This document provides guidance on clinically examining the respiratory system. It describes how to inspect, palpate, percuss, and auscultate the chest. Inspection involves examining chest shape, symmetry, movement, and veins. Palpation checks the trachea position, apex beat, chest expansion, vocal fremitus, and tenderness. Percussion distinguishes lung from liver dullness. Auscultation assesses breath sounds and vocal resonance. The examination evaluates the lungs, pleura, chest wall, and underlying bony structures in a systematic manner to detect abnormalities.
Doctors should carefully observe patients like detectives during physical examinations. The document outlines the process of a physical assessment including preparation, examination methods, and conducting assessments from head to toe. Key steps involve introducing oneself, obtaining permission before examining, asking about pain or discomfort, inspecting various body systems, and documenting findings and vital signs. Physical assessments provide objective health information through direct observation and examination techniques.
The document discusses the arterial pulse, including:
1. The pulse is a wave felt by fingers produced by cardiac systole that travels through arteries faster than blood flow. Different arteries have different time lags from cardiac systole.
2. The pulse provides important information about heart function, circulation, and arterial health. It can help detect arrhythmias and diagnose conditions like aortic regurgitation and heart failure.
3. The pulse should be examined in multiple locations and compared between sides. Features like rate, rhythm, volume, and characteristics provide clues to cardiovascular conditions. Certain pulse types indicate specific problems like aortic stenosis or mitral regurgitation.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
This document provides guidelines for performing a local chest examination, including inspection, palpation, percussion, and auscultation. The examination involves observing the patient's breathing patterns and chest shape, feeling the trachea, apex beat, and chest expansion, tapping to assess percussion notes, and listening for breath sounds, adventitious sounds like rhonchi or crackles, and vocal resonance. The examination is designed to evaluate the lungs, check for abnormalities, and compare both sides of the chest.
The document summarizes the examination of the respiratory system. It describes inspecting the chest shape and movements, palpating the apex beat and trachea position, percussing the chest to compare resonance, and auscultating breath sounds including vesicular, bronchial, vocal resonance, and added sounds like rhonchi or crepitations. The general exam includes appearance factors and the specific exam involves inspection, palpation, percussion, and auscultation of the chest and lungs to assess respiratory function and identify any abnormalities.
Dyspnea is a subjective experience of breathing discomfort that results from interactions between physiological, psychological, social, and environmental factors. The document discusses the mechanisms, causes, evaluation, and management of dyspnea. Evaluation involves obtaining a thorough history regarding onset, timing, severity, and relieving/precipitating factors. A physical exam focuses on vital signs, respiratory exam, cardiovascular exam, and neurological exam to help identify potential causes like heart failure, COPD, pneumonia, or asthma.
Clubbing, also known as Hippocrates fingers, is the bulbous enlargement of the fingertips and nails. It is caused by proliferation of subcutaneous tissues due to chronic hypoxemia from conditions like lung diseases, heart diseases, and liver or gastrointestinal diseases. Examination involves comparing the fingernails to look for reduced or absent diamond-shaped spaces, indicating clubbing. While clubbing itself has no treatment, addressing the underlying condition can potentially reverse it over time.
Doctors should carefully observe patients like detectives during physical examinations. The document outlines the process of a physical assessment including preparation, examination methods, and conducting assessments from head to toe. Key steps involve introducing oneself, obtaining permission before examining, asking about pain or discomfort, inspecting various body systems, and documenting findings and vital signs. Physical assessments provide objective health information through direct observation and examination techniques.
The document discusses the arterial pulse, including:
1. The pulse is a wave felt by fingers produced by cardiac systole that travels through arteries faster than blood flow. Different arteries have different time lags from cardiac systole.
2. The pulse provides important information about heart function, circulation, and arterial health. It can help detect arrhythmias and diagnose conditions like aortic regurgitation and heart failure.
3. The pulse should be examined in multiple locations and compared between sides. Features like rate, rhythm, volume, and characteristics provide clues to cardiovascular conditions. Certain pulse types indicate specific problems like aortic stenosis or mitral regurgitation.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
This document provides guidelines for performing a local chest examination, including inspection, palpation, percussion, and auscultation. The examination involves observing the patient's breathing patterns and chest shape, feeling the trachea, apex beat, and chest expansion, tapping to assess percussion notes, and listening for breath sounds, adventitious sounds like rhonchi or crackles, and vocal resonance. The examination is designed to evaluate the lungs, check for abnormalities, and compare both sides of the chest.
The document summarizes the examination of the respiratory system. It describes inspecting the chest shape and movements, palpating the apex beat and trachea position, percussing the chest to compare resonance, and auscultating breath sounds including vesicular, bronchial, vocal resonance, and added sounds like rhonchi or crepitations. The general exam includes appearance factors and the specific exam involves inspection, palpation, percussion, and auscultation of the chest and lungs to assess respiratory function and identify any abnormalities.
Dyspnea is a subjective experience of breathing discomfort that results from interactions between physiological, psychological, social, and environmental factors. The document discusses the mechanisms, causes, evaluation, and management of dyspnea. Evaluation involves obtaining a thorough history regarding onset, timing, severity, and relieving/precipitating factors. A physical exam focuses on vital signs, respiratory exam, cardiovascular exam, and neurological exam to help identify potential causes like heart failure, COPD, pneumonia, or asthma.
Clubbing, also known as Hippocrates fingers, is the bulbous enlargement of the fingertips and nails. It is caused by proliferation of subcutaneous tissues due to chronic hypoxemia from conditions like lung diseases, heart diseases, and liver or gastrointestinal diseases. Examination involves comparing the fingernails to look for reduced or absent diamond-shaped spaces, indicating clubbing. While clubbing itself has no treatment, addressing the underlying condition can potentially reverse it over time.
History taking and general examination of respiratory systemHimanshu Rana
This document provides an overview of how to conduct a history and physical examination of the respiratory system. It outlines the components of a respiratory history, including symptoms like cough, sputum production, dyspnea, hemoptysis and chest pain. For each symptom, it describes factors to assess such as duration, severity and aggravating/relieving factors. The document also details the physical exam of the respiratory system, covering vital signs, inspection findings and auscultation of breath sounds. Common causes are provided for abnormal findings on exam.
