1. Respiratory History and Examination
Dr. Robert Lee Dr. Gwen Hollaar & Dr. Lanice Jones
Faculty of Medical Sciences Lao 2006

2. History Taking Associated Symptoms in HPI cough sputum production
dyspnea
hemoptysis
chest pain 
wheezing

3. Family History
Asthma
COPD
Lung Cancer

4. Social History Employment
Exposure to dust, agriculture, carpentry
Exposure to toxins
Smoking – number of years x packs of cigarettes per day
Marijuana
History suggestive of HIV risk – IV drug abuse, prostitutes, homosexual
Risk of exposure to lung flukes, parasites

5. Physical Examination
Inspection
Palpation
Percussion
Auscultation

6. Inspection Nail cyanosis Clubbing
Accessory Muscle Use, thin, leaning on hands
Thick wide chest of emphysema

7. Palpation – Lung Exam chest wall movement tactile fremitus
Patient repeats “99” while feeling with medial side of hand
Consolidation increases transmission of vibrations
Pleural effusion decreases fremitus

8. Tactile Fremitus
Consolidation acts as a solid, transmits vibration better
Effusion creates an air/water interface, decreases vibration

9. Trachea Inspection for masses, obvious deviation
Best examined by palpation

10. Percussion
Ask the patient to cross their arms in front – pulls scapula from midline
Percuss by tapping on distal third of middle finger
Keep rest of fingers off the chest – increases resonance
Work between ribs if possible

12. Review of Lung Anatomy Anterior
Anterior – Focus on Upper Lobes

13. Posterior Lung Anatomy

14. Right Lateral Chest Anatomy - RML

15. Lung Anatomy Left Lateral

16. Auscultation Listen for posterior lobes in the back
4 areas in the posterior chest is enough for normal examinations
Listen in more areas if abnormalities
Lateral chest for lingula and RML
Anterior chest for anterior lobes

17. Ausculation – normal sounds
Vesicular breath sounds on inspiration
Little or no sound on expiration

18. Auscultation – abnormal sounds
Rales or crackles
Rhonchi or wheezes – whistling
sound, mostly on expiration
Stridor – wheeze on inspiration –suggests obstuction at tracheal level
Bronchial breathing
Decreased breath sounds
Pleural rub

19. Tactile Fremitus
Consolidation acts as a solid, transmits vibration better
Effusion creates an air/water interface, decreases vibration

20. Some examples

22. Pleural effusion Reduced chest expansion
Dullness to percussion over lower chest
Diminished or absent breath sounds
Decreased tactile and vocal fremitus

24. Consolidation – eg lobar pneumonia
Reduced chest expansion
Dullness on percussion
Bronchial breathing
Rales or crepitations
Increased tactile and vocal fremitus

27. Questions?? Comments