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Workbook Respiratory System

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21 views35 pages

Workbook Respiratory System

Uploaded by

Navya Mathew
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RESPIRATORY SYSTEM

Dr Rahul Rajeev MBBS MD DM


CHECKLIST FOR SYMPTOMATOLOGY
• Cough
• Hemoptysis
• Breathlessness
• Chest pain
• Fever
• Hoarseness of voice
• Stridor
COUGH
Forced expiration against a closed glottis

• Acute cough - URTI, Pneumonia

• Chronic cough - Chronic bronchitis , Pulmonary TB, Ca Lung,


Lung abscess, Bronchiectasis,
Bronchial asthma, Interstitial lung disease
COUGH

• Productive cough - URTI, Pneumonia , Chronic bronchitis,

Suppurative lung diseases, Pulmonary TB, Pulmonary edema

• Dry cough

- Pleural diseases, Early stages of URTI & Pneumonia, Interstitial Lung Disease

• Nocturnal cough - Asthma , LV dysfunction, Post nasal drip


Nature of sputum
• Rusty sputum - Pneumonia

Mucoid sputum - Chronic bronchitis

Purulent sputum - Bacterial LRTI

Foul smelling sputum - Lung abscess, Bronchiectasis, Anerobic bacterial infection

Pink frothy sputum - Pulmonary edema

Serous sputum - Bronchoalveolar cell carcinoma


Copious sputum production

• Bronchiectasis

• Lung abscess

• Empyema rupturing to bronchus

• Necrotizing pneumonia
HEMOPTYSIS
• Pulmonary TB
• Ca Lung
• Lung abscess
• Bronchiectasis
• Collagen vascular diseases
Hemoptysis Hematemesis
Preceding symptoms Cough Nausea, vomiting
Color Bright red Dark brown
Frothy nature Present Absent
Melena Absent Present
Background illness Respiratory disease Acid Peptic disease
Chronic Liver Disease
BREATHLESSNESS
• Tracheobronchial diseases
• Interstitial diseases
• Parenchymal diseases
• Pleural diseases
• Thoracic wall deformities
CHEST PAIN
• Pleuritis

• Pneumothorax

• Pulmonary embolism

• Mediastinitis, Mediastinal tumor


FEVER
• URTI
• Pulmonary TB
• Bronchiectasis
• Lung abscess
Features of Respiratory Failure
• Cyanosis
• Bounding pulse
• Altered sensorium
• Palmar erythema
• Warm extremities
• Flapping tremor
• Conjunctival chemosis
• Papilledema
• Muscle twitching
INSPECTION
• Shape of chest
• Position of the trachea
• Position of apex beat
• Respiratory movements
• Respiratory rate
• Rhythm of respiration
• Type of Respiration
• Intercostal retraction
• Dilated veins, visible pulsations, scars, sinuses or edema of the chest wall
Shape of Chest
• Normal shape - Bilaterally symmetrical & elliptical

- Transverse diameter > AP-diameter (7:5)


• Abnormalities in shape

- Flail chest (2:1)


- Barrel shaped (1:1)
- Pectus excavatum (funnel chest)
- Pectus carinatum (pigeon chest)
- Rachitic chest (with Harrison’s sulcus)
- Thoracic kyphoscoliosis
• Look for drooping of shoulder

- Fibrosis
- Collapse
Position of Trachea

• Normally - Central

• Tracheal shift

To opposite side of pathology - Pleural effusion, Pneumothorax, Mass lesion of upper lobe

To same side of pathology - Fibrosis, Collapse

No tracheal shift - Consolidation, Bronchiectasis, ILD, COPD, Bronchial asthma

• Trail’s sign - prominence of sternal head of sternocleidomastoid on the side of tracheal shift
Position of apex beat
• Shifted in pleuro-pulmonary diseases affecting lower lobes

• Shift of apex beat

To same side of pathology - Fibrosis, Pathology

To opposite side of pathology - Pleural effusion, Pneumothorax


Respiratory movements
• Normal - equal on both sides

• Reduced movements on one side


Pleural effusion
Pneumothorax
Fibrosis
Collapse
Consolidation
Mass lesion

• Reduced movements on both sides


COPD
Interstitial Lung Disease
Ankylosing Spondylitis
Respiratory rate
• Normal : 16-20/minute

• Tachypnea
Anxiety, Fever, Exercise, Pneumonia, Pulmonary edema, ARDS, Acidosis

• Bradypnea
Raised ICT, Narcotic poisoning, Myxedema coma
Rhythm of respiration
• Normal - Regular