Clubbing refers to enlargement of the fingers and toes, particularly on the dorsal surface at the nail bed. It is graded based on changes to the nail bed and angle of the finger. Clubbing is associated with lung, heart, gastrointestinal and endocrine diseases. Some common causes that can be remembered with the acronym CLUBBING include congenital heart diseases, lung diseases, and cancers of the lungs, liver or bowels. Current evidence suggests clubbing may be caused by platelets that normally break down in the lungs but in lung diseases reach the extremities, releasing growth factors that stimulate connective tissue proliferation and clubbing. Clinical tests to assess clubbing include checking for nail bed fluctuation, loss of the Lovib
This document provides information on performing a local examination of the chest. It describes the key components of inspection, palpation, percussion, and auscultation. Inspection involves examining the shape of the chest and spine for any deformities. Palpation is used to confirm respiratory movements and feel for pulsations, adventitious sounds, and tracheal position. Percussion determines the lung borders and areas of dullness or resonance. Auscultation identifies breath sounds and adventitious sounds such as rhonchi or pleural rubs. Performing a thorough local chest exam provides important clinical information.
This document outlines the steps for performing a cardiovascular examination, including inspection, palpation of pulses, auscultation of heart sounds, and assessment for common cardiovascular problems. The exam involves checking general appearance, eyes, face, precordium, and ankles. Key pulses, jugular venous pressure, heart sounds, murmurs and extra sounds are auscultated systematically. Common presenting complaints like chest pain, breathlessness, palpitations, and syncope are discussed.
This document provides an examination of the cardiovascular system. It begins with a general examination including vital signs. It then discusses signs such as pallor, cyanosis, clubbing, and edema. The document examines the pulse, blood pressure, jugular venous pressure, and auscultation of heart sounds. It provides details on normal and abnormal findings for each of these exam components. The document concludes with an examination of peripheral pulses and abnormalities of the jugular venous pulse.
Local chest examination record modifiedSamiaa Sadek
1. The document describes the techniques of respiratory system examination including inspection, palpation, percussion, and auscultation.
2. Inspection evaluates respiratory movements and patterns, chest shape and size, pulsations, scars, and skin changes.
3. Palpation assesses tactile vocal fremitus, chest wall tenderness, pulsations, and adventitious lung sounds.
4. Percussion determines chest wall resonance and changes related to underlying conditions like consolidation or effusion.
This document provides an overview of how to perform an abdominal examination. It discusses examining the abdomen by inspection, palpation, percussion and auscultation in a systematic manner. Key points covered include examining the abdomen in four quadrants, assessing for masses, tenderness, organomegaly and ascites. Common clinical tests discussed are Murphy's sign, McBurney's point and shifting dullness.
This document provides an overview of lung sounds and their characteristics. It begins by outlining proper auscultation technique and then describes the features of normal and abnormal breath sounds including vesicular, tracheal, bronchovesicular, bronchial, adventitious sounds like wheezes, crackles, and stridor. It notes the locations and causes of different lung sounds. In summary, it is a guide for identifying and interpreting various lung sounds through auscultation.
This document provides details on the clinical examination of the respiratory system, including the typical sequence and key aspects to examine at each step. It describes the important findings from inspection, palpation, percussion, and auscultation of the chest. Abnormal findings are highlighted, along with the potential underlying conditions. Key diagnostic signs and breath sounds are defined. The document serves as a comprehensive guide to performing a thorough respiratory examination.
The document provides guidance on performing a respiratory system examination, including:
- Surface anatomy and landmarks of the lungs and lobes
- Steps for a full examination, covering inspection, palpation, percussion, auscultation, and assessment of vocal resonance and tactile fremitus
- Descriptions of normal and abnormal breath sounds such as wheezes, crackles, stridor, and pleural rubs
- How findings on examination can indicate potential respiratory conditions such as consolidation, pleural effusion, or pneumothorax
The document summarizes the clinical examination of the cardiovascular system. It outlines the key steps in examining the heart, including inspection of the chest shape and pulsations, palpation of the apex beat and other areas, percussion of the cardiac borders, and auscultation of the heart sounds at different locations. It then provides the normal findings for each part of the examination, such as the location of the apex beat, normal heart sounds, and absence of murmurs, thrills, or other abnormalities.
Chronic bronchitis is defined as a persistent cough with mucus production for at least three months in a year for two consecutive years. It is primarily caused by long-term irritation and inflammation of the airways due to cigarette smoke or other inhaled chemicals. Chronic bronchitis can progress to more severe lung diseases like COPD or lung cancer and, if left untreated, may result in heart failure or respiratory infections. The pathology involves damage to the airways, thickening of the mucus membranes, and increased mucus production.
This document summarizes common presenting symptoms of respiratory disorders including cough, sputum production, hemoptysis, breathlessness, chest pain, voice changes, and hiccups. For each symptom, it describes typical causes, associated features to ask about, and examples of patients presenting with that symptom. It provides clinical details to help physicians evaluate respiratory symptoms and determine potential etiologies.
This document describes a case of a 46-year-old male presenting with 3 weeks of fever, 1 day of slurred speech, and 1 day of left-sided weakness. He has a history of valvular heart disease. Examination found a pansystolic murmur and left hemiparesis. Tests showed vegetations on the mitral valve and multiple brain infarcts. He was diagnosed with infective endocarditis and treated with antibiotics. A discussion of infective endocarditis follows covering topics like pathogenesis, risk factors, clinical manifestations, complications, and diagnosis.
Pulse Examination PPT -- By Prof.Dr.R.R.deshpande -- This is PPT abput Pulse Examination .Prof.Deshpande has explained how pulse should be examined for Rate,Rhythm,Volume ,Tension ,equality on both side ,Condition of vessel wall .He also explained about Sphygmograph .
Mobile – 922 68 10630
Also visit – www.ayurvedicfriend.com
Abnormal findings can occur in the pulse rate, rhythm, volume, character, vessel walls, and radiofemoral delay.
Tachycardia is a pulse rate over 100 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions. Bradycardia is a pulse rate under 60 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions.
An irregular pulse can be occasionally, regularly, or irregularly irregular and caused by conditions like extrasystole, ectopic beats, arrhythmias, and atrial fibrillation.
