symtoms and signs of the respiratory system m.abbas

8/14/2019 Symtoms and Signs of the Respiratory System M.abbaS

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Symptoms andSymptoms andsigns of thesigns of the

respiratory systemrespiratory system

M.AbbasM.Abbas


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Symptoms of theSymptoms of the

respiratory systemrespiratory system Symptoms of the respiratory tractSymptoms of the respiratory tract

Other presenting symptomsOther presenting symptoms

Treatment (DH)Treatment (DH)

History of previous illnessHistory of previous illness

Occupational historyOccupational history Social historySocial history

Family historyFamily history


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The six principalThe six principal

symptoms of thesymptoms of the

respiratory tractrespiratory tract CoughCough

SputumSputum

HaemoptysisHaemoptysis

DyspneaDyspnea

Chest painChest pain WheezeWheeze


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CoughCough

Cough is a commonCough is a common

presenting respiratorypresenting respiratory

symptom.symptom. It occurs when deepIt occurs when deep

inspiration is followed byinspiration is followed by

explosive expiration.explosive expiration. Coughing enables the airwaysCoughing enables the airways

to be cleared of secretionsto be cleared of secretions

and foreign bodies.and foreign bodies.


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Cough that wakes a patient fromCough that wakes a patient from

sleep may be a symptom ofsleep may be a symptom of

cardiac failure or of the reflux ofcardiac failure or of the reflux ofacid from the oesophagus into theacid from the oesophagus into the

lungs that can occur when alungs that can occur when a

person lies down.person lies down.


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A change in the character of aA change in the character of a

chronic cough may indicate thechronic cough may indicate the

development of a new anddevelopment of a new andserious underlying problem (e.g.serious underlying problem (e.g.

infection or lung cancer).infection or lung cancer).


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A cough associated withA cough associated with

inflammation of the epiglottisinflammation of the epiglottis

may have a barking quality.may have a barking quality. Cough caused by trachealCough caused by tracheal

compression by a tumour may becompression by a tumour may be

loud and brassyloud and brassy


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Cough associated with recurrentCough associated with recurrent

laryngeal nerve palsy has a hollowlaryngeal nerve palsy has a hollow

sound because the vocal cords aresound because the vocal cords areunable to close completely; this hasunable to close completely; this has

been described as a bovine cough.been described as a bovine cough.

A cough that is worse at night isA cough that is worse at night is

suggestive of asthma or heart failure,suggestive of asthma or heart failure,while coughing that comes onwhile coughing that comes on

immediately after eating or drinkingimmediately after eating or drinking

may be due to a tracheo-oesophagealmay be due to a tracheo-oesophageal

fistula or oesophageal reflux.fistula or oesophageal reflux.


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DurationDuration

Dry/productiveDry/productive

Aggravating factors (dust, cold)Aggravating factors (dust, cold)

Painless/painfulPainless/painful


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DurationDuration

Acute coughAcute cough

Chronic coughChronic cough


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Acute coughAcute cough

Duration less than 3 weeksDuration less than 3 weeks


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CausesCauses

Acute bronchitisAcute bronchitis

Acute tracheitisAcute tracheitis

Acute laryngitisAcute laryngitis

PneumoniaPneumonia


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Chronic coughChronic cough

Duration more than 3 weeksDuration more than 3 weeks


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CausesCauses

Bronchial asthmaBronchial asthma

Chronic sinusitisChronic sinusitis

Gastro-esophageal refluxGastro-esophageal reflux

Chronic bronchitisChronic bronchitis

BronchiectasisBronchiectasis Fibrosing alveolitisFibrosing alveolitis

Bronchogenic carcinomaBronchogenic carcinoma

ACE inhibitors-drugs used in HTNACE inhibitors-drugs used in HTN


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SputumSputum

When the patient has sputum,When the patient has sputum,

information should be obtained asinformation should be obtained as

toto amountamount,, charactercharacter,, viscosityviscosityandand tastetaste oror odour .odour .


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AmountAmount

This can seldom be accuratelyThis can seldom be accurately

estimated by the patient althoughestimated by the patient although

statement that it is very largestatement that it is very large(e.g. a teacupful per day) or very(e.g. a teacupful per day) or very

small (one or two spits per day)small (one or two spits per day)

are usually reliable .are usually reliable .


