3. EXAMINATION OF RESPIRATORY SYSTEM

4.  INSPECTION  PALPATION  AUSCULTATION  PERCUSSION

5. GENERAL EXAMINATION CYANOSIS  Central  Peripheral causes  COPD  Type 2 resp. failure  Pulmonary fibrosis  B. asthma  Congenital cyanotic heart disease  Pulmonary embolism

9. OEDEMA Right ventricular failure—cor pulmonale FACE  Pink puffers  Blue bloaters  Congested neck veins  Rashes

12. EYES  Horner,s syndrome---ca. bronchus  Chemosis---SVC obstruction ---COPD NECK Lymph nodes----TB ---lymphoma --sarcoidosis ---malignancy

23. SKIN  Rashes—herpes zoster  Scars---previous operation,burns, biopsies  Pigmentation—haemochromotosis  Dilated veins---SVC obstruction

27. HANDS  Cyanosis  Clubbing---ca. bronchus ---TB ---empyema ---abcess ---fibrosing alveolitis ---bronchiectasis  Wasting of small muscles of hand ---pancoast tumour

35. PULSE  Tachycardia---> 120/min—infections ---P.E --B. asthma --COPD exacerbation  Small volume

36.  Collapsing pulse—large volume bounding pulse,carbon dioxide retention --type 2 resp. failure PULSES PARADOXUS  Status asthmaticus  Massive pulmonary embolism  Tension pneumothorax

37. EXAMINATION OF THE CHEST Inspection  A-P diameter --pectus excavatum---funnel chest --pectus carinatum---pigeon chest  kyphoscoliosis  respiratory movements---resp. rate-{14-18/min} i:e –hyperventillation—DKA, PE ---hypoventillation—type 2 resp. failure

38.  Chyne stokes breathing---cyclical variation in the depth of respiration with period of apnoea.  Use of accessory muscles---status asthmaticus  Tenderness—fractured ribs,metastasis, neuralgia

39.  SHAPE OF THE CHEST  Pectus excavetum  Pectus carinatum DILATED VEINS  SVC obstruction---Ca lung

46. Palpation Trachea 4-5 cm of the upper trachea can be felt in the neck between the cricoid cartilage and the sternal notch.  Pushed –pneumothorax -pleural effusion  Pulled—fibrosis --collapse

49.  Chest expansion– normal up to 5 cm -abnormal < 2 cm  Apex beat  Tactile fremitus --Ask the patient to say 99 --you should feel the vibration transmitted through the airways to the lung.

50.  Increased in---pneumothorax --emphysema  Decreased---pleural effusion Auscultation Breath sounds—  Vesicular—normal --insp. twice that of expiration --no pause  Bronchial –inspiration is shorter than expiration ---gap between insp. and exp.

51. Vesicular bronchial

52.  Increased---consolidation ---large cavity near the surface  Decreased---COPD ---Pleural effusion --pneumothorax

54. Added sounds  Crepitations---fine ---heart failure --fibrosing alveolitis ---coarse—bronchiectasis --infections  Wheezes or rhonchi---COPD --bronchial asthma

55. Pleural rub Whispering pectroloquy---consolidation --ask the patient to whisper 99 --you should hear only faint sounds or nothing----if you hear the sound clearly then this is referred as whispering pectroloquy.

56.  Egophany --ask the patient to say “ ee “ continously --you should hear muffled ‘’ee ‘’---if you hear an ‘’ ay ‘’ then it is egophany.

57. Percussion  The percussion note loses its normal resonance when ever aerated lung tissue is separated from the chest wall by fluid or pleural thickening. OR  When lung tissue is separated from chest wall by collapse or consolidation or fibrosis