Other abnormalities include high or low pulse volume caused by physiological or pathological conditions, varying volume seen with
This document provides an overview of how to examine the cardiovascular system through history, examination of vital signs, inspection, palpation, and auscultation. It details how to examine the pulse, blood pressure, jugular venous pulse, apex beat, and heart sounds. It describes normal findings as well as abnormalities that may be found and how to characterize different types of murmurs. The examination is supported by additional tests like ECG, chest x-ray, and echocardiogram.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
Case Presentation On Respiratory Medicinedrtanoybose
A 68-year-old male presented with a 1-month history of persistent dry cough, nocturnal coughing exacerbations, hemoptysis, and chest pain exacerbated by coughing, along with weight loss and malaise. He had a history of recurrent gastrointestinal bleeding, exposure to tuberculosis, and long-term exposure to cable processing industry. Examination found decreased breath sounds and dullness on the right lung. Investigations showed anemia, elevated ESR, and a consolidation in the right lower lobe on HRCT with pleural adhesions. A provisional diagnosis of carcinoma, tuberculosis, or interstitial lung disease was made.
Examinating the Resipiratory System.pptxssuser504dda
This document provides guidance on examining the respiratory system through history taking and physical examination. It details what to ask patients regarding symptoms like breathlessness, cough, sputum production, and chest pain. It also explains how to inspect, palpate, percuss and auscultate the chest. Specific tests are described like measuring chest expansion, examining neck veins, and evaluating breath sounds and vocal fremitus. A thorough respiratory exam provides clues to underlying cardiopulmonary conditions.
This document provides an overview of assessing the respiratory system, including:
1) The anatomy and physiology of the respiratory system and descriptions of normal breath sounds.
2) The basic steps of respiratory assessment - Inspection, Palpation, Percussion, and Auscultation (IPPA).
3) Details on inspecting the chest wall, palpating tactile fremitus, percussing the chest, and auscultating breath sounds at different locations.
History taking and general examination of respiratory systemHimanshu Rana
This document provides an overview of how to conduct a history and physical examination of the respiratory system. It outlines the components of a respiratory history, including symptoms like cough, sputum production, dyspnea, hemoptysis and chest pain. For each symptom, it describes factors to assess such as duration, severity and aggravating/relieving factors. The document also details the physical exam of the respiratory system, covering vital signs, inspection findings and auscultation of breath sounds. Common causes are provided for abnormal findings on exam.
Clubbing refers to enlargement of the fingers and toes, particularly on the dorsal surface at the nail bed. It is graded based on changes to the nail bed and angle of the finger. Clubbing is associated with lung, heart, gastrointestinal and endocrine diseases. Some common causes that can be remembered with the acronym CLUBBING include congenital heart diseases, lung diseases, and cancers of the lungs, liver or bowels. Current evidence suggests clubbing may be caused by platelets that normally break down in the lungs but in lung diseases reach the extremities, releasing growth factors that stimulate connective tissue proliferation and clubbing. Clinical tests to assess clubbing include checking for nail bed fluctuation, loss of the Lovib
This document provides information on performing a local examination of the chest. It describes the key components of inspection, palpation, percussion, and auscultation. Inspection involves examining the shape of the chest and spine for any deformities. Palpation is used to confirm respiratory movements and feel for pulsations, adventitious sounds, and tracheal position. Percussion determines the lung borders and areas of dullness or resonance. Auscultation identifies breath sounds and adventitious sounds such as rhonchi or pleural rubs. Performing a thorough local chest exam provides important clinical information.
This document outlines the steps for performing a cardiovascular examination, including inspection, palpation of pulses, auscultation of heart sounds, and assessment for common cardiovascular problems. The exam involves checking general appearance, eyes, face, precordium, and ankles. Key pulses, jugular venous pressure, heart sounds, murmurs and extra sounds are auscultated systematically. Common presenting complaints like chest pain, breathlessness, palpitations, and syncope are discussed.
This document provides an examination of the cardiovascular system. It begins with a general examination including vital signs. It then discusses signs such as pallor, cyanosis, clubbing, and edema. The document examines the pulse, blood pressure, jugular venous pressure, and auscultation of heart sounds. It provides details on normal and abnormal findings for each of these exam components. The document concludes with an examination of peripheral pulses and abnormalities of the jugular venous pulse.
Local chest examination record modifiedSamiaa Sadek
1. The document describes the techniques of respiratory system examination including inspection, palpation, percussion, and auscultation.
2. Inspection evaluates respiratory movements and patterns, chest shape and size, pulsations, scars, and skin changes.
3. Palpation assesses tactile vocal fremitus, chest wall tenderness, pulsations, and adventitious lung sounds.
4. Percussion determines chest wall resonance and changes related to underlying conditions like consolidation or effusion.
This document provides an overview of how to perform an abdominal examination. It discusses examining the abdomen by inspection, palpation, percussion and auscultation in a systematic manner. Key points covered include examining the abdomen in four quadrants, assessing for masses, tenderness, organomegaly and ascites. Common clinical tests discussed are Murphy's sign, McBurney's point and shifting dullness.
This document provides an overview of lung sounds and their characteristics. It begins by outlining proper auscultation technique and then describes the features of normal and abnormal breath sounds including vesicular, tracheal, bronchovesicular, bronchial, adventitious sounds like wheezes, crackles, and stridor. It notes the locations and causes of different lung sounds. In summary, it is a guide for identifying and interpreting various lung sounds through auscultation.
This document provides details on the clinical examination of the respiratory system, including the typical sequence and key aspects to examine at each step. It describes the important findings from inspection, palpation, percussion, and auscultation of the chest. Abnormal findings are highlighted, along with the potential underlying conditions. Key diagnostic signs and breath sounds are defined. The document serves as a comprehensive guide to performing a thorough respiratory examination.
The document provides guidance on performing a respiratory system examination, including:
- Surface anatomy and landmarks of the lungs and lobes
- Steps for a full examination, covering inspection, palpation, percussion, auscultation, and assessment of vocal resonance and tactile fremitus
- Descriptions of normal and abnormal breath sounds such as wheezes, crackles, stridor, and pleural rubs
- How findings on examination can indicate potential respiratory conditions such as consolidation, pleural effusion, or pneumothorax
The document summarizes the clinical examination of the cardiovascular system. It outlines the key steps in examining the heart, including inspection of the chest shape and pulsations, palpation of the apex beat and other areas, percussion of the cardiac borders, and auscultation of the heart sounds at different locations. It then provides the normal findings for each part of the examination, such as the location of the apex beat, normal heart sounds, and absence of murmurs, thrills, or other abnormalities.