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If it is important to obtain preciseIf it is important to obtain precise

information about the amount ofinformation about the amount of

sputum, the patient should besputum, the patient should begiven a graduated container andgiven a graduated container and

a 24-hour collection measured .a 24-hour collection measured .


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BronchorrhoeaBronchorrhoea

Volumes of sputum in excess ofVolumes of sputum in excess of

100 ml per day are arbitrarily100 ml per day are arbitrarily

defined as bronchorrhoeadefined as bronchorrhoea


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CausesCauses

BronchiectasisBronchiectasis

Chronic bronchitisChronic bronchitis

Invasive aspergillosisInvasive aspergillosis

Lung cancer : alveolar cellLung cancer : alveolar cell

carcinomacarcinoma


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CharacterCharacter

SerousSerous

MucoidMucoid

PurulentPurulent

MucopurulentMucopurulent


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Serous sputumSerous sputum

Usually described by patients asUsually described by patients as

clear and/or frothy, as seen inclear and/or frothy, as seen in

acute pulmonary edema, in whichacute pulmonary edema, in whichit may acquire a pink colourit may acquire a pink colour

through admixture with red bloodthrough admixture with red blood

cells, and in the rare condition ofcells, and in the rare condition ofalveolar cell carcinoma .alveolar cell carcinoma .


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Mucoid sputumMucoid sputum

Characteristic feature of chronicCharacteristic feature of chronic

bronchitis, is usually described bybronchitis, is usually described by

the patients as grey, clear orthe patients as grey, clear orsometimes black (when itsometimes black (when it

contains soot particles)contains soot particles)


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Purulent andPurulent and

mucopurulenrt sputummucopurulenrt sputum Usually described as yellow orUsually described as yellow or

green .green .


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ViscosityViscosity

Mucoid sputum is often moreMucoid sputum is often more

viscous than purulent sputum andviscous than purulent sputum and

for that reason is often morefor that reason is often moredifficult to cough up .difficult to cough up .


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Taste or odourTaste or odour

When this is described as nastyWhen this is described as nasty

the patient may merely bethe patient may merely be

referring to the normal taste ofreferring to the normal taste ofpurulent sputum .purulent sputum .


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Only when terms such asOnly when terms such as

offensive, nauseating are usedoffensive, nauseating are used

can it be assumed that thecan it be assumed that thesputum is fetidsputum is fetid


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Lung abscess with anaerobicLung abscess with anaerobic

organisms (organisms (Foul-smelling dark-Foul-smelling dark-

coloured sputumcoloured sputum)) Bronchiectasis(Bronchiectasis(a large volume ofa large volume of

purulent (yellow or green)purulent (yellow or green)

sputumsputum))


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Is coughing up of bloodIs coughing up of blood

The blood is bright red at first butThe blood is bright red at first but

may latter become dark red .may latter become dark red . It is often frothy .It is often frothy .

Ranges from blood-stainedRanges from blood-stained

sputum to frank haemoptysissputum to frank haemoptysis


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Blood-stained sputum, in whichBlood-stained sputum, in which

the blood and sputum arethe blood and sputum are

intimately mixed in variousintimately mixed in variousproportions .proportions .

Frank haemoptysis, in which theFrank haemoptysis, in which the

material coughed up containsmaterial coughed up containswholly blood .wholly blood .

Haemoptysis can be a sinisterHaemoptysis can be a sinister

sign of lung disease and mustsign of lung disease and must


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It is best to rely on the patient'sIt is best to rely on the patient's

assessment of the taste of theassessment of the taste of the

sputum, which, not unexpectedly,sputum, which, not unexpectedly,is foul in conditions likeis foul in conditions like

bronchiectasis or lung abscessbronchiectasis or lung abscess

Should be differentiated from :Should be differentiated from :* Haematemesis* Haematemesis

* Bleeding from the U.R.T* Bleeding from the U.R.T


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* Respiratory symptoms* Respiratory symptoms

* Usually frothy* Usually frothy

* Alkaline* Alkaline


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HaematemesisHaematemesis

* G.I.T symptoms* G.I.T symptoms

* Coffee-ground* Coffee-ground

* Acidic* Acidic


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Bleeding from theBleeding from the

U.R.TU.R.T On occasion blood from the noseOn occasion blood from the nose

or throat is inhaled; coughed andor throat is inhaled; coughed and

expectorated .expectorated . When there is doubt as to theWhen there is doubt as to the

source of bleeding, the patientsource of bleeding, the patient

should assumed to have lungshould assumed to have lungdisease and should be manageddisease and should be managed

accordingly .accordingly .


