General symptoms and signs of hypoxia (Intoxicatio et febris)
General complaints often come to the forefront in respiratory diseases. Intoxication syndrome includes decreased appetite, weight loss, and characteristic nocturnal hyperhidrosis. A specific localization of this sweating is the upper half of the torso and the scalp.
The type of fever directly depends on the pathological process:
- Acute pneumonia presents with persistent low-grade or high-grade fever.
- Purulent destructive processes (pleural empyema, lung destruction) cause a debilitating (hectic) type of fever with massive daily temperature fluctuations.
If hypoxia joins the intoxication, the patient may complain of hand tremors, and in cases of severe oxygen deprivation, seizures develop.
Details of the history of present illness (Anamnesis morbi)
When inquiring about the development of the disease, the physician uses a clear algorithm: clarifies the chronology, features of the onset, presence of relapses (and their triggers), effectiveness of past treatment, and the appearance of complications.
The features of the initial period are of paramount differential diagnostic significance:
- Viral pneumonia begins with a prodromal period (fever, malaise, chills a few days before the onset of pulmonary symptoms).
- Pneumococcal (lobar) pneumonia starts acutely and suddenly: general and respiratory symptoms appear almost simultaneously.
Sudden severe dyspnea is assessed separately. Its acute nature requires the immediate exclusion of severe and emergency conditions: an asthma attack, pneumothorax, or acute respiratory failure.
Etiological search: environmental and iatrogenic factors
The search for the cause of pathology is impossible without assessing the patient's environment and occupation:
- Occupational hazards: prolonged contact with inorganic dust (silicon dioxide, aluminum, talc, asbestos, iron) leads to the development of pneumoconiosis.
- Exogenous allergic alveolitis: triggered by contact with organic products. Risk groups include people working with birds, raw grain, and moldy hay (forming conditions such as "bird fancier's lung", "farmer's lung", "cheese-washer's lung").
- Drug history: medications can damage lung tissue. The intake of amiodarone, cytostatics, nitrofurans, or radiation therapy causes diffuse lung changes. The use of acetylsalicylic acid and other NSAIDs can trigger bronchial obstruction ("aspirin-induced asthma").
Life history (Anamnesis vitae) and heredity
In the family history (Heredity), the physician looks for genetic pathologies (cystic fibrosis, $\alpha_1$-antitrypsin deficiency), predisposition to bronchial asthma or bronchiectasis, as well as infectious contacts (especially the presence of tuberculosis patients in the family).
A key risk factor is smoking. The physician must clarify the smoking history and the number of cigarettes (pack-years index). Smoking is associated with COPD, emphysema, chronic "smoker's bronchitis", and bronchogenic carcinoma (the incidence of which is increasing among women). Alcohol abuse drastically worsens the prognosis of infections, increasing the risk of abscessing pneumonia even in young patients.
Allergological history focuses on triggers of bronchospasm, angioedema, or urticaria (food, odors). Special attention is paid to drug intolerance, particularly vitamins and antibiotics, which is critical for treatment selection.
In the late stages of chronic pulmonary diseases, cor pulmonale syndrome develops. Due to persistent pulmonary hypertension, right ventricular failure occurs. It manifests with lower extremity edema and pain in the right upper quadrant (due to rapid venous congestion, the liver enlarges and its Glisson's capsule becomes overstretched).
Clinical case: course of lobar pneumonia
The dynamics of acute pathology is well illustrated by lobar pneumonia (e.g., right-sided lower lobe pneumonia). The disease begins with a sharp temperature spike up to 39 °C, chills, and pleural chest pain aggravated by inspiration. Cough, tachypnea (respiratory rate up to 26 per minute), tachycardia, and severe weakness join.
Objective examination reveals skin hyperemia, mild cyanosis of the lips and nose, and lagging of the right hemithorax during breathing. Palpation shows increased vocal fremitus, percussion reveals a dull-tympanic sound. Auscultation reveals indistinct crepitus (crepitatio indux). Blood tests show marked leukocytosis with a left shift (increase in immature and band forms) and an elevated ESR.
Against the background of penicillin therapy, by the 9th–11th day, lysis (gradual decrease) of temperature and normalization of parameters occur. However, a severe course is possible — crisis (turning point of the disease). In this case, on the 11th day, high fever ($39^\circ$C) with severe respiratory failure and pathognomonic "rusty" sputum sharply drops to subfebrile figures ($37.7^\circ$C). This critical decrease is often accompanied by a collapse-like state — a sharp drop in blood pressure down to 80/40 mm Hg.
To remember the causes of exogenous allergic alveolitis, think of a "rural farm": it has hay ("farmer's lung"), birds ("bird fancier's lung"), and cheese ("cheese-washer's lung") — all of which involve contact with organic matter.
Class and exam questions
Why does the right upper quadrant hurt in cor pulmonale?
Due to pulmonary hypertension, right ventricular failure develops. Blood stagnates in the systemic circulation, the liver rapidly increases in size (hepatomegaly), and its Glisson's capsule becomes overstretched, causing pain.
What is the difference between the onset of viral and lobar pneumonia?
Viral pneumonia has a prodromal period (malaise and fever appear a few days before the cough). Lobar pneumonia starts suddenly: pulmonary and general symptoms occur simultaneously.
Which drugs can cause diffuse changes in the lungs?
Such iatrogenic factors include cytostatics, nitrofurans, and amiodarone (and its analogs). Radiation therapy also provokes such changes.
What else to study on this topic
- Mechanisms of pulmonary hypertension development
- Physical findings in lung tissue consolidation syndrome
- Differential diagnosis of sputum types
- Assessment of the smoking index (pack-years)
Master the entire topic in the "Propaedeutics" course
This is a summary. The course covers everything tested in classes and exams.
- Full guide on "History taking in respiratory system diseases" and 3,152 other pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 113 video lessons on the subject
Other topics in the "Respiratory System" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.