Chronic bronchitis is defined as a persistent cough with mucus production for at least three months in a year for two consecutive years. It is primarily caused by long-term irritation and inflammation of the airways due to cigarette smoke or other inhaled chemicals. Chronic bronchitis can progress to more severe lung diseases like COPD or lung cancer and, if left untreated, may result in heart failure or respiratory infections. The pathology involves damage to the airways, thickening of the mucus membranes, and increased mucus production.
This document summarizes common presenting symptoms of respiratory disorders including cough, sputum production, hemoptysis, breathlessness, chest pain, voice changes, and hiccups. For each symptom, it describes typical causes, associated features to ask about, and examples of patients presenting with that symptom. It provides clinical details to help physicians evaluate respiratory symptoms and determine potential etiologies.
This document describes a case of a 46-year-old male presenting with 3 weeks of fever, 1 day of slurred speech, and 1 day of left-sided weakness. He has a history of valvular heart disease. Examination found a pansystolic murmur and left hemiparesis. Tests showed vegetations on the mitral valve and multiple brain infarcts. He was diagnosed with infective endocarditis and treated with antibiotics. A discussion of infective endocarditis follows covering topics like pathogenesis, risk factors, clinical manifestations, complications, and diagnosis.
Pulse Examination PPT -- By Prof.Dr.R.R.deshpande -- This is PPT abput Pulse Examination .Prof.Deshpande has explained how pulse should be examined for Rate,Rhythm,Volume ,Tension ,equality on both side ,Condition of vessel wall .He also explained about Sphygmograph .
Mobile – 922 68 10630
Also visit – www.ayurvedicfriend.com
Abnormal findings can occur in the pulse rate, rhythm, volume, character, vessel walls, and radiofemoral delay.
Tachycardia is a pulse rate over 100 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions. Bradycardia is a pulse rate under 60 bpm and can be caused by sinus rhythm, arrhythmias, medications, and medical conditions.
An irregular pulse can be occasionally, regularly, or irregularly irregular and caused by conditions like extrasystole, ectopic beats, arrhythmias, and atrial fibrillation.
Other abnormalities include high or low pulse volume caused by physiological or pathological conditions, varying volume seen with
This document provides an overview of how to examine the cardiovascular system through history, examination of vital signs, inspection, palpation, and auscultation. It details how to examine the pulse, blood pressure, jugular venous pulse, apex beat, and heart sounds. It describes normal findings as well as abnormalities that may be found and how to characterize different types of murmurs. The examination is supported by additional tests like ECG, chest x-ray, and echocardiogram.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
Case Presentation On Respiratory Medicinedrtanoybose
A 68-year-old male presented with a 1-month history of persistent dry cough, nocturnal coughing exacerbations, hemoptysis, and chest pain exacerbated by coughing, along with weight loss and malaise. He had a history of recurrent gastrointestinal bleeding, exposure to tuberculosis, and long-term exposure to cable processing industry. Examination found decreased breath sounds and dullness on the right lung. Investigations showed anemia, elevated ESR, and a consolidation in the right lower lobe on HRCT with pleural adhesions. A provisional diagnosis of carcinoma, tuberculosis, or interstitial lung disease was made.
Examinating the Resipiratory System.pptxssuser504dda
This document provides guidance on examining the respiratory system through history taking and physical examination. It details what to ask patients regarding symptoms like breathlessness, cough, sputum production, and chest pain. It also explains how to inspect, palpate, percuss and auscultate the chest. Specific tests are described like measuring chest expansion, examining neck veins, and evaluating breath sounds and vocal fremitus. A thorough respiratory exam provides clues to underlying cardiopulmonary conditions.
This document provides an overview of assessing the respiratory system, including:
1) The anatomy and physiology of the respiratory system and descriptions of normal breath sounds.
2) The basic steps of respiratory assessment - Inspection, Palpation, Percussion, and Auscultation (IPPA).
3) Details on inspecting the chest wall, palpating tactile fremitus, percussing the chest, and auscultating breath sounds at different locations.
The document provides information on assessing the respiratory system through physical examination. It discusses the anatomy and physiology of the respiratory system and outlines the key steps in examination, which include inspection, palpation, percussion, and auscultation. The document describes how to perform and evaluate each part of the examination, noting normal and abnormal findings. The goal is to comprehensively assess respiratory system function and identify any potential issues.
This document provides an overview of respiratory system physical examination. It begins with learning objectives focused on anatomy, examination techniques, and abnormal findings. It then details anatomy of the lungs, trachea, and bronchi. The cardinal steps of respiratory examination are described as inspection, palpation, percussion, and auscultation. Normal findings for each step are outlined. The document provides guidance on examining breathing patterns, chest shape, symmetry of movement, clubbing, cyanosis, and more. Percussion notes and auscultation of breath sounds are also explained.
This document discusses pneumothorax, which is the presence of air in the pleural space outside the lung. It describes different types of pneumothorax including primary spontaneous, secondary spontaneous, closed, open, and tension pneumothorax. Risk factors, clinical features, diagnosis using chest x-ray, treatment options including chest tube insertion, and postoperative management of chest drains are covered. Surgical intervention is indicated for recurrent pneumothorax or when chest drainage fails.
This document provides an overview of chest radiograph interpretation for interns, covering normal anatomy, common pathologies, and technical factors. It summarizes how to evaluate for adequate penetration, inspiration, rotation, magnification, and angulation. Common pathologies like pleural effusion, pneumothorax, pneumonia, and pulmonary tuberculosis are described with examples. Normal pediatric and adult chest x-ray features are outlined along with how to read and interpret the major anatomical structures visible.
This document provides guidance on evaluating patients presenting with dyspnea (shortness of breath). It defines dyspnea and lists some specific types based on position. Common causes are outlined for pulmonary, cardiac, mixed, and non-cardiopulmonary origins. A clinical approach is described beginning with vital signs and history, followed by physical exam focusing on respiratory, cardiac, and fluid status findings. Initial investigations include chest X-ray, blood gases, ECG, and blood tests. Further tests may include lung function, exercise testing, and biomarkers to differentiate cardiac from pulmonary causes when the chest X-ray is normal. Careful history taking and physical exam remain important to identify underlying conditions.
