1. COUGH & EXPECTORATION
DR.N.SANKAR

2. 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

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

4. 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

5. 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

6. 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

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

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

9. 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

10. 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

11. EXPECTORATION

12. LOOK FOR QUANTITY QUALITY & COLOUR CONSISTENCY ODOUR
MICROSCOPIC EXAMINATION

13. 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

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

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

16. ODOUR
OFFENSIVE

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

18. 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

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

20. THANK YOU