causes of bronchial breath sounds

Primary Causes

Pneumonia (consolidation from bacterial, viral, or fungal infection)

Lung abscess or cavitary lesions (e.g., necrotic tumor, tuberculosis cavity)

Bronchiectasis (dilated airways with chronic inflammation)

Pleural effusion (over compressed underlying lung)

Atelectasis or lung collapse (obstructive or compressive)

Secondary Causes

Pulmonary fibrosis (scarring stiffens parenchyma)

Pulmonary edema (fluid overload in alveoli)

Large tumors compressing airways

Sinusitis symptoms

 Major symptoms 

1.purulent anterior nasal discharge 

2.purulent or discolored posterior nasal discharge 

3.Nasal congestion or obstruction 

4.Facial congestion or fullness

5.Facial pain or pressure

6.Hyposmia or anosmia 

7.Fever

Minor symptoms 

1.Headache

2.Halitosis

3.Ear pain, pressure or fullness

4.Dental pain

5.Cough

6.Fever

7.Fatigue

Presence of atleast 2 major or 1 major and 2 minor criteria -diagnosis of Sinusitis is made.

Reference - IDSA 2012

Causes of dry cough with hemoptysis

 Causes of dry cough with hemoptysis 

Malignancy

Bronchiectasis sicca

Pulmonary embolism

Use of anticoagulants

Pulmonary vasculitis

Mitral stenosis

Dynamic auscultation in Respiratory System

 Dynamic auscultation is listening to breath sounds while the patient performs specific maneuvers (like deep breathing, coughing, forced expiration, or posture change) to reveal abnormal findings not heard during quiet breathing.

1. Forced expiratory auscultation

• Ask patient to blow out forcefully

         Example: Wheeze appears → Asthma, COPD

2. Post-tussive auscultation (after cough)

• Ask patient to cough, then listen again

         Example: Crackles disappear/change → secretions (Bronchiectasis)

Persistent crackles → Pneumonia

3. Deep inspiration auscultation

• Ask patient to take slow deep breaths

Example: Late inspiratory crackles → Pulmonary fibrosis

4.Mouth open vs closed breathing

• Compare breathing with mouth open vs closed

Example: Sound changes/stridor → upper airway obstruction

5.Postural (position) change auscultation

• Listen in sitting vs lying position

Example: Shifting findings → Pleural effusion

spurious and pseudo hemoptysis

Spurious hemoptysis

Spurious hemoptysis means there is real blood in the sputum, but it comes from the upper respiratory tract (above the larynx), such as from an upper‑airway infection, epistaxis, or gingival bleeding, rather than from the lungs or bronchi.

The blood is genuinely present under the microscope, but the source is not the lower respiratory tract (below the glottis).

Pseudo‑hemoptysis

Pseudo‑hemoptysis (or pseudohemoptysis) refers to blood‑like sputum that may look like blood but sometimes does not actually contain blood cells; for example, red pigment (prodigiosin) from Serratia marcescens infection can stain sputum red without true bleeding.

It can also include situations where blood is aspirated from the upper aerodigestive or gastrointestinal tract (e.g., hematemesis aspirated into the lungs) and then expectorated, so the bleeding source is extrapulmonary

kilip classification

Heart failure and predict mortality in patients with acute myocardial infarction (AMI), especially in the first 24–48 hours. 

Killip classes (I–IV)

Class I: No clinical evidence of heart failure.

Vital signs and physical exam are normal; no pulmonary rales, no S₃, no jugular venous distension. 

Class II: Mild to moderate left‑ventricular (LV) failure.

Rales/crackles in the lungs, S₃ gallop, elevated jugular venous pressure, or combination

Class III: Severe LV failure – acute pulmonary edema.

Frank pulmonary edema with marked dyspnea, frothy sputum, diffuse rales; oxygenation is impaired. 

Class IV: Cardiogenic shock.

Hypotension (systolic BP ≤90 mmHg), tachycardia, cold clammy skin, oliguria, and evidence of peripheral hypoperfusion; often with pulmonary edema. 

Higher the class , there increased risk or short term mortality 

Post TB sequelae

 -Airway-related

Bronchiectasis

Bronchial stenosis / stricture

Tracheobronchomalacia

-Parenchymal (lung tissue)

Fibrosis (fibro-cavitary disease)

Destroyed lung

Residual cavities

-Pleural

Pleural thickening

Fibrothorax

-Vascular

Pulmonary hypertension

Rasmussen aneurysm (pulmonary artery aneurysm in cavity wall)

-Infective / colonization

Aspergilloma (fungal ball)

Functional consequence

Chronic respiratory failure / COPD-like picture

Aggravating factors of cough

PDFCE 

Pollution, Pollen, Posture

Drugs, Diurnal, Dry air

Food

Cold weather, Common cold

Exercise

Aggravating factors of cough

PDFCE 

Pollution, Pollen, Posture

Drugs, Diurnal, Dry air

Food

Cold weather, Common cold

Exercise

Tidal percussion on the left side

 Tidal percussion is a clinical percussion technique used to detect early splenomegaly by observing changes in percussion note during respiration.

Site

Over Traube's space. Typically along the left mid-axillary line

Boundaries of Traube’s Space

Superior: Left 6th rib

Inferior: Left costal margin

Lateral: Left anterior axillary line

This area overlies the fundus of the stomach (normally tympanic due to air). In splenomegaly, this area becomes dull → basis of tidal percussion.

Technique 

Patient lies supine

Start percussion over Traube’s space (normally tympanic)

Ask patient to take a deep inspiration

Continue percussion during breathing

 - Interpretation

Normal:

Remains tympanic during inspiration

Positive tidal percussion:

Tympany → dullness on inspiration

Indicates splenic enlargement (spleen descends and occupies the space)

 Mechanism

During inspiration, the diaphragm descends

Enlarged spleen moves inferiorly & anteriorly

Replaces air-filled stomach → dull note