This document provides a summary of key findings that may be seen on chest x-rays. It begins with examples of normal chest x-rays and describes the basic knowledge needed to interpret x-rays. It then discusses specific lung diseases and findings, including pleural diseases, pneumothorax, tuberculosis, pneumonia, interstitial pulmonary fibrosis, COPD, sarcoidosis, and pericardial effusion. Each section provides examples of chest x-rays demonstrating the relevant findings. The document is intended as a study aid for medical exams.
This document presents the case of a 50-year-old male smoker with COPD who presented with acute dyspnea and left chest pain for 3 days. On examination, the patient was dyspneic with decreased breath sounds and chest expansion on the left side. A chest X-ray showed a 41% pneumothorax on the left. A tube thoracostomy was performed and the lung re-expanded. The tube was removed after 2 days and the patient was discharged on medications with instructions to follow up after 1 week.
The document provides details on inspecting and examining the chest through various techniques including inspection of shape and movements, palpation, percussion, and auscultation. It describes assessing respiratory rate and patterns, intercostal retractions, areas of dullness or resonance on percussion over different regions of the chest, and listening for breath sounds and adventitious sounds by auscultation. The examination aims to evaluate the lungs, pleura, mediastinum, and underlying cardiac and skeletal structures.
Tetralogy of Fallot is a congenital heart defect characterized by four abnormalities: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and overriding of the aorta. It occurs in approximately 1 in 2,500 live births. Without treatment, it can cause cyanosis and heart failure in infants. The definitive treatment is open-heart surgery to repair the abnormalities. After successful surgery, patients typically enjoy an active life without symptoms.
This document discusses upper airway obstruction, including its location, signs and symptoms, causes, and types. The upper airway extends from the nose or mouth to the main carina. Common causes of obstruction include infections, tumors, and trauma. Signs include noisy breathing, dyspnea, and hypoxemia. Obstructions can be fixed or variable. Fixed obstructions do not change size during breathing and result in flattened flow-volume loops. Variable obstructions change size during breathing, most commonly seen in vocal cord paralysis. Proper diagnosis relies on patient history and examination of flow-volume loops.
Assessing the and Peripheral Vascular System.docxwrite22
This document discusses a patient presenting with shortness of breath, cough, and fever. On examination, the patient has diminished breath sounds and rales. A chest x-ray shows an infiltrate in the right middle lobe. Potential diagnoses discussed include pneumonia, myocardial infarction, pulmonary embolism, congestive heart failure, and asthma. Pneumonia is considered the most likely based on symptoms and exam findings. References from 2013-2018 are provided to support the different diagnoses.
This document discusses the radiographic findings of complete opacification of one hemithorax seen on a chest x-ray. It notes that the position of the mediastinum and trachea can help narrow the differential diagnosis. Specifically:
- If the trachea is pulled towards the opacified side, possibilities include pneumonectomy, total lung collapse, pulmonary agenesis, or pulmonary hypoplasia.
- If the trachea remains central, consolidation, pulmonary edema/ARDS, a pleural mass, or chest wall mass should be considered.
- If the trachea is pushed away from the opacified side, a pleural effusion, diaphragmatic hernia,
Radiology in newborn collected by Dr. Saiful islam MDDr. Habibur Rahim
This document summarizes a presentation on radiology in newborns. It discusses:
1. Types of radiographic examinations performed in newborns including chest x-rays, abdominal x-rays, and contrast studies.
2. How to assess the quality of chest x-rays and what normal findings look like.
3. Common chest x-ray findings for conditions like respiratory distress syndrome, transient tachypnea of the newborn, and pneumonia.
4. Positioning of tubes and catheters visible on chest x-rays.
5. Common abdominal x-ray findings including those for intestinal obstruction and duodenal atresia.
This document summarizes a presentation on radiology in newborns. It discusses:
- Types of radiographic examinations including chest x-rays, abdominal x-rays, and contrast studies.
- How to assess the quality of chest x-rays and common findings seen in newborns such as respiratory distress syndrome, transient tachypnea of the newborn, and pneumonia.
- Position of tubes and catheters visible on x-rays including endotracheal tubes, umbilical lines, and how to identify malpositions.
- Normal abdominal findings in newborns and common conditions seen on abdominal x-rays like intestinal obstruction.
This document provides an overview of the respiratory system including anatomy, physiology, clinical syndromes, examination techniques, and common respiratory complaints. Key points include:
- The respiratory system includes the upper and lower respiratory tract, primary and accessory muscles of respiration, and lungs.
- Respiratory physiology involves ventilation, oxygenation, and control centers in the brainstem and chemoreceptors.
- The pulmonary exam follows inspection, palpation, percussion, and auscultation and evaluates the chest shape/movement, fremitus, expansion, and percussion notes to identify abnormalities.
- Common respiratory complaints are cough, sputum production, shortness of breath, chest pain, and wheezing which
The document discusses the development, anatomy, openings, effect on respiration, and disorders of the diaphragm. It begins by describing the diaphragm's embryological development from four sources and its adult anatomy. It then discusses openings in the diaphragm, how its curved shape facilitates respiration, and disorders such as diaphragm fatigue, paralysis, hernias, and tumors. Radiographic appearance and management of various conditions are also outlined.
This document provides an overview of respiratory medicine, covering topics such as anatomy and physiology of the lungs, respiratory failure, pleural diseases, asthma, COPD, and more. It defines conditions, lists their typical causes and presentations, and outlines recommended diagnostic tests and treatment approaches. Key areas covered include the mechanics of breathing, definitions of respiratory failure types, common pleural effusions and their management, asthma diagnosis and treatment guidelines, risk factors and management of COPD, and criteria for exacerbation treatment.
