemberton’s sign)
Chest Examination:
- Inspection: shape (barrel-chest, pectus excavatum, pectus carinatum, kyphoscoliosis), symmetry (assessment of upper and lower lobes should be done posteriorly looking for decreased or delayed chest movement during moderate respiration), scars, prominent veins (in case of SVC obstruction)
- Palpation:
  - trachea (normally central, slight right displacement could be, check for gross displacement, tracheal tug means the distance between sternal notch and cricoid cartilage is less than 3-4-finger breadths and occurs in chest over expansion as COPD)
  - apex beat and mediastinum (check for displacement)
  - chest expansion (expansion ≥ 5 cm)
  - tactile vocal fremitus (TVF) can be done with the palm of one hand
- Percussion: done symmetrically (left compared with right), posteriorly (the back), anteriorly (the front), and laterally (the sides), supraclavicular area, then clavicles should be percussed directly to evaluate the upper lobes, liver dullness (of the upper edge starting at the 6th rib MCL, resonant note below this area indicates hyper-inflation (COPD, severe asthma), cardiac dullness (may be decreased in a hyperinflated chest)
- Auscultation:
  - Breath Sounds:
    - intensity (normal, decreased as in consolidation, collapse, pleural effusion, pneumothorax, lung fibrosis), quality (vesicular or bronchial in consolidation
    - Differentiation between vesicular and bronchial:
    - Vesicular breath sounds are louder and longer on inspiration than the expiratory phase and have no gap between the two phases.
    - Bronchial breath sounds are louder and longer on the expiratory phase and have a gap between the two phases.
  - Added Sounds:
    - type (wheezes, crackles, friction rub)
    - timing (inspiratory or expiratory)
    - Wheezes: continuous musical polyphonic sounds, heard louder on expiration and can be heard on inspiration (may imply severe airway narrowing), high-pitched wheezes are found in asthma due to acute/chronic airflow limitation and low-pitched in COPD, localized monophonic wheeze due to fixed airway obstruction in bronchogenic cancer
    - Crackles: interrupted, non-musical inspiratory sounds, may be early, late, or pan-inspiratory and fine, medium, or coarse, late/pan-inspiratory coarse crackles in bronchiectasis, late/pan-inspiratory medium crackles in pulmonary edema, late/pan-inspiratory fine crackles in pulmonary fibrosis
    - Friction rub: due to thickened or roughened pleural surfaces rubbing together as lungs expand and contract and give off a continuous or intermittent grating sound, indicates pleurisy and may be heard in pneumonia or pulmonary infarction.
  - Vocal Resonance: It’s the ability to transmit sounds.

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Description

This quiz explores the classifications and causes of cough, sputum characteristics, and hemoptysis. You'll learn about acute, subacute, and chronic cough, as well as what different types of sputum can indicate about respiratory health. Test your knowledge on these essential respiratory symptoms.