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Questions to be askedQuestions to be asked

Type : blood-stained/frankType : blood-stained/frank

haemoptysishaemoptysis

AmountAmount DurationDuration


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Frank haemoptysisFrank haemoptysis

Minor : less than 50 ml/dayMinor : less than 50 ml/day

Moderate : 50-200 ml/dayModerate : 50-200 ml/day

Massive :Massive : > 200 ml/day> 200 ml/day


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CausesCauses

InfectionsInfections


TumorsTumors

Pulmonary embolismPulmonary embolism

Coagulation disordersCoagulation disorders


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Vascular abnormalities (A.V.Vascular abnormalities (A.V.

malformation) .malformation) .

Mitral stenosis(Mitral stenosis(severesevere).). Diffuse alveolar haemorrhage.Diffuse alveolar haemorrhage.


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InfectionsInfections

Bacterial pneumoniasBacterial pneumonias

Pulmonary tuberculosisPulmonary tuberculosis

Lung abscessLung abscess

AspergillomaAspergilloma

Acute or chronic bronchitisAcute or chronic bronchitis


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Bacterial pneumoniasBacterial pneumonias

The sputum is usually blood-The sputum is usually blood-

stained, and mixed with pus .stained, and mixed with pus .

Frank haemoptysis is uncommon,Frank haemoptysis is uncommon,except in :except in :


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Massive haemoptysisMassive haemoptysis

In the majority of patientsIn the majority of patients

massive haemoptysis is causedmassive haemoptysis is caused

by bleeding from the bronchialby bleeding from the bronchialcirculation .circulation .


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CausesCauses

Pulmonary T.BPulmonary T.B


AspergillomaAspergilloma

Lung abscess Lung cancerLung abscess Lung cancer


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othersothers

Acute left ventricular failure.Acute left ventricular failure.

Goodpasture's* syndromeGoodpasture's* syndrome::

pulmonary haemorrhage,pulmonary haemorrhage,glomerulonephritis, antibody toglomerulonephritis, antibody to

basement membrane antigens.basement membrane antigens.

Rupture of a mucosal bloodRupture of a mucosal bloodvessel after vigorous coughingvessel after vigorous coughing

Bleeding diathesesBleeding diatheses


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Chest painChest pain

Upper retrosternal pain (trachealUpper retrosternal pain (tracheal

pain)pain)

Retrosternal pain associated withRetrosternal pain associated withlesions of the mediastinum .lesions of the mediastinum .

Pleuritic chest painPleuritic chest pain


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Tracheal painTracheal pain

Is referred to behind the sternalIs referred to behind the sternal

manubrium .manubrium .

In the early stages of acuteIn the early stages of acutetracheitis it may be quite severetracheitis it may be quite severe

and momentarily intense onand momentarily intense on

coughing but subsides as soon ascoughing but subsides as soon asthe cough becomes productive .the cough becomes productive .


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Lesions of theLesions of the

mediastinummediastinumTumorsTumors

Acute mediastinitisAcute mediastinitis

Mediastinal emphysemaMediastinal emphysema


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This type of pain, which isThis type of pain, which is

uncommon but importantuncommon but important

symptom, has a constrictivesymptom, has a constrictivecharacter similar to that ofcharacter similar to that of

cardiac pain and may radiate tocardiac pain and may radiate to

the arms and neck, but is seldomthe arms and neck, but is seldomsevere and is not related tosevere and is not related to

exertion .exertion .


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Pleuritic chest painPleuritic chest pain

Caused by stretching of inflamedCaused by stretching of inflamedparietal pleura, and occurs in allparietal pleura, and occurs in all

forms of pleurisy .forms of pleurisy . Recognised by its sharp, stabbingRecognised by its sharp, stabbing

character and its relation tocharacter and its relation tobreathing and coughing .breathing and coughing .

