Respiratory system
History Taking
Common respiratory symptoms
1) Cough:
Definition
Noisy expulsion of air from lungs, at once its known as cough
Causes
Acute ( less than 3 weeks
a) Upper respiratory viral or bacterial infection
b) Other causes are acute asthma, pneumonia and pulmonary edema.
Chronic:
a) Chronic bronchitis ( smooking)
b) Chronic bronchial asthma
c) TB
d) ACT inhibitors
Treatment:
Eliminate irritant exposure
Tobacco smoke
ACT inhibitors
Treatment the cause
Common cold
Asthma
Symptomatic treatment
Dry cough
Productive cough
2) Sputum
Color Type of sputum
White Mucoid
Grey Mucoid ( dust inhalation)
Black Mucoid + coil dust
Yellow or green Purulent
Rusty Altered blood
Blood stain Hemoptysis
Examination of sputum
Quantity:
o Scanty: like bronchitis
o Moderate amount: TB
o Large amount: bronchiectasis and chronic bronchitis
Appearance:
o Watery: pulmonary edema
o Mucoid: acute and chronic bronchitis
o Mucopurulent: all infection of lung
o Purulent: bronchiectasis and lung abscess
Colour:
o Blackish: due to inhalation of carbon
o Rusty: due to altered blood mixed with sputum
o Raddish: indicate hemoptysis
3) Hemoptysis:
Definition
Expectoration of blood or blood stained sputum
Source:
Below the vocal code
Causes:
From airways in:
o Bronchitis
o Bronchiectasis
o Bronchogenic carcinoma
From pulmonary vascular:
o Mitral stenosis
o Pulmonary infraction
Massive hemoptysis: ( 200 – 600 ml of blood in 24 h) occurs in:
o Bronchiectasis
o TB
Investigation:
o Chest X – ray: TB
o Bronchoscopy: lung carcinoma
o CT scan: to diagnosis Bronchiectasis
Treatment:
o Treatment the cause
o Symptomatic management
4) Shortness of breathing ( dyspnea)
Definition
Is an unpleasant subjective a awareness of the sensation of breathing
Causes:
Increased ventilator y drive causing increase respiratory rate occurs in:
o Fever
o Exercise
o Hypoxia: in asthma and COPD
o Hypercarbia: COPD
Reduced ventilatory capacity occurs in:
o Reduced lung volume: in pneumonia
o Pleural pain
o Increase resistance
5) Chest pain :
Pleuritis
Pneumonia
Pneumothorax
.
Thank You
Examination of respiratory system
Introduction
Position the patient
Exposure
Scheme of examination:
Start examination from inspection, then palpation, percussion and auscultation and the
end physical examination related respiratory system such as clubbing cyanosis and
lymphadenopathy
I. Examination of chest
First exam the front and side of the chest with the patient lie.
Than exam posterior aspect of the chest
Complete examination starting:
1. Inspection
Inspection of the chest can be under three heading: A, B, C
A: appearance
o Its include the shape and symmetry of the chest
Shape and symmetry of the chest
o normal chest bilateral symmetry
o abnormalities are:
a) barrel chest: when AP diameter increase with the lateral diameter
indicate hyperinflation in sever asthma or emphysema.
b) Pigeon chest: it is localized prominence ( an outword bowing of the
sternum and costal cartilage)
c) Funnel chest: development defect involving localized depression lower
end of sternum
d) Kyphosis: refers to exaggerated forward curvature of spine while
Scoliosis is lateral
Lesion of chest wall
look scars and previous thoracic surgery
B: Breathing
Respiratory frequency
Normal resting respiratory rate about 14 breaths/min
Increases in fever, respiratory infection, asthma, COPD and
pulmonary edema.
Mode of breathing
Femal :Thoraco-abdominal
Male: abdomino- thorasic
C: Chest movements:
Normal
o symmetry chest movement
Abnormal
o Unilateral dimensioned movement indicate local lung
disease such as lung collapse, pleural infusion and
pneumothorax.
o Bilateral reduction of chest wall: indicate diffuse
abnormalities such as COPD
2. Palpation:
a) Apex beat
o Displacement apex beat: result
Collapse of lower lobe
Localized pulmonary fibrosis
Over inflated lung
b) Trachea
o Normal trachea is centralized
o Abnormal may be
Tracheal displacement to the side lung lesion (Pulled): volume
lose such as lung collapse
Tracheal displacement away from the side lung lesion (Pushed)
volume increase such as massive pleural infusion.
Tracheal tug: when the fingers are placed on the trachea above
the suprasternal notch and is felt that the trachea moves
inferiorly with each inspiration.
Its sign of gross over inflation in COPD
c) Chest movement
Reduced chest movement on one side indicate lesion on that side e.g:
o Pleural infusion
o Consolidation
o Collapse
o Pneumothorax
o and localized fibrosis
d) chest expansion
3. percussion
the position which percussion note on two side should be
compared are as the following:
o anterior chest wall
clavicle
interclavicular region
second to sixth intercostals space
o lateral chest wall
four to seventh intercostals space
o posterior chest wall
4. auscultation
quality of breathing sound
a) normal vascular breathing (alveola)
lauder and long on inspiration on expiration
expiration is shorter and softer than inspiration
there is no gap between inspiration and expiration
b) bronchial breathing
inspiration and expiration are same duration and intensity
there is gab between inspiration and expiration
vocal resonance is increased to allow whispering pectoriloquy to
be heard.
c) Wheezing or rhonchi ( due to airway narrowing)
d) Crepitation: are bubbling sound
o Coarse crepitations: bronchiectasis
o Fine crepitations: parenchymal lung disease
e) Pleural rub: creaking sound
f) Vocal resonsnce ( say ninety –nine consolidated are audible)
