Examination of the Respiratory System-1.ppt

Examination of the Respiratory System-1.ppt

1. EXAMINATION OF
RESPIRATORY SYSTEM

2. The sequence of Examination
INSPECTION
PALPATION
AUSCULTATION
PERCUSSION

3. GENERAL EXAMINATION
CYANOSIS
Central
Peripheral
causes
Chronic Obstructive Pulmonary Disease (COPD)
Type 2 resp. failure
Pulmonary fibrosis
Brochial asthma
Congenital cyanotic heart disease
Pulmonary embolism

4. General Examination cont.’
Cyanosis

5. General Examination cont.’
Cyanosis

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

8. Oedema; pitting oedema

9. Patient with facial oedema

10. Examination of the Respiratory
System
EYES
Horner,s syndrome---ca. bronchus
Chemosis---SVC obstruction
---COPD
NECK
Lymph nodes----TB
---lymphoma
--sarcoidosis
---malignancy

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

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

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

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

34. 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

35. 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

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

37. •Dilated veins

38. Shapes of the chest
•Pectus excavetum

43. 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

46. 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.

47. 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.

48. Vesicular bronchial

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

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

52. •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.

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

54. 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

55. The lung fields in a chest x-ray