1 / 60

Physical Examination in Respiratory System

Physical Examination in Respiratory System. Zhao Li, M.D. Suprasternal fossa. Supraclavicular fossa. Infraclavicular fossa. Sternal line. Parasternal line. Anterior midline. Midclavicular line. epigastric angle. Anterior imaginary lines and landmarks. Posterior axillary line.

dena
Download Presentation

Physical Examination in Respiratory System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Physical Examination in Respiratory System Zhao Li, M.D.

  2. Suprasternal fossa Supraclavicular fossa Infraclavicular fossa Sternal line Parasternal line Anterior midline Midclavicular line epigastric angle Anterior imaginary lines and landmarks

  3. Posterior axillary line Anterior axillary line Midaxillary line Lateral imaginary lines

  4. Suprascapular region Interscapular region Infrascapular region Scapular line Posterior midline Posterior imaginary lines and landmarks

  5. Anterior view of lobes

  6. Posterior view of lobes

  7. Right lateral view of lobes

  8. Left lateral view of lobes

  9. Pectus excavatum Barrel chest Kyphosis Thoracic deformity

  10. Inspection • Respiratory movement • Abdominal breathing: male adult and child • Thoracic breathing: female adult • Respiratory rate: 16-18 f/min • Tachypnea: >20 f/min • Bradypnea: <12 f/min • Shallow and fast • respiratory muscular paralysis, elevated intraabdominal pressure, pneumonia, pleurisy • Deep and fast • Agitation, intension • Deep and slow • Severe metabolic acidosis (Kussmaul’s breathing)

  11. Inspection • Respiratory rhythm • Cheyne-Stokes’ breathing • Biot’s breathing _____Decreased excitability of respiratory center • Inhibited breathing • Sudden cessation of breathing due to chest pain • Pleurisy, thoracic trauma • Sighing breathing • Depression, intension

  12. Palpation • Thoracic expansion • Massive hydrothorax, pneumonia, pleural thickening, atelectasis • Vocal fremitus (tactil fremitus) • Pleural friction fremitus • Cellulose exudation in pleura due to pleurisy • Holding breathing disappeared • Tuberculous pleurisy, uremia, pulmo embolism

  13. Percussion

  14. 1. Method • Mediate • Pleximeter: distal inter-phalangeal joint of left middle finger • Plexor: right middle finger tip • Immediate • Order • Up to down, anterior to posterior

  15. 2. Affected factors • Thickness of thoracic wall • Calcification of costal cartilage • Hydrothorax • Containing gas in alveoli • Alveolar tension • Alveolar elasticity

  16. 3. Classification • Resonance • Normal • Hyperresonance • Emphysema • Tympany • Cavity or pneumothorax • Dullness • Hydrothorax, atelectasis • Flatness • Massive Hydrothorax

  17. 4. Normal sound • Lung’s sound in percussion • Resonance • Slight dullness in some areas (upper, right, back) due to thickness of muscles and skeletons

  18. 4. Normal sound Border of lungs in percussion • Apex of lungs • Kronig’s isthmus: 5cm in width • Narrow: TB, fibrosis • wider: emphysema • Anterior border • absolute cardiac dullness area • Lower border • 6th, 8th, 10th intercostal space in midclavicular line, midaxillary line, scapular line, respectively • Down: emphysema • Up: atelectasis, intraabdominal pressure goes up

  19. Shifting range of bottom of lung • Along the scapular line • Percussing bottom of lung, marking • Asking the pat. to inspire deeply and hold • Percussing bottom of lung, marking • Asking the pat. to expire deeply and hold • Percussing bottom of lung, marking • Measuring the dist. between upper and lower lines Shifting range of bottom of lung 4. Normal sound s 6-8 cm • Decreased: emphysema, atelactasis, fibrosis, pulmo. edema, pneumonia • Detected impossibly: pleura adhesion, massive hydrothorax, pneumothorax, diaphragmatic paralysis

  20. 5. Abnormal sound • Dullness, flatness, hyperresonance or tympany appear in the area of supposed resonance. • Unchanged sound (resonance) • The depth of the lesion > 5 cm • The diameter of the lesion  3 cm • Mild hydrothorax

  21. 5. Abnormal sound Dullness or flatness • Decreased containing gas in alveoli • Pneumonia • Atelectasis? • TB • Pulmo. embolism • Pulmo. edema • Pulmo. fibrosis • No gas in alveoli • Tumor • Pulmo. Hydatid (肺包虫) • Pneumocystis (肺囊虫) • Non-liquefied lung abscess • Others • Hydrothorax • Pleural thickness

  22. 5. Abnormal sound • Hyperresonance • Emphysema • Tympany • Pneumothorax • Large cavity (TB, lung abscess, lung cyst) • Amphorophony (空瓮音) • Large and shallow cavity with smooth wall • Tension pneumothorax • Tympanitic dullness (浊鼓音) • Decreased tension and gas in alveoli • Atelectasis • Congestive or resolution stage of pneumonia • Pulmo. edema

  23. Garland’s triangle area (tympanitic dullness) Damoiseau’s curve Grocco’s triangle area (dullness) 5. Abnormal sound • Special areas on percussion in moderate hydrothorax

