EXAMINATION OF RESPIRATORY SYSTEM

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