This document provides an overview of techniques for respiratory assessment, including inspection, palpation, percussion, and auscultation. Inspection involves examining general conditions like consciousness and posture, as well as the neck, skin, chest shape, and breathing patterns. Palpation feels for areas of tenderness, masses, and evaluates chest expansion. Percussion distinguishes the sounds over different body tissues. Auscultation listens for abnormal breath sounds like wheezes, rhonchi, crackles, and stridor which can indicate various respiratory conditions. The assessment methods allow for evaluating signs of respiratory disease or injury.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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6. 1. 2nd Rib joins
2. Arch of Aorta(beginning and
the end)
3. Trachea bifurcates into the
two bronchi
4. Pulmonary trunk bifurcation
5. Left recurrent laryngeal nerve
looping under the arch of the
aorta
6. Azygous Vein draining into
the superior vena cava.
7. Thoracic duct emptying into
the left subclavian vein
12. Pallor (Anemia)
The pallor of anemia is best seen in the
mucous membranes of the conjunctivae, lips
and tongue and in the nail beds
Anaemia may occur when there is
a. Haemoptysis
b. Excessive sputum production and protein
loss
c. Loss of appetite leading to malnutrition
13. Cyanosis
This is a blue discoloration of the skin and mucous membranes caused
by increased concentration of reduced hemoglobin (5g/dl)
Central cyanosis may result from the reduced arterial oxygen saturation
caused by cardiac or pulmonary disease. Intracardiac or extracardiac
shunting.
Impaired pulmonary function
a. Alveolar hypoventilation
b. Ventilation—Perfusion mismatch
c. Impaired oxygen diffusion.
14. Bulbous enlargement of the distal portion
of the digit due to increased subungual soft
tissue.
Clubbing
15. Grading of Clubbing
Grade I Positive nail bed fluctuation
Grade II Obliteration of the Lovibond angle
Grade III Parrot beak / Drumstick appearance
Grade IV Hypertrophic osteoarthropathy.
16. Pulmonary and Thoracic Causes
a. Bronchogenic carcinoma (rare in adenocarcinoma)
b. Metastatic lung cancer
c. Suppurative lung disease
1. Bronchiectasis
2. Cystic fibrosis
3. Lung abscess
4. Empyema
d. Interstitial lung disease
e. Longstanding pulmonary tuberculosis
f. Chronic bronchitis
g. Mesothelioma
h. Neurogenic diaphragmatic tumour
i. Pulmonary AV malformation
j. Sarcoidosis.
17. Hypertrophic Osteoarthropathy
It is a painful swelling of the wrist, elbow, knee, ankle,
with radiographic evidence of sub-periosteal new bone
formation. It can be familial or idiopathic.
common disorders that can produce it are:
a. Bronchogenic carcinoma
b. Cystic fibrosis
c. Neurofibroma
d. A-V malformation.
18. Lymphadenopathy
Scalene lymph node enlargement
1. Large and fixed in secondary involvement from a
primary lung malignancy
2. Hard and craggy, matted, with or without sinus
formation in healed and calcified tuberculous
lymphadenopathy.
19. Blood Pressure
Pulsus Paradoxus
Systolic blood pressure normally falls during quiet inspiration in
normal individuals.
Pulsus paradoxus is defined as a fall of systolic blood pressure of
>10 mmHg during the inspiratory phase.
severe acute asthma or exacerbations of chronic obstructive
pulmonary disease.
20. Examination of the Neck Veins
Jugular Venous Pulse
COPD/cor pulmonale
Bilateral non-pulsatile
SVC obstruction
Massive right sided pleural effusion
21. 2) Examination of the Chest
Inspection
Palpation
Percussion
Auscultation
The subject should be examined in the Standing or Sitting position in an
erect, and in good light.
22. All the findings in the clinical examination should
be compared on both sides in the following areas:
1. Supraclavicular area
2. Infraclavicular area
3. Mammary region
4. Inframammary region
5. Axillary region
6. Infra-axillary region
7. Suprascapular region
8. Interscapular region
9. Infrascapular region.
23. Inspection
Inspection for Position of trachea
Inspection for Symmetry of Chest
Inspection for Chest wall abnormalities
Inspection for Movement of the Chest
Inspection for Apex beat
Inspection for Dilated and engorged veins
Inspection for Surgical or any Scars or Sinuses
24. Inspection for Position of trachea
Trail’s sign: It is the undue prominence of the clavicular head of
sternomastoid on the side to which the trachea is deviated.
Position of Apex Beat
The apex beat is shifted to the side of mediastinal shift.
25. Inspection for Symmetry of Chest
Normal chest is symmetrical and elliptical in cross section.
The normal antero-posterior to transverse diameter ratio
(Hutchinson’s index) is 5 : 7.
The normal subcostal angle is 90°. It is more acute in
males than in females.
AP
T
AP:T = 5:7
26. Look for the following:
1. Drooping of the shoulder
2. Hollowness or fullness in the supraclavicular and infraclavicular fossa
3. Crowding of ribs
4. Kyphosis (forward bending of the spine)
5. Scoliosis (lateral bending of the spine).
27. Inspection for Chest wall abnormalities
1.Flat chest: The antero-posterior to transverse diameter ratio is 1 :
2.
Seen in pulmonary TB and fibrothorax
28. 2.Barrel chest: The anteroposterior to transverse diameter
ratio is 1 : 1.
Seen in physiological states like infancy and old age and in
pathological states like COPD (emphysema)
29. 3. Pigeon chest (Pectus carinatum) : It is forward protrusion of
sternum and adjacent costal cartilage,
seen in Marfan’s syndrome, in childhood asthma and rickets
30. 4.Pectus excavatum (funnel chest, cobbler’s chest)
It is the exaggeration of the normal hollowness over the
lower end of the sternum. It is a developmental defect.
The apex beat shifted further to the left and the ventilatory
capacity of the lung is restricted.
It is seen in Marfan’s syndrome
31. 5. Harrison’s sulcus: It is due to the indrawing of ribs to form
symmetrical horizontal grooves above the costal margin, along the line of
attachment of diaphragm
occurs in chronic respiratory
disease in childhood,
childhood asthma, rickets and
blocked nasopharynx due to
adenoid enlargement
32. 6. Scorbutic rosary: It is the sharp
angulation, with or without beading or
rosary formation, of the ribs, arising as
a result of backward displacement or
pushing in of the sternum,
e.g. Vitamin C deficiency.
7. Rickety rosary: It is a bead like
enlargement of costochondral junction,
e.g. rickets
33.
