5. Examination of Respiratory System

Main Symptoms (Always ask about onset, duration, progression, severity, and associated factors)

1. Cough

• Dry: Often seen in viral infections, interstitial lung diseases, asthma.
• Productive: Suggests infection (e.g., pneumonia, bronchitis), bronchiectasis, COPD.
• Ask about duration: acute (<3 weeks), subacute (3–8 weeks), chronic (>8 weeks).
• Timing: Nocturnal (asthma), postural (bronchiectasis), morning (COPD).

2. Sputum

• Color:
• Clear/white → viral infection or allergies.
• Yellow/green → bacterial infection.
• Rusty → pneumococcal pneumonia.
• Pink frothy → pulmonary edema.
• Bloody → hemoptysis.
• Amount: Large volume → bronchiectasis or lung abscess.
• Odor: Foul-smelling → anaerobic infections or abscess.

3. Dyspnea (Shortness of Breath)

• On exertion: Early sign of many chronic respiratory diseases.
• At rest: Seen in severe disease or acute conditions.
• Orthopnea: Suggests cardiac origin (CHF).
• Paroxysmal nocturnal dyspnea: CHF but can occur in severe asthma.
• Grading:
• Grade I: Only on strenuous exertion.
• Grade II: On moderate exertion (e.g. walking uphill).
• Grade III: On minimal exertion.
• Grade IV: At rest.

4. Chest Pain

• Pleuritic: Sharp, worse on inspiration or coughing → pleuritis, pneumonia, PE, pneumothorax.
• Non-pleuritic: Dull, constant → malignancy, chest wall pain.
• Localize and characterize!

5. Hemoptysis

• Small streaks → bronchitis.
• Frank blood → TB, bronchiectasis, cancer, PE.
• Rule out GI (hematemesis).

6. Wheezing or Stridor

• Wheezing: Expiratory musical sound → asthma, COPD.
• Stridor: High-pitched inspiratory sound → upper airway obstruction (tumor, foreign body, croup).