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EXAMINATION OF RESPIRATORY SYSTEM

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EXAMINATION OF RESPIRATORY SYSTEM Powered By Docstoc
					  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

				
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posted:9/7/2011
language:English
pages:60