It may be present only at the endIt may be present only at the endof deep inspiration .of deep inspiration .


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It may be of sudden onset inIt may be of sudden onset in

patients with lobar pneumonia,patients with lobar pneumonia,

pulmonary embolism andpulmonary embolism andinfarction or pneumothorax, andinfarction or pneumothorax, and

is often associated withis often associated with

dyspnoea.dyspnoea.


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Other presentingOther presenting

symptomssymptoms

It may be of sudden onsetIt may be of sudden onset inin

patients with lobar pneumonia,patients with lobar pneumonia,

pulmonary embolism andpulmonary embolism andinfarction or pneumothorax, andinfarction or pneumothorax, and

is often associated withis often associated with

dyspnoea.dyspnoea. TuberculosisTuberculosis(+ night sweating(+ night sweating),),

pneumonia and mesotheliomapneumonia and mesothelioma

should always be considered inshould always be considered in


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HoarsenessHoarseness may sometimes bemay sometimes be

considered a respiratory systemconsidered a respiratory system

symptom.symptom. It can be due to transientIt can be due to transient

inflammation of the vocal cordsinflammation of the vocal cords

(laryngitis), vocal cord tumour or(laryngitis), vocal cord tumour orrecurrent laryngeal nerve palsy.recurrent laryngeal nerve palsy.


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Sleep apnoeaSleep apnoea is an abnormalis an abnormal

increase in the periodic cessationincrease in the periodic cessation

of breathing during sleep.of breathing during sleep. (a)(a)obstructive sleep apnoea :obstructive sleep apnoea :

where airflow stops during sleepwhere airflow stops during sleep

for periods of at least 10 secondsfor periods of at least 10 secondsand sometimes for over 2and sometimes for over 2

minutes .minutes .


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typically present with daytimetypically present with daytime

somnolence, chronic fatigue,somnolence, chronic fatigue,

morning headaches andmorning headaches andpersonality disturbances & Verypersonality disturbances & Very

loud snoring .loud snoring .

These patients are often obeseThese patients are often obeseand hypertensive.and hypertensive.


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(b)(b) central sleep apnoea :central sleep apnoea :where there is cessation ofwhere there is cessation of

inspiratory muscle activity .inspiratory muscle activity . may also present withmay also present with

somnolence but do not snoresomnolence but do not snore

excessively .excessively .


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Some patients respond to anxietySome patients respond to anxiety

by increasing the rate and depthby increasing the rate and depth

of their breathing. This is calledof their breathing. This is calledhyperventilation & result inhyperventilation & result in

alkalosisalkalosis


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patients C/Opatients C/O

variable dyspnoea;variable dyspnoea;

paraesthesiae of the fingers andparaesthesiae of the fingers andaround the mouth (around the mouth (alkalk).).

light-headedness, chest pain andlight-headedness, chest pain and

a feeling of impending collapsea feeling of impending collapse((alkalk).).


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Treatment (DH)Treatment (DH)

It is important to find out whatIt is important to find out what

drugs the patient is using.drugs the patient is using.

how often they are taken andhow often they are taken andwhether they are inhaled orwhether they are inhaled or

swallowed.swallowed.

patient's previous and currentpatient's previous and currentmedications may give a clue tomedications may give a clue to

the current diagnosis.the current diagnosis.


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Bronchodilators and inhaledBronchodilators and inhaled

steroids are prescribed for chronicsteroids are prescribed for chronic

obstructive pulmonary disease,obstructive pulmonary disease,asthma.asthma.

A patient's increased use ofA patient's increased use of

bronchodilators suggests poorbronchodilators suggests poorcontrol of asthma and the needcontrol of asthma and the need

for review of treatment .for review of treatment .


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Chronic respiratory disease,Chronic respiratory disease,

includingincluding sarcoidosissarcoidosis,,

hypersensitivityhypersensitivity pneumoniaspneumonias andandasthmaasthma, may have been treated, may have been treated

withwith oral steroidsoral steroids..

Oral steroid use may predisposeOral steroid use may predisposeto tuberculosis.to tuberculosis.


