This document provides an overview of examining the respiratory system. It discusses common symptoms like cough, dyspnea, and hemoptysis. For cough, it describes different types and potential causes like acute or chronic bronchitis, asthma, and GERD. For dyspnea, it discusses grades and positions as well as acute and chronic causes. Hemoptysis expectoration is examined based on amount and potential causes in the airways, vasculature, or parenchyma. The physical exam of the respiratory system is outlined, including inspection of breathing patterns, percussion notes, tactile fremitus, and auscultation of breath sounds.

1. EXAMINATION OF RESPIRATORY SYSTEM

2. Objectives
 Common symptoms of the respiratory
system
 Signs of respiratory diseases
 Differential diagnoses of respiratory
diseases

3. HISTORY TAKING IN RESPIRATORY CASE
 COUGH
 DYSPNEA
 HEMOPTYSIS
 CHEST PAIN
SPUTUM

4. COUGH:
Cough is a major defensive mechanism which
helps clear off respiratory pathogens.
Acute/Chronic cough
(>3 wks duration)
Expectorant/Dry cough
H/o exposure to allergens
Acute cough :
URTI along with fever&cold
Aspiration,
Pulmonary embolism
pulmonary edema
pneumonia
Chronic cough:
Chronic bronchitis(smokers)
Asthma,
GERD
Drugs like ACE inhibitors
Sinusitis,malignancy
Absence of cough:
Early post operative period
Neuromuscular diseases

5. Complications of cough:
Cough syncope, Bronchospasm,
Urinary incontinence,Conjunctival haemorrhage
Dry cough
Drug induced ACE inhibitors
allergens
Expectoration
Black-Smokers
Brown-
puemonia,pneumococci
Green/yellowish-infection
Pink frothy-P. edema
Bloody –TB,bronchiectasis
malignancy,
Types of cough:
Bovine cough-RLN palsy
Barking cough-epiglotitis
Paroxysmal cough-pertussis
Stridor- laryngotracheo -
bronchitis

6. DYSPNEA:SHORTNESS OF BREATH
Acute/chronic
Position:PND,orthopnea
Exertion
Acute dyspnea:
Asthma,pneumothorax,
Pulmonary edema,ARDS
Pulmonary emboli
Pulmonary infections
Chronic dyspnea:
COPD,asthma,CCF.
Grades of Dyspnea:
1-No dyspnea on normal
activity
2-Dyspnea on more than
normal activity but
comfortable at rest
3-Dyspnea on minimal
activity,comfortable only
at rest
4-Dyspnea on less than
minimal activity

7. HEMOPTYSIS
Expectoration of blood from below vocal cords
MILD,MODERATE,MASSIVE
1.Airways:
Chronic bronchitis,Bronchiectasis,Bronchogenic carcinoma
2.Pulmonary vasculature:
LVF,Pulmonary emboli,AV malformations.
3.Pulmonary parenchyma:
pneumonia, cocaine inhalation, Good pasteur’s syndrome,
Wegener’s granulomatosis.
4.Iatrogenic :
following lung biopsies, Anticoagulation.

8. PMH:
H/o frequent lung infections, Allergies, exposure to toxic
agents
Occupational history:
exposur to specific agents as in asbestosis, silicosis
General physical examination –
ill ( pneumonia), cachectic, in respiratory distress, stridor
 Hands – clubbing in respiratory disease from cancer –
non small cell bronchial carcinoma, chronic inflammation
e.g. bronchiectasis, lung abscess, fibrosis
 Wasting of the intrinsic muscle of the hand suggest T1
lesions e.g. pancoast tumor, wrist tenderness suggests
hypertrophic osteoarthropathy from lung cancer
 Colour – peripheral cyanosis,
 Asterixis is a CO2 retention flap, pulsus paradoxus is
weakened pulse in inspiration.eg severe asthma
 Face – ptosis and constricted pupil from horners
syndrome, with pancoast tumor – cervical sympathetic
plexus and brachial plexus. colour – are tongue/lips
blue/purplish from central cyanosis

9. INSPECTION OF RESPIRATORY SYSTEM
Respiratory pattern
Chest wall symmetry
Look for any abnormal shape
Like Barrel shaped chest
Pectus carinatum(pigeon’s)
Pectus excavatum(funnel’s)
Kypho-scoliosis

10. Lung and Pleural reflections:

11. Diagramatic representation of abnormal breath sounds

12. PALPATION IN RESPIRATORY CASE:
Position of trachea,tracheal tug
Chest expansion
Tactile fremitus
Here vibrations of the sounds are felt onto the chest
Wall as the sound waves are conducted through
the air in the bronchi,bronchioles,alveoli, chest wall
Compare the strengths of these vibrations on either side of
Chest-front,back,over apical, middle and basal zones.
Increased TF:Pneumonic consolidation
Decreased TF:pleural effusion,collapse

13. PALPATION OF CHEST WALL FOR EXPANSION AND
TACTILE FREMITUS

15. PERCUSSION OF CHEST:
Normal chest is resonant on percussion
Percussion must be done in all lung zones,including
the anterior aspects of lungs above clavicle.
Anything solid in pleural space or in lung parenchyma
decreases this resonance ,causing dullness on percussion
Any extra air in either pleural space or in the lung substance
will cause increase in sound resonance -hyperresonance

16. Percussion notes in different conditions:

17. Difference B/W

18. AUSCULTATION OF CHEST
Normal sounds of breathing consists of an inspiratory phase
followed by a shorter,softer,expiratory phase with no gap.
This is called the normal vesicular breathing
TYPES OF BREATHING
Vesicular
Bronchial
Bronchovesicular
Added sounds
Wheeze-high pitched, muscial,
air through narrowed tubes.
Asthma,COPD
Crackles- fine, medium,
coarse. Not cleared by
coughing as in
Pulmonary edema
Crepitations-consolidation
Pleural rub- crackly,grating,dry
low pitched, machine-like in
Plueritis

19. AUSCULTATORY ZONES OF LUNG:

21. RESPIRATORY SOUNDS

22. TAKE A GUESS!

23.  m