respiratory system examination

Respiratory System

Examination

By Dr. Walid G. Babikr

MRCPI


Introduction

• Diseases of the respiratory system account for a third of deaths in most countries.

• Accounts for a major proportion of visits and time a way from work and school.

• Key to success is clear and carefully recorded history.

• Symptoms range from trivial to extremely distressing


The History

• Most patients with respiratory disease

will present with one or more of the

following symptoms:

• BREATHLESSNESS

Breathlessness inappropriate to the

level of physical exertion is called

‘dyspnea’


• What is the mechanism of dyspnea ?

• People with cardiac disease may become dysnpneic as well.

• Is the dyspnea related only to exertion?

• How far can the patient walk without feeling short of breath?

• Is there variability of symptoms?

• Variable airway obstruction due to asthma is very often worse at night and in the early morning.


Cough

• May be dry or productive of sputum.

• How long has the cough been present?

• Is the cough worse at any time of day

or night?

• Is the cough aggravated by any thing

e.g.. dust, pollen or cold air?


SPUTUM

• Is sputum produced?

• Ask for a description of its color and

consistency.

• How much is produced?


HEMOPTESIS• Means the coughing of blood in the

sputum.

• Careful evaluation is mandatory.

• Ask specifically about it ‘Is there any blood in the sputum?’

• Is it fresh or altered blood?

• How often has it been seen and for how long? Any associated conditions e.g.. epistaxis


WHEEZING

• Always ask whether the patient hears

any noises coming from his chest.

• Sometimes it will have been noticed by

others but not by he patient.

• Strider may sometimes be mistaken as

wheezes ‘by both patient and doctor'.

This is serious finding indicates

narrowing of the larynx, trachea or

main bronchi.


CHEST PAIN

• Can be musculoskeletal caused by

bouts of cough.

• Chest pain caused by lung disease

usually arises from the pleura ’a sharp

or stabbing pain and is made worse by

deep breathing and coughing.


OTHER SYMPTOMS

• Ear, nose and throat

Is there any recurrent sinusitis-may be

linked with asthma or less commonly

with bronchiectasis.

• Is there any change in the voice? This

may indicate involvement of the left

recurrent laryngeal nerve by a

carcinoma of the lung.


THE SMOKING HISTORY

• Always take a full smoking history-be sympathetic and non condemnatory.

• Advise for stopping smoking should be left at the end ..not at the spot.

• Simply asking do you smoke? is not enough.


respiratory system examination

Health & Medicine