Transcript EXAMINATION OF RESPIRATORY SYSTEM

EXAMINATION OF
RESPIRATORY SYSTEM
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INSPECTION
PALPATION
AUSCULTATION
PERCUSSION
GENERAL EXAMINATION
CYANOSIS
 Central
 Peripheral
causes
 COPD
 Type 2 resp. failure
 Pulmonary fibrosis
 B. asthma
 Congenital cyanotic heart disease
 Pulmonary embolism
OEDEMA
Right ventricular failure—cor pulmonale
FACE
 Pink puffers
 Blue bloaters
 Congested neck veins
 Rashes
EYES
 Horner,s syndrome---ca. bronchus
 Chemosis---SVC obstruction
---COPD
NECK
Lymph nodes----TB
---lymphoma
--sarcoidosis
---malignancy
SKIN
 Rashes—herpes zoster
 Scars---previous operation,burns ,
biopsies
 Pigmentation—haemochromotosis
 Dilated veins---SVC obstruction
HANDS
 Cyanosis
 Clubbing---ca. bronchus
---TB
---empyema
---abcess
---fibrosing alveolitis
---bronchiectasis
 Wasting of small muscles of hand ---pancoast
tumour
PULSE
 Tachycardia---> 120/min—infections
---P.E
--B. asthma
--COPD
exacerbation
 Small volume
 Collapsing pulse—large volume bounding
pulse ,carbon dioxide retention --type 2
resp. failure
PULSES PARADOXUS
 Status asthmaticus
 Massive pulmonary embolism
 Tension pneumothorax
EXAMINATION OF THE CHEST
Inspection
 A-P diameter
--pectus excavatum---funnel chest
--pectus carinatum---pigeon chest
 kyphoscoliosis
 respiratory movements---resp. rate-{14-18/min}
i:e –hyperventillation—DKA, PE
---hypoventillation—type 2 resp. failure
 Chyne stokes breathing---cyclical variation
in the depth of respiration with period of
apnoea.
 Use of accessory muscles---status
asthmaticus
 Tenderness—fractured ribs,metastasis ,
neuralgia
SHAPE OF THE CHEST
Pectus excavetum
Pectus carinatum
DILATED VEINS
SVC obstruction---Ca lung
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
 Pulled—fibrosis
--collapse
 Chest expansion– normal up to 5 cm
-abnormal < 2 cm
 Apex beat
 Tactile fremitus
--Ask the patient to say 99
--you should feel the vibration transmitted
through the airways to the lung.
 Increased in---pneumothorax
--emphysema
 Decreased---pleural effusion
Auscultation
Breath sounds—
 Vesicular—normal
--insp. twice that of expiration
--no pause
 Bronchial –inspiration is shorter than expiration
---gap between insp. and exp.
Vesicular
bronchial
 Increased---consolidation
---large cavity near the surface
 Decreased---COPD
---Pleural effusion
--pneumothorax
Added sounds
 Crepitations---fine ---heart failure
--fibrosing alveolitis
---coarse—bronchiectasis
--infections
 Wheezes or rhonchi---COPD
--bronchial asthma
• 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.
 Egophany
--ask the patient to say “ ee “ continously
--you should hear muffled ‘’ee ‘’---if you hear
an ‘’ ay ‘’ then it is egophany.
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