34. Spinal Deformity
Kyphoscoliosis : It is a disfiguring or
disabling deformity of the spine, producing a
shift of the apex beat. It reduces the
ventilatory capacity of the lung and
increases the work of breathing.
35. Inspection for Movement of the Chest
It is described in terms of rate, rhythm, equality and type of breathing
Rate
• The normal respiratory rate in relaxed adults is 14-18
breaths per minute
• The type of breathing in women is thoraco-abdominal
and in men is abdomino-thoracic
• The ratio of pulse rate to respiratory rate is 4 : 1.
36. Tachypnoea: It is an increase in respiratory rate more
than 20 per minute(Adult). Conditions causing tachypnoea
are:
a. Nervousness
b. Exertion
c. Fever
d. Hypoxia
e. Respiratory conditions
i. Acute pulmonary oedema
ii. Pneumonia
iii. Pulmonary embolism
iv. ARDS
v. Metabolic acidosis
37. Bradypnoea: It is a decrease in the rate of respiration.
Conditions causing bradypnoea are:
a. Alkalosis
b. Hypothyroidism (myxoedema)
c. Narcotic drug poisoning
d. Raised intracranial tension.
Hyperpnoea: It is an increase in depth of respiration.
Conditions causing hyperpnoea are:
a. Acidosis
b. Brainstem lesion
c. Hysteria.
38. Rhythm
Inspiration: It is an active process brought about by the
contraction of the external intercostal muscles and the
diaphragm
Expiration: It is a passive process and it depends upon
elastic recoil of the lungs.
Accessory muscles of inspiration are the scaleni,
trapezius and pectoral muscles.
Accessory muscles of expiration are abdominal
muscles and latissimus dorsi.
39. Abnormal Breathing Patterns
Abnormal breathing patterns may be regular or irregular
Regular abnormal breathing patterns
a. Cheyne-Stokes breathing: It is characterised by hyperpnoea
followed by apnoea.
It occurs in cardiac failure, renal failure, narcotic drug
poisoning and raised intracranial pressure
b. Kussmaul’s breathing: It is characterised by increase in rate and
depth of breathing.
It occurs in metabolic acidosis and pontine lesions.
40. Irregular abnormal breathing patterns
a. Biots breathing: It is characterised by apnoea between several
shallow or few deep inspirations. It occurs in meningitis
b. Ataxic breathing: It is characterised by irregular pattern of
breathing where both deep and shallow breaths occur randomly. It
occurs in brainstem lesions
c. Apneustic breathing: It is characterised by pause at
full inspiration, alternating with a pause in expiration,
lasting for 2 to 3 seconds. It occurs in pontine
lesions
41. Palpation
Palpation for Apex Beat (Position and Character)
Palpation for Position of trachea
Palpation for Measurement of the Chest Expansion
Palpation for Assessing of Chest Expansion
Palpation for Vocal fremitus (VF)
Palpation for Direction of flow in veins
Palpation for Tender points
42. The position of the trachea is confirmed by slightly flexing the neck
so that the chin remains in the midline.
The index finger is then inserted in the suprasternal notch and the
tracheal ring is felt.
Slight shift of trachea to the right is normal
Palpation for Position of trachea
43.
44.
45. Measurement of the Chest Expansion
The expansion of the chest should be measured with a tape
measure placed around the chest just below the level of the
nipples/inferior angle of scapula.
Chest circumference in full expiration
Chest circumference at full inspiration
Chest expansion
Right/Left Hemithorax
Normal expansion of the chest is 5-8 cm
In severe emphysema, it is less than 1 cm
46. General Restriction of Expansion
a. COPD
b. Extensive bilateral disease
c. Ankylosing spondylitis
d. Interstitial lung disease
e. Systemic sclerosis (hide bound chest).
Asymmetrical Expansion of the Chest
a. Pleural effusion
b. Pneumothorax
c. Extensive consolidation
d. Collapse
e. Fibrosis.
In all these above conditions, diminished
expansion occurs on the affected side.
49. It is a vibration felt by the hand when the patient is
asked to repeat ninety-nine or one-one-one, by putting
the vocal cord into action.
Identical areas of the chest are compared on both sides.
It is felt with the flat of the hand or with the ulnar
border of the hand for accurate localization.
It is increased in consolidation.
It is decreased in pleural effusion
Palpation for Vocal fremitus (VF)
50. Tenderness over the Chest Wall
It may be due to:
1. Empyema
2. Local inflammation of parietal pleura, soft tissue and
osteomyelitis
3. Infiltration with tumor
4. Non-respiratory cause (amoebic liver abscess).
52. Cardinal Rules of Percussion
a. The pleximeter: The middle finger of the examiner’s left hand should
be opposed tightly over the chest wall, over the intercostal spaces. The
other fingers should not touch the chest wall. Greater pressure should be
applied over a thick chest wall to remove air pockets
b. The plexor: The middle or the index finger of the examiner’s right
hand is used to hit the middle phalanx of the pleximeter
c. The percussion movement should be sudden, originating from the
wrist. The finger should be removed immediately after striking to avoid
damping
d. Proceed from the area of normal resonance to the area of impaired or
dull note, as the difference is then easily appreciated
e. The long axis of the pleximeter is kept parallel to the border of the
organ to be percussed.
53. Direct percussion—clavicle
Anterior Chest Wall
Clavicle: Direct percussion is used and percussion is
done within the medial 1/3rd of the clavicle
Supraclavicular region (Kronig’s isthumus):
It is a band of resonance 5-7 cm size over the
Supraclavicular fossa. The percussion is done by
standing behind the patient and the resonance of the
lung apices is assessed by this method.
Second to sixth intercostal spaces. However, the percussion
note cannot be compared due to relative cardiac dullness on
the left side.
Liver dullness can be percussed from the right 5th rib
downwards in the midclavicular line.
54. Lateral Chest Wall
Fourth to seventh intercostal spaces.
Liver dullness can be percussed from the right 8th rib
downwards in the midaxillary line.
Posterior Chest Wall
a. Suprascapular (above the spine of the scapula)
b. Interscapular region
c. Infrascapular region up to the eleventh rib.
Liver dullness can be percussed from the right 10th rib
downwards in the midscapular line.
55.
56.
57. Tidal Percussion
This is done to differentiate upward enlargement of liver or
subdiaphragmatic abscess from right sided parenchymal or pleural
disorder.
