dyspnea aggregating factors

Common aggravating factors:

Physical exertion, like walking or climbing stairs.

Supine position, especially if orthopnea is present

Environmental triggers, such as smoke, dust, pollution, cold air, or allergens.

Respiratory infections or worsening bronchospasm.

Anxiety or panic, which can intensify the sensation of breathlessness.

Anemia

obesity, and poor fitness, which can reduce exercise tolerance and worsen symptoms 

CNS - Cardinal symptoms

Cardinal symptoms of CNS

1. Syncope

2.Dizziness

3.vertigo

4.Fatigue

5.Muscke weakness and paralysis

6.numbness

7.Tingling sensation 

8.sensory loss

9.Gait disorder 

10.Imbalance and fall

11.confusion

12.delirium

13.coma

14.dementia

15.aphasia, dysarthria

16.memory loss

17.headache

18.sleep disorders.

Hantavirus pulmonary syndrome

Hantavirus Pulmonary Syndrome (HPS) is an acute febrile illness (i.e., temperature greater than 101.0 F [greater than 38.3 C]) with a prodrome consisting of fever, chills, myalgia, headache, and gastrointestinal symptoms,and one or more of the following clinical features: Bilateral diffuse interstitial edema, or

- Clinical diagnosis of acute respiratory distress syndrome (ARDS), or

- Radiographic evidence of noncardiogenic pulmonary edema, or

- An unexplained respiratory illness resulting in death, and includes an autopsy examination demonstrating noncardiogenic pulmonary edema without an identifiable cause, or

- Healthcare record with a diagnosis of hantavirus pulmonary syndrome, or

- Death certificate lists hantavirus pulmonary syndrome as a cause of death or a significant condition contributing to death

Laboratory Criteria For Diagnosis

- Detection of hantavirus-specific immunoglobulin M or rising titers of hantavirus-specific immunoglobulin G, or

- Detection of hantavirus-specific ribonucleic acid in clinical specimens, or

- Detection of hantavirus antigen by immunohistochemistry in lung biopsy or autopsy tissues

Pleuritic chest pain - features

 Pleuritic Chest Pain — Classical Features

Pleuritic chest pain is pain arising from irritation/inflammation of the parietal pleura. It has a characteristic clinical profile:

Key Features

Sharp, stabbing pain

Often described as “knife-like” or “catching”

Worsens with respiration

Increased by:

Deep inspiration

Coughing

Sneezing

Yawning

Laughing

Localized pain

Patient can often point with one finger to the painful area

Sudden onset is common

Especially in conditions like pneumothorax or pulmonary embolism

Reduced by shallow breathing / splinting

Patients avoid deep breaths because of pain

May radiate

To shoulder or neck if diaphragmatic pleura involved (via phrenic nerve)

Associated pleural rub

A scratching/grating sound on auscultation in pleuritis

Subpulmonic effusion -Radiological sign

Radiological Signs (Erect Chest X-ray):

1.Pseudodiaphragm Appearance: The dome of the diaphragm appears elevated, often creating a smooth, "flatter" contour.

2.Lateral Diaphragmatic Peak: The peak of the diaphragm is displaced laterally rather than being in the middle, creating a "hump".

3.Increased Left Lung-Gastric Bubble Distance: On the left side, the distance between the lung base and the stomach bubble (air-fluid interface) is increased, usually > 2cm

SURFACE ANATOMY

Apex: lung apex and pleural cupola extend about 2–3 cm above the medial third of the clavicle into the root of the neck. 

Anterior margin (right): follows the right side of the sternum from about the 2nd to the 4th costal cartilages then slopes laterally to reach the 6th right costal cartilage. 

Anterior margin (left): similar but deviates laterally to form the cardiac notch and reaches approximately 3 cm lateral to the left sternal edge at the upper margin of the 6th costal cartilage (the cardiac notch produces the lingula). 

Inferior margins (costal landmark lines)

Mid-clavicular line: inferior border of lung at 6th rib (pleural reflection ~2 ribs lower). 

Mid-axillary line: inferior border of lung at 8th rib. 

Posteriorly (paravertebral): inferior border reaches roughly the 10th rib/vertebral level. 

Note: the parietal pleura extends ~2 ribs lower than the lung at these points, creating the costodiaphragmatic recess. 

miliary tb ct finding

Nodule size and number: Numerous micronodules usually 1–3 mm (sometimes up to ~4–5 mm) and often too many to count. 

Distribution: Random (hematogenous) distribution with no centrilobular clustering or polygonal secondary-lobule pattern; nodules are bilateral and diffuse across all lung zones (may show mild basilar predominance acutely and mild upper-zone predominance chronically). 

Margins and background: Nodules often sharply marginated but can be ill-defined; ground-glass attenuation or interlobular septal thickening/reticular change may be present superimposed on the nodules. 

Pulsus paradoxus

Paradoxical pulse refers to an inspiratory decline in systolic pressure greater than 10 mmHg. In normal circumstances, inspiration results in an increase in venous return as blood is ‘sucked into’ the thorax by the decline in intrathoracic pressure. This increases right ventricular stroke volume, but left ventricular stroke volume falls slightly (ventricular interdependence). When the heart is constrained in a ‘fixed box’ by a pericardial effusion (cardiac tamponade) or by thickened pericardium (pericardial constriction), the increased inspiratory right ventricular blood volume reduces left ventricular compliance, resulting in a more pronounced reduction in left ventricular filling stroke volume and systolic blood pressure during inspiration. ‘Pulsus paradoxus’ therefore represents an exaggeration of the normal inspiratory decline in systolic pressure and is not truly paradoxical. Pulsus paradoxus in acute severe asthma is thought to be due to negative pleural pressure increasing afterload and thereby impedance to left ventricular emptying. It is measured by inflating a blood pressure cuff until no sounds are heard. The pressure is then slowly decreased until systolic sounds are first heard during expiration but not during inspiration – note this reading. The pressure is slowly decreased further until sounds are heard throughout the respiratory cycle (inspiration and expiration) – note this second reading. If the pressure difference between the two readings is >10 mmHg, it can be classified as pulsus paradoxus. 

Ref- Hutchison's 24E

CARDINAL SYMPTOMS OF GASTROINTESTINAL SYSTEM

1. Dysphagia and odynophagia
2. Heartburn and reflux
3. Indigestion
4. Flatulence
5. Vomiting
6. Anorexia
7. Constipation
8. Diarrhoea
9. Alteration of bowel pattern
10. Abdominal pain
11. Abdominal distension
12. Weight loss
13. Haematemesis
14. Rectal bleeding
15. Melaena
16. Jaundice
17. Itching
18. Urinary symptoms

Ref- Hutchison's clinical methods 24E

What is pulsus paradoxus and what are its respiratory causes?

 Pulsus paradoxus is an exaggerated fall in systolic blood pressure during inspiration.

Normally during inspiration, systolic BP falls slightly (≤10 mmHg).

In pulsus paradoxus, the fall is >10 mmHg.

Despite the name, there is no true paradox. The “paradox” refers to the fact that:

Heart sounds may still be heard,

But the peripheral pulse becomes weak or disappears during inspiration.

Mechanism

During inspiration:

More venous blood enters the right ventricle.

In conditions with limited cardiac space/filling (e.g., tamponade), the RV expands at the expense of the LV.

LV filling decreases → stroke volume falls → systolic BP drops markedly.

Conditions causing pulsus paradoxus

Cardiac causes

Cardiac tamponade (classic)

Constrictive pericarditis (less common)

Severe heart failure

Respiratory causes

Severe asthma

Severe COPD exacerbation

Tension pneumothorax

Massive pulmonary embolism