More Related Content
What's hot
What's hot (20)
Similar to General physical examination of the respiratory system
Similar to General physical examination of the respiratory system (20)
Recently uploaded
Recently uploaded (20)
General physical examination of the respiratory system
- 1. GENERAL PHYSICAL EXAMINATION OF THE RESPIRATORY SYSTEM DR.BERMIO.V.S
- 2. GENERAL EXAMINATION • HEAD TO FOOT EXAMINATION • ANTHROPOMETRY • VITAL SIGNS
- 3. HEAD TO FOOT EXAMINATION • GENERAL APPEARANCE • POSTURE, GAIT, STANCE • NUTRITION AND HYDRATION INCLUDING EDEMA • SKIN – PALLOR, ICTERUS, CYANOSIS, SCARS, SWELLINGS,LESIONS ETC • EYES – PALLOR, ICTERUS, SUBCONJUNCTIVAL EDEMA • FACE – EDEMA, PLETHORA • NECK – THYROID SWELLING, TRACHEAL TUG
- 4. • CHEST - GYNAECOMASTIA • HANDS – FINE TREMOR (INHALED BETA AGONISTS), FLAPS (HYPERCAPNIA), SMALL MUSCLE WASTING (DUE TO T1 INVOLVEMENT IN PANCOAST TUMOUR) • NAILS – CLUBBING, PALLOR, CYANOSIS, COLOUR, NICOTINE STAINS, ETC • LYMPH NODES • FEET • SPECIAL CONSIDERATION: • STIGMATA OF TUBERCULOSIS • FEATURES OF HORNERS SYNDROME
- 5. • EXAMINATION SHOULD BE DONE IN 45 DEG POSITION
- 6. GENERAL APPEARANCE • CONSCIOUSNESS LEVEL (CO2 NARCOSIS, METASTATIC MALIGNANCY) • COMFORTABLE/DISTRESSED • INABILITY TO COMPLETE A SENTENCE • USE OF ACCESSORY MUSCLES OF RESPIRATION (STERNOCLEIDOMASTOID, TRAPEZIUS, SCALENES, ALAE NASI) • INTERCOSTAL INDRAWING • PURSED LIP BREATHING (SEVERE COPD) • AUDIBLE WHEEZE (INSPIRATORY NOISE)/STRIDOR (EXPIRATORY NOISE) • HOARSENESS OF VOICE/ WEAKNESS OF VOICE • SURROUNDINGS (INHALERS, PEAK FLOW METERS, TISSUES, SPUTUM POT, OXYGEN MASK)
- 8. POSTURE • SITTING FORWARD WITH ARMS BRACED ON THE TABLE (SO THAT THEY CAN USE PECTORALIS MAJOR TO PULL THE RIBS OUTWARD) • LYING TOWARDS THE AFFECTED SIDE IN PNEUMONIA AND PLEURITIS (AUTO SPLINTING)
- 10. NUTRITION • MALNOURISHMENT • OBESITY • OBSTRUCTIVE SLEEP APNEA • CUSHINGOID HABITUS • CHRONIC STEROID USE • PARANEOPLASTIC
- 11. EDEMA IN RESPIRATORY SYSTEM • COR PULMONALE – B/L EDEMA • DEEP VEIN THROMBOSIS- U/L EDEMA
- 12. SKIN • A LIST OF PULMONARY CUTANEOUS SYNDROMES • DISTINCT SWELLING – METASTATIC NODULES IN LUNG CANCER • ERYTHEMA NODOSUM – SARCOIDOSIS, TB, HISTOPLASMOSIS, COCCIDIOIDOMYCOSIS • SKIN ABSCESS, IV MARKS – SOURCE OF LUNG ABSCESS • VASCULITIC CHANGES – PULMONARY RENAL SYNDROMES • PARANEOPLASTIC SKIN MANIFESTATIONS – ACANTHOSIS NIGRICANS, PEMPHIGOID, POLYMYOSITIS-DERMATOMYOSITIS, RAYNAUD PHENOMENON • ATOPIC DERMATITIS – SUGGESTS A COEXISTING BRONCHIAL ASTHMA • DAHL’S SIGN - COPD
- 13. SKIN
- 14. FACE – PLETHORA IN SVC OBSTRUCTION
- 15. NECK • TRACHEAL TUG (OLLIVERS SIGN) – SYSTOLIC DOWNWARD MOVEMENT OF THE TRACHEA IN AORTIC ANEURYSM
- 16. PALLOR IN RESPIRATORY DISEASES • HEMOPTYSIS • EXCESSIVE SPUTUM PRODUCTION CAUSING PROTEIN LOSS • LOSS OF APPETITE
- 17. ICTERUS • PULMONARY INFARCTION • DRUG INDUCED LIVER INJURY (ATT) • LIVER SECONDARIES
- 18. CYANOSIS • BLUISH DISCOLOURATION OF THE SKIN THAT IS CAUSED BY INCREASED AMOUNTS OF REDUCED HEMOGLOBIN IN THE SUBCAPILLARY VENOUS PLEXUS (MORE THAN 5 G%) • OR DUE TO ABNORMAL PIGMENTS IN BLOOD (METHB >1.5, SULFHB >0.5 G%) • CYANOSIS IS ABSENT IN SEVERE ANEMIA AND CO POISONING