If on deep inspiration, the previous dull note in the fifth right
intercostal space on the mid clavicular line becomes resonant, it
indicates that the dullness was due to the liver, which had been
pushed down by the right hemidiaphragm with deep inspiration.
If the dullness persists on the other hand, it indicates underlying
right sided parenchymal or pleural pathology, in the absence of
diaphragmatic paralysis.
Shifting Dullness
This is done to demonstrate the shift of fluid in hydropneumothorax.
The immediate shift of fluid can be demonstrated by the dull area
percussed in the axilla in the sitting posture, becoming resonant on
lying down on the healthy side.
59. Listen with the patient relaxed and breathing deeply
through his open mouth.
Auscultate each side alternately, comparing findings over a
large number of equivalent positions to ensure that you do
not miss localised abnormalities.
Listen:
■ anteriorly from above the clavicle down to the sixth rib
■ laterally from the axilla to the eighth rib
■ posteriorly down to the level of the 11th rib.
■ Assess the quality and amplitude of the breath sounds.
Identifyany gap between inspiration and expiration, and
listen for added sounds.
Avoid auscultation within 3 cm of the midline anteriorly or
posteriorly, as these areas may transmit soundsdirectly from
the trachea or main bronchi.
60. Vesicular breath sounds
low pitched, rustling in
nature
produced by attenuating and
filtering effect of the lung
parenchyma.
Duration of the inspiratory
phase is longer than the
expiratory phase in a ratio of
3 : 1.
There is no pause between
the end of inspiration and the
beginning of expiration.
Bronchial breath sounds
It is loud and high pitched,
with an aspirate or guttural
quality.
It is produced by passage of
air through the trachea and
large bronchi
The duration of inspiration is
shortened whereas that of
expiration is prolonged or
equal
There is a pause between
inspiration and expiration.
64. Added sounds
Added sounds are abnormal sounds that arise in the lung itself or in the
pleura.
The added sounds most commonly arising in the lung are best referred
to as wheezes and crackles.
Pleural rub is a “creaking” or “rubbing” sound produced by friction
between the two layers of inflamed and roughened pleura.
NEW Terms OLD Terms Definations
coarse crackles râles non-musical, interruptedshort,
explosive sounds often described as
bubbling or clicking.
fine crackles crepitations
wheezes rhonchi Continuous musical sounds
associated with airway narrowing.
65. Vocal resonance is the detection of vibrations transmitted to the
chest from the vocal cords as the patient repeats a phrase, usually the
words ‘ninetynine’
assess the quality and amplitude of vocal resonance.
Types
a. Bronchophony: Voice sounds appear to be heard near the earpiece
of stethoscope and words are unclear, e.g. consolidation, cavity
communicating with a bronchus,
b. Aegophony: Voice sound has a nasal or bleating quality. On saying
‘E’, it will be heard as ‘A’ (E to A sign),
e.g. consolidation, cavity.
c. Whispering pectoriloquy: The patient is asked to whisper words at
the end of expiration, and this whispered voice individual syllables
are recognised clearly,
e.g. pneumonic consolidation, cavity communicating with a bronchus
66. Examination of RS
Name:
Age:
Sex:
Address:
Occupation:
1) General Physical Examination:
Young patient moderately built and moderately nourished, well oriented to
time place and person, conscious and cooperative
Pallor
Icterus
Cyanosis
Clubbing
Edema
Lymphadenopathy
Temperature
Pulse
Respiratory Rate
BP
JVP
67. 3) Examination of the Chest
Inspection:
Trachea appears Central in Position
Shape of the chest is elliptical, Bilaterally symmetrical
Movement of the chest is equal on both sides and normal
Respiratory Movement
Rate : 14 – 18 Breaths per minute
Rhythm : Regular
Depth : Normal
Type : Abdominothoracic / Thoracoabdominal
Accessory muscles of Respiration not in use
No skeletal deformity seen
Apical impulse not seen/seen at Left 5th ICS medial to MCL
No dilated or engorged veins present
No scars or swelling or other visible pulsations seen
68. Palpation:
Apical Impulse felt at Left 5th ICS medial to MCL and is of
Normal Character
Trachea centrally Placed (slightly deviated to right side)
Expansion of the chest is normal and symmetrical, expansion
is more at the base compared to apex and sides of chest
Measurement of the Chest Expansion
Transverse Diameter : ___cm
Anteroposterior Diameter : ___cm
Right/Left Hemithorax : ___cm
Chest circumference in expiration : ___cm
Chest circumference at full inspiration: ___cm
Chest expansion : ___cm
No tenderness present
69. Area Right Left
Supraclavicular area Equal on both sides
Infraclavicular area Equal on both sides
Mammary region Equal on both sides
Inframammary region Equal on both sides
Axillary region Equal on both sides
Infra-axillary region Equal on both sides
Suprascapular region Equal on both sides
Interscapular region Equal on both sides
Infrascapular region Equal on both sides
Vocal fremitus (VF)
70. Percussion:
Area Right Left
Supraclavicular area Resonant Resonant
Infraclavicular area Resonant Resonant
Mammary region Resonant Dullness
Inframammary region Dullness(5th ICS onwards) Dullness
Axillary region Resonant Resonant
Infra-axillary region Resonant Resonant
Suprascapular region Resonant Resonant
Interscapular region Resonant Resonant
Infrascapular region Resonant Resonant
71. Auscultation
Breath Sounds
Area Right Left
Supraclavicular area Vesicular Vesicular
Infraclavicular area Vesicular Vesicular
Mammary region Vesicular Vesicular
Inframammary region Vesicular Vesicular
Axillary region Vesicular Vesicular
Infra-axillary region Vesicular Vesicular
Suprascapular region Vesicular Vesicular
Interscapular region Vesicular Vesicular
Infrascapular region Vesicular Vesicular
No added Sounds
72. Area Right Left
Supraclavicular area Equal on both sides
Infraclavicular area Equal on both sides
Mammary region Equal on both sides
Inframammary region Equal on both sides
Axillary region Equal on both sides
Infra-axillary region Equal on both sides
Suprascapular region Equal on both sides
Interscapular region Equal on both sides
Infrascapular region Equal on both sides
Vocal Resonance (VR)
Report: Examination of the respiratory system of the subject is clinically normal