Questions on presenting problems of respiratory system



Presenting problems

What are the common presentations (symptoms) of respiratory diseases?
  • Cough
  • Sputum
  • Wheeze
  • Breathlessness
  • Chest pain
  • Hemoptysis.


What are the causes of cough?
  1. Acute cough (<3 weeks)
    1. Viral respiratory tract infection (rhinitis/sinusitis)
    2. Bacterial infection (acute bronchitis)
    3. Inhaled foreign body
    4. Pneumonia
    5. Acute extrinsic allergic alveolitis.
  2. Chronic cough (>8 weeks)
    1. COPD
    2. Asthma
    3. Tuberculosis
    4. Lung carcinoma
    5. Bronchiectasis
    6. Interstitial lung disease.
    7. GERD
    8. Postviral bronchial hyper-reactivity
    9. Rhinitis/sinusitis
    10. Cigaret smoking
    11. Drugs, especially ACE inhibitors.
What are the 'Red flag' symptoms associated with cough?
  • Hemoptysis
  • Breathlessness
  • Fever
  • Chest pain
  • Weight loss.
What are the causes of cough with normal chest X-ray?
  • GERD
  • Cough variant asthma
  • Postnasal drip (rhinitis/sinusitis)
  • Postviral bronchial hyper-reactivity
  • Cigaret smoking
  • Drugs, especially ACE inhibitors
  • Viral respiratory tract infection
  • Bacterial infection (acute bronchitis)
  • Inhalation of irritant dusts/fumes.
What are the causes of productive cough?
  • Pneumonia
  • Bronchiectasis
  • Lung abscess
  • Acute pulmonary edema
  • Chronic bronchitis/COPD
  • Cystic fibrosis
  • Alveolar cell cancer.


What are the causes of purulent sputum?
  • Pneumonia
  • Bronchiectasis
  • Lung abscess
  • COPD (infective exacerbation)
  • Cystic fibrosis.
What are the causes of copious amount of sputum?
  • Bronchiectasis
  • Rupture of a lung abscess or empyema into the bronchial tree
  • Pulmonary edema
  • Alveolar cell cancer.
What is the cause of rusty sputum?

Pneumococcal pneumonia is the cause of rusty sputum.

What are the causes of frothy sputum?
  • Pulmonary edema
  • Alveolar cell carcinoma.

Wheeze and stridor

What is wheeze?

Musical sound produced by obstruction of small bronchus and bronchioles.

What are the causes of wheeze?
  • Asthma
  • COPD.
* Pre-exam preparation for medicine, HN Sarker
What is stridor?

Sound produced by obstruction of large bronchus whether intrathoracic or extrathoracic.

Breathlessness/ dyspnea

What are the causes of breathlessness according to time frame?
  1. Minutes
    1. Pulmonary thromboembolism
    2. Pneumothorax
    3. Acute left ventricular failure
    4. Acute severe asthma
    5. Inhaled foreign body.
  2. Hours to days
    1. Pneumonia
    2. Asthma
    3. Exacerbation of COPD.
  3. Weeks to months
    1.  Anemia
    2. Pleural effusion
    3. Respiratory neuromuscular disorders.
  4. Months to years
    1. COPD
    2. Pulmonary fibrosis
    3. Pulmonary tuberculosis.
What are the causes of chronic breathlessness, according to lung and heart cause?

Lung causes are:

  • Chronic obstructive pulmonary disease
  • Chronic asthma
  • Chronic pulmonary thromboembolism
  • Bronchial carcinoma
  • Interstitial lung diseases: Sarcoidosis, fibrosing alveolitis, and extrinsic allergic alveolitis.
  • Lymphatic carcinomatosis
  • Large pleural effusion(s).

Heart causes are:

  • Chronic congestive cardiac failure
  • Myocardial ischemia.

Read more about dyspnoea at Symptoms of cardiovascular disease

Tell the MRC grading of dyspnea.

See more about dyspnoea at COPD

* Davidson’s Principles and Practice of Medicine, 22nd Edition Page: 674


What is hemoptysis?

Hemoptysis means coughing up blood.

What is massive hemoptysis?

Coughing out 200ml of blood in 24 hours.

Tell six common causes of hemoptysis.
  • Tuberculosis
  • Bronchial carcinoma
  • Bronchiectasis
  • Pneumonia
  • Mitral stenosis
  • Pulmonary infarction.
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