PULMONARY SYSTEM (PS) examination

1. PULMONARY SYSTEM (PS)
DR.QURATULAIN MUGHAL
(DPT)
ISRA UNIVERSITY,KARACHI
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2. CONTENTS
1. Dyspnea
2. Onset of cough
3. Change in cough
4. Sputum
5. Hemoptysis
6. Clubbing of nails
7. Stridor
8. Wheezing
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3. 1. DYSPNEA
• Also known as Shortness of breath.
DEFINITION:
“ Is a feeling like one cannot breathe well enough.”
OR
“Difficulty in breathing”.
OR
“Disordered or inadequate breathing”.
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4. CAUSES
• Asthma
• Pneumonia
• Cardiac ischemia
• Interstitial lung disease
• Congestive heart failure
• Chronic obstructive pulmonary disease
• Psychogenic (panic disorder and anxiety)
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5. 2. ONSET OF COUGH
3. CHANGE IN COUGH
1. Duration:
• ACUTE (of sudden onset) if it is present less than three
weeks.
• SUBACUTE if it is present between three or eight
weeks.
• CHRONIC when lasting longer than eight weeks.
2. Character
3. Quality
4. Timing
• Non-productive (dry)
• Productive (when sputum is coughed up)
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6. 4. SPUTUM
• Is mucus and is the name used for the coughed-
up material (phlegm) from the lower airways
(trachea and bronchi).
• This process is known as sputilization.
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7. COLOUR OF SPUTUM
1. Bloody (hemoptysis):
(A) Blood-streaked sputum
(B) Pink sputum
(C) Massive blood
2. Green or greenish colored:
indicative of longstanding respiratory infection
(green from degenerative changes in cell debris)
as in pneumonia, ruptured lung abscess,
chronic infectious bronchitis, and infected
bronchiectasis or cystic fibrosis.
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8. COLOUR OF SPUTUM
3. Rust colored :
• caused by pneumococcal bacteria (in pneumonia)
• pulmonary embolism
• lung cancer
• pulmonary tuberculosis
4. Brownish:
• chronic bronchitis (greenish/yellowish/brown)
• chronic pneumonia (whitish-brown)
• tuberculosis
• lung cancer
5. Yellow, yellowish purulent: containing pus.
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9. 5. HEMOPTYSIS
DEFINITION:
“Is the act of coughing up blood or blood-
stained mucus from the bronchi, larynx, trachea,
or lungs.”
(A) Blood-streaked sputum
(B) Pink sputum
(C) Massive blood
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10. (A) Blood-streaked sputum
• Inflammation of throat (larynx and/or trachea)
or bronchi
• Due to:
• lung cancer other bleeding erosions, ulcers, or
tumors of the lower airway.
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11. (B) Pink sputum
• Sputum evenly mixed with blood
from alveoli and/or small peripheral bronchi.
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12. (C) Massive blood
• Cavitary tuberculosis or tumor such as lung
cancer of lung.
• lung abscess: bronchiectasis
• lung infarction
• pulmonary embolism.
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13. 6. CLUBBING OF NAILS
• Also known as digital clubbing.
• Is a deformity of the finger or
toe nails associated with a number of diseases,
mostly of the heart and lungs.
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14. CLUBBING IS ASSOCIATED WITH LUNG
DISEASES
• Lung cancer
• Interstitial lung disease most commonly fibrosing
alveolitis
• Complicated tuberculosis
• SUPPURATIVE LUNG DISEASE:
• lung abscess
• empyema
• bronchiectasis
• cystic fibrosis
• Arteriovenous fistula or malformation
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15. CLUBBING IS ASSOCIATED WITH
HEART DISEASES
• chronic hypoxia
• Congenital cyanotic heart disease (most
common cardiac cause)
• Subacute bacterial endocarditis
• Atrial myxoma (benign tumor)
• Tetralogy of Fallot
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16. Schamroth's test or Schamroth's
window test
• Is a popular test for clubbing.
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17. 7. STRIDOR
DEFINITION:
“A high-pitched musical breath sound resulting
from turbulent air flow in the larynx or lower in the bronchial
tree.”
Common causes:
Typically obstruction in respiratory tract including:
• Foreign bodies
• Croup (also known as laryngotracheobronchitis, is a type
of respiratory infection that is usually caused by a virus)
• Epiglottitis
• Tumours
• Infection
• Anaphylaxis
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18. 8. WHEEZING
DEFINITION:
“ A continuous musical sound on expiration or
inspiration.”
OR
“Whistling sound produced in the
respiratory airways during breathing.”
• A wheeze is the result of narrowed airways.
Common causes:
• Asthma and emphysema
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