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EXAMINATION OF RESPIRATORY SYSTEM

EXAMINATION OF RESPIRATORY SYSTEM. INSPECTION PALPATION AUSCULTATION PERCUSSION. GENERAL EXAMINATION. CYANOSIS Central Peripheral causes COPD Type 2 resp. failure Pulmonary fibrosis B. asthma Congenital cyanotic heart disease Pulmonary embolism. OEDEMA

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EXAMINATION OF RESPIRATORY SYSTEM

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  1. EXAMINATION OF RESPIRATORY SYSTEM

  2. INSPECTION • PALPATION • AUSCULTATION • PERCUSSION

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

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

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

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

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

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

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

  10. 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

  11. 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

  12. SHAPE OF THE CHEST • Pectus excavetum • Pectus carinatum DILATED VEINS • SVC obstruction---Ca lung

  13. 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

  14. 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.

  15. 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.

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