Foul smelling sputum

 Foul smelling sputum suggests anaerobic bacterial infection.

It occurs in Bronchiectasis,lung abscess and empyema.

In Bronchiectasis a change of sputum taste may indicate infective exacerbation.

REF- Macleod's , page no- 141,13th edition 

Diseases associated with cattles

 Brucellosis

Bovine Tb

Q fever

Rabies

Prion diseases

 NYHA CLASSIFICATION OF BREATHING DIFFICULTY

CLASS                                              SYMPTOMS

CLASS 1                        No limitation of physical activity, Ordinary physical activity does not cause                                                  undue fatigue, palpitations or breathing difficulty

CLASS 2                        Slight limitation of physical activity. Comfortable at rest but Ordinary physical                                              activity cause  undue fatigue, palpitations or breathing difficulty

CLASS 3                       Marked limitation of physical activity. Less than ordinary activities cause fatigue,                                         palpitations and breathing difficulty

CLASS 4                       Unable to carry out any physical activity without discomfort. Symptoms are                                                 present even at rest.

Fever Patterns

 Sustained/Continuous fever:Persistent rise in temperature with minimal(<1C)diurnal variation.eg- Pneumonia, meningitis,UTI,brucella

Intermittent fever: Exaggeration of normal circadian rhythm.If the variation between high and low is extremely large it is called hectic.eg-Deep seated infection,abscesses,malignancy,kala-azar,drug fever.

Remittent fever: Temperature spikes fall daily with diurnal variation of >2 degree celsius,but doesn't touches baseline.eg-Tuberculosis,infective endocarditis,

Relapsing fever:Febrile episodes seperated by intervals of normal temperature .eg-malaria,borrelia,lymphoma.

If it occurs daily,it is called quotidian fever.cause- plasmodium falciparum.

Double quotidian fever when there are 2 spikes of fever everyday,once in morning and once in evening.causes-miliary tuberculosis 

If it occurs every 48 hrs- tertian fever.causes-plasmodium falciparum,ovale and vivax.

If it occurs every 72 hrs- quartan fever.cause-plasmodium malariae.

Inverse fever -Temperature rises in the early hours of morning rather than evening.some cases of  military tuberculosis

REFERENCE -HUTCHISON'S 24th edition,Page no-144.

Causes of PND & Orthopnea

 Causes of PND: 

Left ventricular failure 

Mitral stenosis 

Causes of Orthopnea:

Pulmonary edema

Sleep apnea

Hypothyroidism

Copd 

Ascites 

Pleural effusion

Anxiety 

Definition of emphysema

 Abnormal permanent dilatation of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls and without obvious fibrosis.

Periorbital edema in renal disease

  In acute or chronic renal failure, periorbital edema occurs ,when Na intake exceeds kidneys’ ability to excrete Na secondary to marked reductions in glomerular filtration.Sodium retention causes periorbital edema.

Referrence- Harrison 20th edition

Chronic Bronchitis and Emphysema

 Chronic Bronchitis is defined as cough and sputum for atleast 3 consecutive months in each of 2 consecutive years.

Emphysema is abnormal permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls.

Refference -Robbin's pathology.

Eosinophilic bronchitis - BHR

 Bronchial hyperreactivity is absent in Eosinophilic bronchitis and is present in asthma

Reference: Murray and Nadel’s textbook of respiratory medicine, 7th edition