sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
Respiratory system analysis & Diagnosis Assessment.pdf
1. Respiratory System
Analysis & Diagnosis
Assessment
1
Arul
Selvan.S
(Via Physiological
Aspects)
Third Professional Bachelor of Siddha Medicine &
Surgery
Government Siddha Medical
College
4. Cough
• Is it acute, subacute or chronic?
• Dry or Productive?
• Associated symptoms – fever, dyspnea,
chest pain, etc.?
• Risk factors – Smoking, environmental
factors, HIV, family h/o TB ?
• Symptoms of postnasal discharge,
GERD(Acid reflux)?
• Is the patient on ACE (Angiotensin
converting enzyme)inhibitor?
4
5. Acute cough <3 week's
• URI - Upper Respiratory Infection (URI or
Common Cold)
• Pneumonia
• Pulmonary embolism
5
6. Subacute cough (3- 8 weeks)
• Viral infections
• Post infectious
• Post nasal drip (Secretions from the nose that
drain down into the throat, causing congestion
and cough. Postnasal drip is usually caused by
allergies or the common cold)
• GERD
6
7. Chronic cough >8 weeks
• Pulmonary Tuberculosis
• Asthma
• COPD (Chronic obstructive pulmonary) disease
• Bronchogenic CA (Bronchogenic carcinoma begin as a small
focus of atypical epithelial cells within the bronchial mucosa.)
• Eosinophilic bronchitis (Airway inflammation due to
excessive mast cell recruitment)
• Post nasal drip
• GERD
7
11. Sputum :
Copious Amount
Bronchiectasis (condition in which the lungs airways become dama
making it hard to clear mucus.)
Lung Abscess - formation of cavities (more than 2 cm) containing necr
debris or fluid caused by microbial infection.
Necrotizing pneumonia (characterized by rapid progression
consolidation to necrosis and cavitation which may lead to pulmon
gangrene)
Alveolar cell CA
Empyema rupturing into bronchus
Postural variation
Lung Abscess & Bronchiectasis
11
12. Color of sputum
Yellow / Green — Bacterial infection
Black — coal worker pneumoconiosis (inhalation of dust
has caused interstitial fibrosis)
Pink frothy sputum — Pulmonary edema
Anchovy sauce ( Brown colored pus to compared this
one )— Ruptured amoebic liver abscess.
12
14. Dyspnea
• Within minutes
Pneumothorax
Pulmonary embolism
Inhalation of foreign body
Larnygeal edema
14
15. Dyspnea
• Hours to Days
ARDS (Acute respiratory distress syndrome)
Bronchial Asthma
Pneumoia
15
16. Dyspnea
• Weeks to Months
COPD
ILD - Interstitial Lung Disease (umbrella
term used for a large group of diseases
that cause scarring fibrosis of the lungs)
Pleural effusion
Anemia
Thyrotoxicosis
16
31. Inspection
• Symmetry of chest
• Position of Trachea
• Position of Apex impulse
• Movements of chest
• Accessory muscles
• Hollowness/Bulging/flattening/retraction/
crowding of ribs
• Kyphosis / Scoliosis.
• Scar/sinus/dilated veins.
31
37. Symmetry of chest--
• Spinal deformity — Kyphosis , Scoliosis.
• Bulging — Pleural effusion, Pneumothorax,
empyema necessitans (pleural space infections and
occurs when the infected fluid dissects spontaneously
into the chest wall from the pleural space.
• Flattening or depression — Fibrosis, Collapse.
37
41. Palpation
• Temperature
• Tenderness
• Position of trachea and apex beat
• Movement of chest
• Chest expansion
• Tactile vocal fremitus
• Others – flow in dilated veins,
subcutaneous emphysema.
41
42. Local pain / tenderness
• Empyema
• Infiltration of chest wall by tumor
• Osteomyelitis
• Costochondritis
• Herpes zoster
42
43. • Chest expention – Normal 2 inch
• < 1.5 inch..abnormal
• Chest movements are assessed in all areas.
• Inspection is better then palpation (for movements)
43
44. Chest expansion
General Restriction
• Extensive bilateral disorder
(abnormal accumulation of
surfactant-derived lipoprotein
compounds within the alveoli of
the lung)
• COPD
• ILD
• Ankylosing spondylitis
• Spinal deformity
Asymmetrical expansion
• Pleural effusion
• Pneumothorex
• Consolidation
• Collapse
• Fibrosis
44
45. Percussion
• Position of Patient : Sitting
• Anterior – Hands by the side
• Posterior – Hands over opposite shoulders
• Lateral – Hands over head.
45
51. Crackles
• Short, Explosive, Discontinuous Nonmusical sounds
• Bubbling / clicking /Explosive sounds
• Mechanism:
• Flow of air through secretions
• Sudden opening of a succession of small airways, due to rapid equalization
of pressure between 2 airway compartments
• Types—Fine—Arise from alveoli
Coarse—Arise from bronchus & Bronchioles.
51
52. Wheeze
ASTHMA
BRONCHITIS
VOCAL CORD DYSFUNCTION
FOREIGN BODY ASPIRATION
INFECTIONS – CROUP
LARYNGITIS
CONGESTIVE HEART
FAILURE
COPD
CYSTIC FIBROSIS
ILD
FIBROSING ALVELOLITIS
NOT ALL THAT WHEEZES IS ASTHMA
52
53. Pleural rub
• Friction of inflamed visceral & parietal pleural
surfaces against each other in respiration
• Creaking leathery sound
• During both phases
• Best heard at Lateral & Posterior bases of lung
53
54. Disease Mediastin
al shift
Percussion Breath
sounds
Added sounds
Consolida
tion
Midline Dull ↑
Bronchial
(tubular)
Crackles+ Rub+/-
Fibrosis Same side Impaired ↑/↓,
Bronchial
Crackles+
Collapse
(Major
bronchus
obstructio
n)
Same side Dull ↓ Vesicular None
Collapse
(Patent
bronchus)
Same side Dull ↑
Bronchial
tubular
Early – None Late
– Coarse crackles
54
55. Disease Mediastinal
shift
Percussi
on
Breath
sounds
Added sounds
Cavity Midline or
Same
side(if
associated
fibrosis)
Impaired ↑ Bronchial
(Cavernous)
Crackles +/-
Pleural
Effusion
Opposite
side
Stony
dull
↓ or Absent,
above level -
Bronchial
Pleural rub above
level
Pneumoth
orax
Opposite
side
Hyper-
resonant
↓ or Absent None
Emphyse
ma
Midline Hyper-
resonant
Low Wheeze +/-
But low
55