- 20. CYANOSIS IN RESPIRATORY DISEASES • COPD • INTERSTITIAL LUNG DISEASE – CYANOSIS ON EXERTION • ALVEOLAR HYPOVENTILATION
- 22. CLUBBING • BULBOUS ENLARGEMENT OF THE DISTAL SEGMENTS OF THE DIGITS DUE TO INCREASE IN SOFT TISSUE • IT TAKES 2 TO 3 WEEKS FOR CLUBBING TO MANIFEST • CLUBBING FIRST APPEARS IN THE INDEX FINGER • CLUBBING IS SEEN IN 1% OF HOSPITAL ADMISSIONS BUT IS ASSOCIATED WITH A SERIOUS DIAGNOSIS IN 40% INDIVIDUALS
- 25. THEORIES OF CLUBBING • NEUROGENIC • HUMORAL • FERRITIN • HYPOXIC • PDGF THEORY
- 27. RESPIRATORY CAUSES OF CLUBBING • CLUBBING DOES NOT OCCUR IN COPD • HYPERTROPHIC OSTEO ARTHROPATHY – LUNG CANCER, CYSTIC FIBROSIS,SUPPURATIVE LUNG DISEASES • CLUBBING, TENDERNESS OF WRISTS AND ANKLES • SUBPERIOSTEAL NEW BONE FORMATION
- 28. UNILATERAL CLUBBING IN RESPIRATORY SYSTEM • PANCOAST TUMOUR
- 30. LYMPH NODES IN RESPIRATORY SYSTEM
- 31. EXTERNAL MARKERS OF TUBERCULOSIS • TINEA VERSICOLOR • PHLYCTENULAR CONJUNCTIVITIS/KERATITIS • LUPUS VULGARIS • ERYTHEMA NODOSUM • SCROFULODERMA • EPIDIDYMO-ORCHITIS • THICKENED SPERMATIC CORD
- 34. PULSE • BOUNDING PULSE IN CO2 RETENTION • NARROW IN MASSIVE HEMOPTYSIS
- 35. BLOOD PRESSURE • PULSUS PARADOXUS • INSPIRATORY FALL OF SBP >10 MM HG • OMINOUS SIGN IN OBSTRUCTIVE LUNG DISEASE
- 36. RESPIRATION • RATE (12 – 16/MIN) • TACHYPNEA (RATE MORE THAN 20 IS ABNORMAL IN ADULTS) • 15 TO 20 BREATHS PER MIN MAYBE DUE TO ANXIETY • DIFFERENT FROM DYSPNEA • BRADYPNEA • APNEA (CENTRAL APNEA/ OBSTRUCTIVE APNEA) • TYPE OF RESPIRATION • ABDOMINOTHORACIC • THORACOABDOMINAL • THORACIC – DIAPHRAGMATIC PARALYSIS, PERITONITIS, ASCITES • ABDOMINAL – PLEURITIS, LUNG COLLAPSE • PATTERN OF RESPIRATION • PARADOXICAL RESPIRATION AND THORACO-ABDOMINAL ASYNCHRONY
- 39. • CHEYNE STOKES BREATHING • SEVERELY ILL PATIENTS • SEVERE HEART FAILURE • NARCOTIC DRUG POISONING • NEUROLOGICAL DISORDERS • SLEEP, HEALTHY ADULTS IN ALTITUDE • DUE TO ABNORMAL FEEDBACK FROM CAROTID CHEMORECEPTORS TO RESPIRATORY CENTRE
- 40. NEUROLOGICAL CAUSES OF ABNORMAL BREATHING PATTERNS
- 41. JVP • NON PULSATILE ELEVATION IN JVP – SVC OBSTRUCTION • COR PULMONALE – PULSATILE ELEVATION IN JVP • PULMONARY HYPERTENSION • COPD • INTERSTITIAL LUNG DISEASE • BRONCHIECTASIS • ACUTE • TENSION PNEUMOTHORAX • LARGE PULMONARY EMBOLISM • DIFFICULT TO SEE JVP IN A BREATHLESS PATIENT • A RELAXED STERNOCLEIDOMASTOID IS ESSENTIAL FOR JVP
- 42. PULSE OXIMETRY • IN REST • IN EXERTION
- 43. EXAMINATION OF THE UPPER RESPIRATORY TRACT • NASAL POLYPS • WEGENERS GRANULOMATOSIS • ASTHMA (SAMPTERS TRIAD) • ABPA • CYSTIC FIBROSIS • SINUS TENDERNESS • ORAL HYGIENE • DENTAL CARIES, BITTEN TONGUE • TONSILS • POST NASAL DRIP • ORAL CANDIDIASIS (USE OF INHALED CORTICOSTEROIDS)
- 44. OTHER SYSTEM EXAMINATION • MUSCULOSKELETAL SYSTEM (TO R/O CONNECTIVE TISSUE DISEASES) • CARDIOVASCULAR SYSTEM (TO R/O PULMONARY HYPERTENSION AND COR PULMONALE) • ABDOMEN (ASCITES CAN CAUSE HEPATIC HYDROTHORAX)
- 45. REFERENCES • MACLEOD’S CLINICAL EXAMINATION 14TH ED. • HUTCHISON’S CLINICAL METHODS 24TH ED. • ALAGAPPAN MANUAL OF PRACTICAL MEDICINE, 5TH ED. • P.J.MEHTA’S PRACTICAL MEDICINE • HARRISON PRINCIPLES OF INTERNAL MEDICINE 20TH ED. • FISHMAN’S PULMONARY DISEASES AND DISORDERS, 5TH ED. • MURRAY & NADEL TEXTBOOK OF RESPIRATORY MEDICINE 6TH ED.