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Causes of Hemoptysis


Cardiac Causes


Left ventricular failure - causing Pulmonary Oedema

Primary Pulmonary HypertensionQ

Congenital Causes

Pulmonary Sequestration

Resp causes

Pneumonia tuberculosis, Lung abscess, Bronchiectasis, Pulm Embolism, Av malformation F8 retention.

Immunological causes:


Henoch- Schönlein Purpura.

Goodpasture's syndromeQ

Bleeding Dyscrasias


Idiopathic Thrombocytopenic Purpura (ITP)

Anticoagulant Drugs



Fractured Trachea I Bronchus


Following Intubation, Bronchoscopy, Lung Biopsy


Causes of Clubbing:


1. Cardiac Causes:

i. Cyanotic Congenital Heart Diseases e.g. TOF

ii.Infective endocarditis.

2. Pulmonary Causes

i.  BronchiectasisQ.
ii. Lung AbscessQ

iii. Empyema (Chronic)
iv. Pulmonary Tuberculosis.

3. Intestinal Causes


i.  Ulcerative ColitisQ

ii. Crohn's DiseaseQ.

4. Hepatic Causes       

Cirrhosis (esp. in Biliary Cirrhosis).

5. Endocrinal Causes:.


  1. Central Cyanosis:
    1. Cardiac Causes:
      1. Cyanotic congenital heart diseases e.g. Fallot’s tetralogy.
      2. CCF
      3. ASD / VSD / PDA with reversal of shunt (Eisenmenger's physiology)Q 
    2. Pulmonary Causes:
      1. Any lung pathology with severe involvement of the lung parenchyma. e.g. Severe pneumonia, bronchopneumonia.
      2. Collapse of Lung due to any cause. 
  2. Peripheral Cyanosis:
    1. Shock.
    2. Local vasoconstriction due to any cause.
    3. PolycythemiaQ.
    4. Abnormal Pigments Causing Cyanosis: Methemoglobinemia. 

Pigeon shaped chest


1. Rickets

2. Congenital

3. Skeletal dysplasia.

4. Emphysema

5. Chronic Respiratory Distress.

1. Mucopolysaccharidosis - Type IV.Q

2. Massive CardiomegalyQ.

3. Marfan’s SyndromeQ.

4. Noonan SyndromeQ.



Precordium bulge


Precordial Bulge


1. Cardiomegaly

2. Pericardial Effusion.

3. Retrocardiac tumours

4. Mediastinal tumour.

5. Skeletal

6. Dysplasias.

1. Scoliosis.

2. Rickets

3. Cellulitis

4. Lipoma

5. Rib Tumours



Causes of Decreased Movements of Chest:

  • Consolidation
  • Hydropneumothorax
  • Collapse (Massive collapse)    
  • Emphysema         
  • Obstruction to the main bronchus 

Tactile vocal&Fremitus vocal resonance:


Increase In

  Decrease In


 1.  ConsolidationQ

  1. Pleural .effusion.


 2.  CavityQ.

  2. Pneumothorax



  3.  Emphysema. .



  4.  Collapse I fibrosis.


  5. Bronchial obstruction:


Mediastinal position in respiratory lesions

  1. In the centre
    1. Pneumonia   - Bronchiectasis
    2. Emphysema  - Bronchial asthma  
  2. Shifted :

To Opposite Side,

To Same Side

1   Pleural EffusionQ

2   Pneumothorax

3    Hydropneumothorax

4    Large tumour

1 FibrosisQ

2  CollapseQ


D/D of the dullness on percussion in respiratory diseases


Stony Dullness

Impaired Note

1 Pleural EffusionQ



1 Pneumonia, Collapse  

2 Thickened Pleura   

3 Fibrosis

4 Sequestration 'of Jun"            

5 Abscess

6   Infarct


Causes of bronchial breathing


Tubular breathing

Cavernous breathing

Amphoric breathing

• Pneumonia.

• Collapse

• Infarct

• Cavity with irregular walls


• Pneumonia Communicating with a bronchus.



Causes of Rales


• Pneumonia/Bronchopneumonia Bronchiectasis

• Lung abscess/Cavity

Pulmonary Edema

Left-sided Heart failure



Causes of wheezing

  1. Wheeze associated lower respiratory tract infection.
    1. Bronchial asthma                          
    2. Tropical eosinophilia
    3. Loeffler’s syndrome.                     
    4. Hypersensitivity pneumonitis. 
  2. Upper Respiratory Tract:
    1. Congenital disorders of the nose. 

Respiratory sounds





Oropharyngeal obstruction

Inspiratory, low pitched irregular


By partial closure of glottis

Expiratory, occurs in hyaline membrane disease


Secretions in trachea/bronchi

Inspiratory, coarse. This sound can also be felt by placing hands over the chest


Obstruction larynx/ trachea

Inspiratory sound, may be associated with an expiratory component


Lower airway obstruction

Continuous musical sound predominantly expiratory in nature


Table : Distinguishing between stridor due to supraglottic and tracheal obstruction

Clinical features

Supraglottic obstruction

Tracheal obstruction


Inspiratory and often less serious

Usually expiratory and more serious





Less severe

More marked


Less marked

Deep barking or brasy

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