EXAMINATION OF RESPIRATORY SYSTEM

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EXAMINATION OF RESPIRATORY SYSTEM
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• INSPECTION
• PALPATION
• AUSCULTATION
• PERCUSSION

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GENERAL EXAMINATION

• CYANOSIS
• Central
• Peripheral
• causes
• COPD
• Type 2 resp. failure
• Pulmonary fibrosis
• B. asthma
• Congenital cyanotic heart disease
• Pulmonary embolism

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• OEDEMA
• Right ventricular failurecor pulmonale
• FACE
• Pink puffers
• Blue bloaters
• Congested neck veins
• Rashes

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• EYES
• Horner,s syndrome---ca. bronchus
• Chemosis---SVC obstruction
• ---COPD
• NECK
• Lymph nodes----TB
• ---lymphoma
• --sarcoidosis
• ---malignancy

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• SKIN
• Rashesherpes zoster
• Scars---previous operation,burns , biopsies
• Pigmentationhaemochromotosis
• Dilated veins---SVC obstruction

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• HANDS
• Cyanosis
• Clubbing---ca. bronchus
• ---TB
• ---empyema
• ---abcess
• ---fibrosing alveolitis
• ---bronchiectasis
• Wasting of small muscles of hand ---pancoast
  tumour

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• PULSE
• Tachycardia---gt 120/mininfections
• ---P.E
• --B.
  asthma
• --COPD
  exacerbation
• Small volume

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• Collapsing pulselarge volume bounding pulse
  ,carbon dioxide retention --type 2 resp. failure
• PULSES PARADOXUS
• Status asthmaticus
• Massive pulmonary embolism
• Tension pneumothorax

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EXAMINATION OF THE CHEST

• Inspection
• A-P diameter
• --pectus excavatum---funnel chest
• --pectus carinatum---pigeon chest
• kyphoscoliosis
• respiratory movements---resp. rate-14-18/min
  ie hyperventillationDKA, PE
• ---hypoventillationtype 2 resp. failure

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• Chyne stokes breathing---cyclical variation in
  the depth of respiration with period of apnoea.
• Use of accessory muscles---status asthmaticus
• Tendernessfractured ribs,metastasis , neuralgia

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• SHAPE OF THE CHEST
• Pectus excavetum
• Pectus carinatum
• DILATED VEINS
• SVC obstruction---Ca lung

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• Palpation
• Trachea
• 4-5 cm of the upper trachea can be felt in the
  neck between the cricoid cartilage and the
  sternal notch.
• Pushed pneumothorax
• -pleural effusion
• Pulledfibrosis
• --collapse

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• Chest expansion normal up to 5 cm
• -abnormal lt 2 cm
• Apex beat
• Tactile fremitus
• --Ask the patient to say 99
• --you should feel the vibration transmitted
  through the airways to the lung.

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• Increased in---pneumothorax
• --emphysema
• Decreased---pleural effusion
• Auscultation
• Breath sounds
• Vesicularnormal
• --insp. twice that of expiration
• --no pause
• Bronchial inspiration is shorter than expiration
• ---gap between insp. and exp.

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• Vesicular bronchial

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• Increased---consolidation
• ---large cavity near the
  surface
• Decreased---COPD
• ---Pleural effusion
• --pneumothorax

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• Added sounds
• Crepitations---fine ---heart failure
• --fibrosing
  alveolitis
• ---coarsebronchiectasis
• --infections
• Wheezes or rhonchi---COPD
• --bronchial
  asthma

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• Pleural rub
• Whispering pectroloquy---consolidation
• --ask the patient to whisper 99
• --you should hear only faint sounds or
  nothing----if you hear the sound clearly then
  this is referred as whispering pectroloquy.

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• Egophany
• --ask the patient to say ee continously
• --you should hear muffled ee ---if you hear
  an ay then it is egophany.

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• Percussion
• The percussion note loses its normal resonance
  when ever aerated lung tissue is separated from
  the chest wall by fluid or pleural thickening .
• OR
• When lung tissue is separated from chest wall by
  collapse or consolidation or fibrosis

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