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Patients with chronic lungPatients with chronic lung

conditions like cystic fibrosis orconditions like cystic fibrosis or

bronchiectasis will often be verybronchiectasis will often be veryknowledgeable about theirknowledgeable about their

treatment and can describe thetreatment and can describe the

various forms ofvarious forms ofphysiotherapyphysiotherapythat are essential for keepingthat are essential for keeping

their airways clear.their airways clear.

l d lD l d l


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Drugs related to lungDrugs related to lung

diseasedisease

the oral contraceptive pill,(the oral contraceptive pill,(PEPE).).

cytotoxic agents (e.g.cytotoxic agents (e.g.

methotrexate, cyclophosphamide,methotrexate, cyclophosphamide,bleomycin)(bleomycin)(ILDILD).).

beta-blockers or non-steroidalbeta-blockers or non-steroidal

anti-inflammatory drugsanti-inflammatory drugs((bronchospasmbronchospasm))

ACE inhibitors (ACE inhibitors (coughcough).).


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It is not taken orally (It is not taken orally (e.g.e.g.

timolol; beta-blocker eyetimolol; beta-blocker eye

drops fordrops for glaucomaglaucoma).).


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medications may not bemedications may not be

mentioned by the patientmentioned by the patient

because they are illegal (e.g.because they are illegal (e.g.cocainecocaine))

Hi f iHi t f i


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History of previousHistory of previous

illnessillness

TuberculosisTuberculosis

Pneumonia and pleurisyPneumonia and pleurisy

Childhood measles or whoopingChildhood measles or whoopingcoughcough

Chest injuries and operationsChest injuries and operations

AIDS patient bcz (high risk ofAIDS patient bcz (high risk of

developingdeveloping PneumocystisPneumocystis

cariniicarinii pneumonia &pneumonia &TB .TB .


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previous respiratoryprevious respiratory

investigations:investigations: such assuch as

bronchoscopybronchoscopy,, lung biopsylung biopsy andandvideo-assisted thoracoscopyvideo-assisted thoracoscopy..

SpirometrySpirometry,.,.

Many severe asthmatics performMany severe asthmatics performtheir own regular peak flowtheir own regular peak flow

testing.testing.


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Occupational historyOccupational history

Ask about exposure to dusts inAsk about exposure to dusts in

mining industries and factoriesmining industries and factories

((e.g. asbestos, coal, silica, irone.g. asbestos, coal, silica, ironoxide, tin oxide, cotton, beryllium,oxide, tin oxide, cotton, beryllium,

titanium oxide, silver, nitrogentitanium oxide, silver, nitrogen

dioxide, anhydridesdioxide, anhydrides).).


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WorkWork oror householdhousehold exposure toexposure to

animals, including birds, is alsoanimals, including birds, is also

relevant (e.g.relevant (e.g. Q feverQ fever ororpsittacosispsittacosis))

Exposure toExposure to mouldy haymouldy hay,,

humidifiers or air conditionershumidifiers or air conditionersmay also result in lung diseasemay also result in lung disease

(e.g.(e.g. allergic alveolitisallergic alveolitis))


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AsbestosAsbestos exposure can result inexposure can result in

the development ofthe development ofasbestosisasbestosis,,

mesotheliomamesothelioma oror carcinomacarcinoma of theof thelung up to 30 yearslung up to 30 years

later.(factories).later.(factories).

RelativesRelatives of people working withof people working withasbestos may be exposed whenasbestos may be exposed when

handling work clothes.handling work clothes.


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An improvement in symptomsAn improvement in symptoms

over the weekend is a valuableover the weekend is a valuable

clue to the presence ofclue to the presence ofoccupational lung disease,occupational lung disease,

particularlyparticularly occupational asthma .occupational asthma .


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Social historySocial history

AA smoking historysmoking history (COPD & lung(COPD & lung

cancer)cancer)

It also increases the risk ofIt also increases the risk ofspontaneousspontaneous pneumothoraxpneumothorax andand

ofofGoodpasture'sGoodpasture's syndrome.syndrome.


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It is necessary to ask how manyIt is necessary to ask how many

packets of cigarettespackets of cigarettes aa dayday aa

patient has smoked and howpatient has smoked and howmanymany yearsyears the patient hasthe patient has

smoked.smoked.


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Alcohol historyAlcohol history (aspiration(aspiration

pneumonia& pneumococcal orpneumonia& pneumococcal or

Klebsiella pneumonia)Klebsiella pneumonia)


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I.V drug usersI.V drug users are at risk of lungare at risk of lung

abscess.abscess.


