EXAMINATION OF RESPIRATORY SYSTEM

HISTORY TAKING IN RESPIRATORY CASE

COUGH DYSPNEA HEMOPTYSIS CHEST PAIN

COUGH:Cough is a major defensive mechanism which helps clear off respiratory pathogens.

Acute/Chronic cough(>3 wks duration)Expectorant/Dry coughH/o exposure to allergensAcute cough : URTI along with fever&cold Aspiration, Pulmonary embolism pulmonary edema

Chronic cough:Chronic bronchitis(smokers)Asthma,GERDDrugs like ACE inhibitorsSinusitis,malignancy Absence of cough:Early post operative periodNeuromuscular diseases

Complications of cough:Cough syncope, Bronchospasm, Urinary incontinence,Conjunctival haemorrhage

Dry coughDrug induced ACE inhibitorsallergensExpectorationBlack-SmokersBrown-

puemonia,pneumococciGreen/yellowish-infection Pink frothy-P. edemaBloody –TB,bronchiectasis malignancy,

Types of cough:Bovine cough-RLN palsyBarking cough-epiglotitisStaccato cough-Paroxysmal cough-pertussisStridor- laryngotracheo -

bronchitis

DYSPNEA:SHORTNESS OF BREATH

Acute/chronicPosition:PND,orthopneaExertionAcute dyspnea:Asthma,pneumothorax,Pulmonary edema,ARDSPulmonary emboliPulmonary infectionsChronic dyspnea:COPD,ILD,asthma,CCF.

Grades of Dyspnea:1-No dyspnea on normal

activity2-Dyspnea on more than normal activity but comfortable at rest3-Dyspnea on minimal activity,comfortable only at rest4-Dyspnea on less than minimal activity

HEMPOTYSISExpectoration of blood from below vocal cords

MILD,MODERATE,MASSIVE1.Airways: Chronic bronchitis,Bronchiectasis,Bronchogenic carcinoma2.Pulmonary vasculature: LVF,MS,Pulmonary emboli,AVmalformations.3.Pulmonary parenchyma: pnuemonia,cocaine inhalation,Good pasteur’s syndrome, Wegener’s granulomatosis.4.Iatrogenic : following lung biopsies,Anticoagulation.

PMH:H/o freequent lung infections,Allergies,exposure to toxic agentsOccupational history:exposur to specific agents as in ILD’s like asbestosis,silicosis

General physical examination – ill ( pneumonia), cachectic, in respiratory distress, stridor Hands – clubbing in respiratory disease from cancer –

non small cell bronchial carcinoma, chronic inflammation e.g. bronchiectasis, lung abscess, fibrosis

Wasting of the intrinsic muscle of the hand suggest T1 lesions e.g. pancoast tumor, wrist tenderness suggests hypertrophic osteoarthropathy from lung cancer

Colour – peripheral cyanosis, Asterixis is a CO2 retention flap, pulsus paradoxus is

weakened pulse in inspiration.eg severe asthma Face – ptosis and constricted pupil from horners

syndrome, with pancoast tumor – cervical sympathetic plexus and brachial plexus. colour – are tongue/lips blue/purplish from central cyanosis

INSPECTION OF RESPIRATORY SYSTEM

Respiratory patternChest wall symmetryLook for any abnormal shapeLike Barrel shaped chestPectus carinatum(pigeon’s)Pectus excavatum(funnel’s)Kypho-scoliosis

Lung and Pleural reflections:

Diagramatic representation of abnormal breath sounds

PALPATION IN RESPIRATORY CASE:

Position of trachea,tracheal tugChest expansionTactile fremitusHere vibrations of the sounds are felt onto the chestWall as the sound waves are conducted throughthe air in the bronchi,bronchioles,alveoli, chest wallCompare the strengths of these vibrations on either side of Chest-front,back,over apical, middle and basal zones.Increased TF:Pneumonic consolidationDecreased TF:pleural effusion,collapse

PALPATIONOF CHEST WALL FOR EXPANSION AND TACTILE FREMITUS

PERCUSSION OF CHEST:Normal chest is resonant on percussion

Percussion must be done in all lung zones,including the anterior aspects of lungs above clavicle.Anything solid in pleural space or in lung parenchyma decreases this resonance ,causing dullness on percussionAny extra air in either pleural space or in the lung substance will cause increase in sound resonance -hyperresonance

Percussion notes in different conditions:

Difference B/W

AUSCULTATION OF CHESTNormal sounds of breathing consists of an inspiratory phasefollowed by a shorter,softer,expiratory phase with no gap.This is called the normal vesicular breathing

TYPES OF BREATHINGVesicularBronchialBronchovesicular

Added soundsWheeze-high pitched, muscial,

air through narrowed tubes.

Asthma,COPDCrackles- fine, medium,

coarse. Not cleared by coughing as in

Pulmonary edemaCrepitations-consolidationPleural rub- crackly,grating,dry

low pitched, machine-like in

Plueritis

AUSCULTATORY ZONES OF LUNG:

RESPIRATORY SOUNDS

TAKE A GUESS!

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