• Abnormal

Cheyne Stokes breathing : Raised ICT, Narcotic poisoning , LV failure


Biot’s breathing : Meningitis
Apneustic breathing : Pontine lesions
Ataxic : Medullary lesions
Kussmaul : Metabolic acidosis
Type of Respiration
• Normal
Abdominothoracic - males
Thoracoabdominal - females

• Pathologic
Thoracic - Diaphragmatic paralysis, Peritonitis
Abdominal - Pleurisy, COPD
Intercostal retraction
• Mostly when accessory muscles are working

• Inspiration - active process : Diaphragm & intercostals


Expiration - passive process : Elastic recoil of lungs

• Accessory muscles of inspiration - Scalenus, pectorals, trapezius


• Accessory muscles of expiration - Abdominal muscles & Latissimus dorsi
PALPATION
• Position of trachea
• Apex beat
• Respiratory movements
• Chest expansion
• Anteroposterior & transverse diameters
• Vocal fremitus
• Intercostal narrowing
Vocal Fremitus
• Increased Vocal Fremitus
Consolidation
Upper level of effusion

• Decreased Vocal Fremitus


Pleural effusion
Pneumothorax
PERCUSSION
• Direct percussion - over bone

• Indirect percussion - over all other areas


Kronig’s ishthmus
Anterior chest
Posterior chest
Lateral chest (Axilla)

• Tidal percussion : To differentiate supradiaphragmatic & infradiaphragmatic pathology

• Traube’s space dullness : Left sided pleural effusion

• Shifting dullness - Hydropneumothorax


AUSCULTATION
• Anterior chest
Supraclavicular area
Infraclavicular area
Mammary area
• Lateral chest
Axillary area
Infra-axillary area
• Posterior chest
Suprascapular area
Interscapular area
Infrascapular area
• Breath sounds

• Adventitious sounds

• Vocal Resonance

• Miscellaneous sounds
Breath sounds
• Intensity
Normal & equal bilaterally
Diminished
Absent

• Type of breath sounds


Diminished breath sounds
• Bilateral • Unilateral
COPD Pleural effusion
Interstitial Lung Disease Pneumothorax
Collapse
Fibrosis
Consolidation
Mass lesion
Character of breath sounds
• Normal character - Vesicular

• Bronchial breath sounds


Tubular
Cavernous
Amphoric

• Bronchovesicular
Adventitious sounds
• Rhonchi : Bronchial asthma, COPD

• Crepitations
Crepitations
• Fine - Early stage of consolidation
• Coarse - Resolving pneumonia , Bronchiectasis, Lung abscess

• Early inspiratory coarse crepitations - Bronchiectasis


• Late inspiratory fine crepitations - Pulmonary edema
Vocal Resonance
• Increased Vocal Resonance
Consolidation
Upper level of effusion

• Decreased Vocal Resonance


Pleural effusion
Pneumothorax
Miscellaneous sounds
• Bronchophony
• Aegophony
• Whispering Pectoriloquy
• Pleural rub
• Coin sound
• Post tussive suction
Consolidation Pleural Fibrosis Collapse Cavity Mass Lesion Pneumothorax Emphysema Bronchiectasis
Effusion
Tracheal shift Nil To opposite To same side To same side Nil To opposite To opposite Nil Nil
side side side
Mediastinal Nil Shift to To same side To same side Nil To opposite To opposite Nil Nil
shift opposite side side side

Respiratory Diminished Diminished Diminished Diminished Reduced Diminished Diminished Diminished Normal or Diminished
movements & movement of
chest affected area
expansion

Percussion Impaired or Stony dull Impaired Impaired Variable Dull Hyper- Hyper- Normal or Impaired
Dull resonant resonant
Vocal Increased Reduced Decreased Reduced Increases (if Decreased Decreased Normal or Variable
resonance there is Decreased
communicatio
n with
bronchus)

Breath sounds Diminished or Absent Decreased Absent Cavernous Decreased Absent Diminished Normal
Absent
Tubular
bronchial
breathing
Adventitious Crepitations + Nil Crepitations Nil Nil Rhonchi Coarse leathery crepitations
sounds +/-
Miscellaneous Bronchophony Aegophony at Nil Nil Post-tussive Nil Coin sound
sounds Aegophony the upper level suction
Whispering of effusion
pectoriloquy

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