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Family historyFamily history

TBTB

AsthmaAsthma

cystic fibrosiscystic fibrosis EmphysemaEmphysema

AlphaAlpha11-antitrypsin deficiency, for-antitrypsin deficiency, for

example, is an inherited disease,example, is an inherited disease,

and carriers are extremelyand carriers are extremely

susceptible to the development ofsusceptible to the development of

em h sema.em h sema.

Examination of theExamination of the


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Examination of theExamination of the

respiratory systemrespiratory system

The external features ofThe external features of

respiratory disease .respiratory disease .

The upper respiratory tractThe upper respiratory tractThe chestThe chest


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The external featuresThe external features

CyanosisCyanosis

The handsThe hands

The neckThe neck


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CyanosisCyanosis

Is bluish colouration of the skinIs bluish colouration of the skin

and mucous membranes .and mucous membranes .

It often difficult to appreciate inIt often difficult to appreciate inartificial light unless quite gross .artificial light unless quite gross .


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ClassificationClassification

CentralCentral

PeripheralPeripheral


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Central cyanosisCentral cyanosis

Is bluish colouration of the skinIs bluish colouration of the skin

and mucous membranes; bestand mucous membranes; best

seen on the lips and under theseen on the lips and under thetongue, and the cyanosedtongue, and the cyanosed

extremities are warm .extremities are warm .


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Due to eitherDue to either

Increased or excessive amount ofIncreased or excessive amount of

reduced Hb in the underlyingreduced Hb in the underlying

capillary blood (decrease in O2capillary blood (decrease in O2saturation) .saturation) .

The presence of abnormal HbThe presence of abnormal Hb

(methemoglobinaemia,(methemoglobinaemia,sulfhaemoglobinemia)sulfhaemoglobinemia)


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Peripheral cyanosisPeripheral cyanosis

Seen only in the extremities; andSeen only in the extremities; and

the cyanosed extremity is cold .the cyanosed extremity is cold .

Is due to slowing of blood flowIs due to slowing of blood flowand abnormally great extractionand abnormally great extraction

of oxygen from normallyof oxygen from normally

saturated arterial bloodsaturated arterial blood


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CausesCauses

Cold exposureCold exposure

ShockShock

Congestive heart failureCongestive heart failure Peripheral vascular diseasePeripheral vascular disease


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The cyanosis of heart failure isThe cyanosis of heart failure is

often of the mixed type, due tooften of the mixed type, due to

both central and peripheralboth central and peripheralcyanosis .cyanosis .


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HandsHands

ClubbingClubbing

Nicotine stainingNicotine staining

Flapping tremorsFlapping tremors


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ClubbingClubbing

Is due to swelling of the terminalIs due to swelling of the terminal

phalanges .phalanges .

Less obviously affects the toesLess obviously affects the toesalso .also .

The swelling is due to interstitialThe swelling is due to interstitial

edema and dilatation of theedema and dilatation of thearterioles and capillaries .arterioles and capillaries .


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The early features of clubbingThe early features of clubbing

compromise loss of the normalcompromise loss of the normal

angle between the nail and nailangle between the nail and nailbed and fluctuation of the nailbed and fluctuation of the nail

bed .bed .


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In extreme cases the terminalIn extreme cases the terminal

segment of the finger is bulbous,segment of the finger is bulbous,

like the end of drumstick .like the end of drumstick .


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CausesCauses

Respiratory causesRespiratory causes

Cardiovascular causesCardiovascular causes

Alimentary causesAlimentary causes FamilialFamilial


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Respiratory causesRespiratory causes

Lung cancerLung cancer

Fibrosing alveolitisFibrosing alveolitis

EmpyemaEmpyema BronchiectasisBronchiectasis

Lung abscessLung abscess


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Cardiovascular causesCardiovascular causes

Cyanotic congenital heart diseaseCyanotic congenital heart disease

Subacute bacterial endocarditisSubacute bacterial endocarditis

Chronic abdominalChronic abdominal


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Chronic abdominalChronic abdominal

disordersdisorders

Crohns diseaseCrohns disease

Ulcerative colitisUlcerative colitis

Malabsorption syndromeMalabsorption syndrome Hepatic cirrhosisHepatic cirrhosis


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Flapping tremorFlapping tremor

The sign consists of jerkyThe sign consists of jerky

movements of the hands due tomovements of the hands due to

flexion and extension of theflexion and extension of thewrists and fingers .wrists and fingers .


