3. EXAMINATION OF RESPIRATORY SYSTEM

4. INSPECTION
PALPATION
AUSCULTATION
PERCUSSION

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

9. OEDEMA
Right ventricular failure—cor pulmonale
FACE
Pink puffers
Blue bloaters
Congested neck veins
Rashes

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

23. SKIN
Rashes—herpes zoster
Scars---previous operation,burns , biopsies
Pigmentation—haemochromotosis
Dilated veins---SVC obstruction

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

35. PULSE
Tachycardia---> 120/min—infections
---P.E
--B. asthma
--COPD exacerbation
Small volume

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

37. 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

38. 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

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

46. 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

49. 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.

50. 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.

51. Vesicular bronchial

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

54. Added sounds
Crepitations---fine ---heart failure
--fibrosing alveolitis
---coarse—bronchiectasis
--infections
Wheezes or rhonchi---COPD
--bronchial asthma

55. 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.

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

57. 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