COUGH & EXPECTORATION DR.N.SANKAR

COUGH Defensive mechanism to clear lower air passages. Deeper the inspiration- more effective the cough Glottis close, soft palate raised, all accessory muscles in addition to ordinary are tensed for forced expiration. Then glottis relaxed & contents are expelled from the mouth

CLASSIFICATION OF COUGH DUE TO 1. INFECTIONS 2. MECHANICAL IRRITATION 3. REFLEX CONDITIONS

INFECTIONS COMMON COLD- SHORT COUGH, DRY AT FIRST AND LATER PAROXYSMAL PHARYNGITIS-PERSISTENT, GENERALLY DRY LARYNGITIS- NOISY, HUSKY, STRIDULOUS TRACHEITIS- INTENSELY IRRITATING, PAROXYSMAL; + WHEEZING BRONCHITIS- PRODUCTIVE, FREE OR PAROXYSMAL

PNEUMONIA- 1ST DAY- DRY, THEN RUSTY SPUTUM, THEN FROTHY TUBERCULOSIS- FREQ, SHORT, SHARP DRY –EARLY; LATER ON- COPIOUS PURULENT PLEURISY- SOLITARY, DRY HACKING COUGH SUPPRESSED AS MUCH AS POSSIBLE TO AVOID PAIN. BRONCHIECTASIS- CONSTANT WITH COPIOUS OFFENSIVE PURULENT MORE ON MORN OR CHANGE OF PLACE

LUNG ABCESS- LOOSE COUGH, OFFENSIVE BLOOD STAINED; AFFECTED BY CHANGE OF POSTURE PERTUSSIS- LONG DRAWN SRIDULOUS INSPIRATION SERIES OF SHORT, SHARP, EXPIRATORY COUGH WITH VOMITING OFTEN; FACE CONGESTED

MECHANICAL IRRITATION ENLARGED UVULA- SINUSITIS SMOKING PRESSING UPON TRACHEA ENLARGED HEART

REFLEX CONDITIONS IRRITATION OF PERIPHERAL NERVES ENLARGED LIVER AND DIAPHRAGMATIC DISORDERS NERVOUSNESS- SINGLE SHORT DRY AND EXPLOSIVE HYSTERIA- LOUD BARKING WITH APHONIA

SUDDEN COUGH- TRACHEITIS, BRONCHITIS, BRONCHOPNEUMONIA COUGH WITH PAIN- PNEUMONIA, PLEURISY, COUGH ON LYING DOWN- ENLARGED UVULA, ENLARGED HEART COUGH WITH VOMITING- WHOOPING COUGH DRY COUGH- PHTHISIS, LARYNGITIS, NEUROSIS LOOSE COUGH- BRONCHITIS, BRONCHIECTASIS, PTHISIS SUDDEN PAROXYSM IN A CHILD- FOREIGN BODY, IF WITH FEVER---- LARYNGEAL DIPTHERIA SHORT AND SUPPRESSED- DRY PLEURISY

IRRITABLE- EARLY PTHISIS, PHARYNGITIS PAROXYSMAL- ASTHMA, BRONCHITIS, PERTUSSIS EXPLOSIVE- NEUROSIS, LARYNGITIS BRASSY- ANEURYSM, MEDIASTINAL GROWTH BOVINE- PROLONGED WITH WHEEZING- RL.N INVOLVEMENT BARKING- HYSTERIA HACKING- PHTHISIS, LARYNGITIS, PHARYNGITIS STRIDOR- PERSISTENT THYMUS, LARYNGEAL DIPHTHERIA

EXPECTORATION

LOOK FOR QUANTITY QUALITY & COLOUR CONSISTENCY ODOUR MICROSCOPIC EXAMINATION

QUANTITY(24 HRS) MODERATE(2 OUNCES)- ACUTE BRONCHITIS LITTLE LARGER AMOUNT- CHRONIC BRONCHITIS, RESOLVING PNEUMONIA, B.CA LARGER QUANTITY(OVER 10 OUNCES)- LUNG ABSESS, EMPYEMA, BRONCHIECTASIS FROTHY- ACUTE PULMONARY CONGESTION SUDDEN SEVERAL OUNCES-LUNG ABSCESS, SUBPHRENIC ABSCESS, EMPYEMA SUDDEN CLEAR WATERY SALT TASTING- HYDATID CYST

QUALITY & COLOUR MUCOID RUSTY SEROUS RED CURRANT JELLY FIBRINOUS ANCHOVY SAUCE PUS FROTHY GREENISH PURULENT MUCOPURULENT BLOOD STAINED BLACK

CONSISTENCY METHOD --- LOOK FOR FOLLOWING: BRONCHIAL CASTS DITTRICH’S PLUGS CURSCHMANN’S SPIRALS LUNG STONES LAYER FORMATION

ODOUR OFFENSIVE

MICROSCOPIC EXAMINATION CELLULAR STRUCTURES PUS CELLS EPITHELIUM(HEART FAILURE CELLS) RED CELLS EOSONOPHIL CELLS ELASTIC FIBRES DESTRUCTION OF LUNG TISSUE- ABSCESS, PTHISIS, GANGRENE

ORGANISMS PARASITES(HYDATID CYST, LUNG FLUKE, ECHINICOCCI) TB BACILLI COCCI AND BACILLI CURSCHMANN’S SPIRALS ASTHMA CHARCOT LEYDEN CRYSTALS NEOPLASTIC CELLS- CA ASBESTOSIS- GOLDEN YELLOW DUMBELLS

Bibliography How to examine a patient; a guide for student of medicine menino de souza

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