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CausesCauses

Carbon dioxide retentionCarbon dioxide retention

Hepatic encephalopathyHepatic encephalopathy

UraemiaUraemia


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NeckNeck

For lymph nodes (cervical,For lymph nodes (cervical,

scalene lymph nodes)scalene lymph nodes)

The upper respiratoryThe upper respiratory


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The upper respiratoryThe upper respiratory

tracttract

The larynxThe larynx

The tracheaThe trachea

h h


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The tracheaThe trachea

In normal subjects the upper 4 toIn normal subjects the upper 4 to

5 cm of the trachea can be felt in5 cm of the trachea can be felt in

the neck between the cricoidthe neck between the cricoidcartilage and the suprasternalcartilage and the suprasternal

notch .notch .

i i


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ExaminationExamination

Feel for the trachea in theFeel for the trachea in the

suprasternal notch and decidesuprasternal notch and decide

whether it is central or deviatedwhether it is central or deviatedto one side by its relation to theto one side by its relation to the

suprasternal notch and thesuprasternal notch and the

insertion of the sternomastoidsinsertion of the sternomastoids

Ch i i


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Chest examinationChest examination

InspectionInspection

PalpationPalpation

PercussionPercussion AuscultationAuscultation

iI ti


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InspectionInspection

Abnormalities in the shape of theAbnormalities in the shape of the

chest .chest .

Lesions of the chest wallLesions of the chest wallThe observation of the respiratoryThe observation of the respiratory

movement .movement .

Abnormalities of theAbnormalities of the


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Abnormalities of theAbnormalities of the

shape of the chestshape of the chest

Barrel-shaped chestBarrel-shaped chest

Pectus carinatum (pigeon chest)Pectus carinatum (pigeon chest)

Pectus excavatum (funnel-chest)Pectus excavatum (funnel-chest)Thoracic kyphoscoliosisThoracic kyphoscoliosis

Lesions of the chestLesions of the chest


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Lesions of the chestLesions of the chest

wallwall

Surgical scarsSurgical scars

Radiotherapy scarRadiotherapy scar

Distended veinsDistended veins

The observation of theThe observation of the


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The observation of theThe observation of the

respiratory movementrespiratory movement

Respiratory frequencyRespiratory frequency

Mode of breathing, and use ofMode of breathing, and use of

accessory muscles of respirationaccessory muscles of respiration Maximum chest expansionMaximum chest expansion

Ch t iCh t i


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Chest expansionChest expansion

Is estimated by placing a tapeIs estimated by placing a tape

measure round the lower third ofmeasure round the lower third of

the chest and recording thethe chest and recording themaximum inspiratory/expiratorymaximum inspiratory/expiratory

difference in the chestdifference in the chest

circumference .circumference .

P iP i


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PercussionPercussion

Normal resonanceNormal resonance

Impaired or dullImpaired or dull

Stony dullStony dull HyperresonantHyperresonant

A lt tiA lt ti


107/110

AuscultationAuscultation

Breath soundsBreath sounds

Added soundsAdded sounds

Vocal resonanceVocal resonance

B th dB th d


108/110

Breath soundsBreath sounds

Vesicular breath soundsVesicular breath sounds

Bronchial breathingBronchial breathing

Vesicular breathVesicular breath


109/110

Vesicular breathsoundssounds

Inspiration is longer thanInspiration is longer than

expiration, and no pause betweenexpiration, and no pause between

the end of inspiration and thethe end of inspiration and thebeginning of expiration .beginning of expiration .

May be diminished or absent .May be diminished or absent .

B hi l b thiB hi l b thi


110/110

Bronchial breathingBronchial breathing

The expiratory sound must be asThe expiratory sound must be as

long and as loud as thelong and as loud as the

inspiratory soundinspiratory soundThere must be a pause betweenThere must be a pause between

the end of inspiration andthe end of inspiration and

beginning of expiration .beginning of expiration .

symtoms and signs of the respiratory system m.abbas

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