  24. Auscultation

  25. Order of auscultation

  26. Sound of auscultation • Normal breath sound • Abnormal breath sound • Adventitious sound • Vocal resonance (语音共振)

  27. Bronchial Bronchovesicular Bronchial Bronchovesicular 1. Normal breath sound • Tracheal breath sound • Bronchial breath sound • Larynx, suprasternal fossa, around 6th, 7th cervical vertebra, 1st, 2nd thoracic vertebra • Bronchovesicular breath sound • 1st, 2nd intercostal space beside of sternum, the level of 3rd, 4th thoracic vertebra in interscaplar area, apex of lung • Vesicular breath sound • Most area of lungs

  28. 2. Abnormal breath sound • Abnormal vesicular breath sound • Abnormal bronchial breath sound • Abnormal bronchovesicular breath sound

  29. Abnormal vesicular breath sound(1) • Decreased or disappeared • Movement of thoracic wall • Respiratory muscle weakness • Obstruction of airway • Hydrothorax or pneumothorax • Abdominal diseases: ascites, large tumor • Increased • Movement of respiration

  30. Abnormal vesicular breath sound (2) • Prolonged expiration • Bronchitis • Asthma • emphysema • Cogwheel breath sound • TB • Pneumonia • Coarse breath sound • Early stage of bronchitis or pneumonia

  31. Abnormal bronchial breath sound(tubular breath sound) • Bronchial breath sound appears in supposed vesicular breath sound area • Consolidation: lobar pneumonia (consolidation stage) • Large cavity: TB, lung abscess • Compressed atelectasis: hydrothorax, pneumothorax

  32. Abnormal bronchovesicular breath sound • Bronchovesicular breath sound appears in supposed vesicular breath sound area • The lesion is relatively smaller or mixed with normal lung tissue

  33. 3. Adventitious sound • (moist) Crackles • Rhonchi (wheezes) • Pleural friction rub

  34. Moist crackles Mechanism During inspiration, air flow passes thin secretion in the airway to rupture the bubbles, or to open the collapse of bronchioli due to adhesion by secretion.

  35. Characteristics of crackles • Adventitious sound • Intermittent • Appeared in phase of inspiration or early expiration • Constant in site • Unchanged in character • Medium and fine crackles exist meantime • Less or disappeared after cough

  36. Classification of crackles • According to intensity of the sound • Loud moist crackles • Slight moist crackles • According to diameter of the airway crackles appeared • Coarse: trachea, main bronchi, or cavity • Bronchiectasis, pulmo. edema, TB, lung abscess, coma • Medium: bronchi • bronchitis, pneumonia • Fine: bronchioli • pneumonia • Crepitus: • Bronchiolitis, alveolitis, early pneumonia (pulmo. Congestion), elder subject, pat. bed rest for long time

  37. Site of crackles • Local: local lesion • Pneumonia, TB, bronchiectasis • Both bases • Pulmo. edema, bronchopneumonia, chronic bronchitis • Full fields • Acute pulmo. edema, severe bronchopneumonia, chronic bronchitis with severe infection

  38. Rhonchi (wheezes) Mechanism The turbulent flow is formed in trachea, bronchi or bronchioli due to airway narrow or incomplete obstruction. Causes • Congestion • Secretion • Spasma • Tumor • Foreign subject • Compression

  39. Characteristics of rhonchi • Adventitious sound • High pitch • Dominance in phase of expiration • Variable intensity of character or site • Wheezing

  40. Classification of rhonchi • Sibilant (高调) • Bonchioli, bronchi • Sonorous (低调) • Trachea, main bronchi

  41. Site of rhonchi • Both fields • Asthma • Chronic bronchitis • Acute left heart failure • Local site • Tumor • Endobronchial TB

  42. Pleural friction rub • Cellulose exudation in pleurisy (rough pleura) • Area of auscultation • Anterolateral thoracic wall (maximal shifting area of lung) • Friction rub disappeared if holding breath • Friction rub appeared both breath and heart beat: mediastinal pleurisy • Causes • Tuberculous pleurisy • Pulmo. embolism • Uremia • Pleural mesothelioma

  43. Vocal resonance • Bronchophony (支气管语音） • Consolidation • Pectoriloqny (胸语音) • Massive consolidation • Egophony (羊语音) • Upper area of hydrothorax • Whispered (耳语音) • Consolidation

  44. Main symptoms and signs in common respiratory diseases

  45. Labor pneumonia

  46. Symptoms • Chill • Continued fever: 39-40ºC • Chest pain • Tachypnea • Cough • Rusty sputum

  47. Signs (1) • General signs • Acute facial features, blushing • Nares flaring (dyspnea) • Cyanosis • Tachycardia • Simple herpes around lips

  48. Signs (2) • Congestion • Inspection • Decreased respiratory movement • Palpation • Increased vocal r

  49. Chronic bronchitis with emphysema

  50. Symptoms • Chronic productive cough • White mucous sputum or pus sputum (infection) • Exertional dyspnea • Breathlessness (dyspnea) • Chest depression

More Related