![Page 1: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/1.jpg)
The Respiratory System Examination
Dr Mike HenryDr Claire Bowker
Dept of Respiratory MedicineLeeds General Infirmary
![Page 2: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/2.jpg)
Major Symptoms of Respiratory Disease
• Cough
• Sputum production
• Dyspnoea
• Haemoptysis
• Wheeze
• Chest pain - pleuritic
![Page 3: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/3.jpg)
Cough• Larynx / Pharynx – harsh and painful• Trachea – harsh, dry and painful / productive• Bronchitis - paroxysmal / productive
AcuteChronic
• Carcinoma – short / dry - haemoptysis• Bronchiectasis – productive purulent sputum• Pneumonia – painful and productive• Pulmonary Oedema – dyspnoea/ orthopnoea/ PND• Fibrosing alveolitis – dry / short / persistent
![Page 4: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/4.jpg)
![Page 5: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/5.jpg)
![Page 6: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/6.jpg)
Sputum
• Amount
• Character
• Viscosity
• Taste or odour
![Page 7: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/7.jpg)
Dyspnoea
• Dyspnoea associated with increased work of breathing
• Dyspnoea associated with increased pulmonary ventilation
• Dyspnoea associated with weakness of muscles of respiration
• Dyspnoea associated with multiple factors
![Page 8: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/8.jpg)
Acute Onset Dyspnoea
Sudden Rapid(minutes) (hours – days)
Pneumothorax Acute asthmaSevere acute asthma Pulmonary oedemaPulmonary embolism PneumoniaLaryngeal oedema Acute bronchitisForeign body Allergic alveolitisPulmonary oedema (orthopnoea / PND)
![Page 9: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/9.jpg)
Gradual Onset Dyspnoea
• Onset days – weeks – months
Pleural effusion
Chronic asthma
Fibrosing alveolitis
Tuberculosis
Chronic bronchitis
Bronchial carcinoma
![Page 10: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/10.jpg)
Slow Onset Dyspnoea
• Onset months – years
Pleural fibrosis
Emphysema
Pneumoniconiosis
SarcoidosisChronic broncitis
Ankylosing spondylosis
![Page 11: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/11.jpg)
Haemoptysis
Type and degree
• Frank – whole blood / clots Carcinoma / PE / Bronchiectasis / TB
• Blood Stained – blood/sputum mixedSuppurative pneumonia / Carcinoma
• Blood Streaked – streaks or flecksCarcinoma / chronic bronchitis
• Rusty – degraded HbPneumococcal pneumonia
![Page 12: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/12.jpg)
![Page 13: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/13.jpg)
Aetiology of Wheeze
![Page 14: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/14.jpg)
Chest PainSite CharacterRadiation SeverityDuration Frequency and
periodicityAggravating factors Relieving factors
Associated phenomena
• Upper reterosternal – tracheitis
• Reterosternal – oppressive similar to cardiac pain / not related to exertion
• Pleuritic – stretching of inflammed parietal pleura
![Page 15: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/15.jpg)
The Physical Examinationfrom the end of the bed - Inspection
• Patient comfortable ? / Supine 45• Look around the bed• Measures of respiratory compromise
RESPIRATORY RATE Use of accessory muscles
• Audible sounds• Patient in pain• Cyanosis• Oedema• SVCO
![Page 16: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/16.jpg)
Palpation• Hands
Finger clubbingCyanosis
Signs of CO2 retention• Eyes
Signs of CO2 retentionAnaemiaHorners syndromePapilloedema
![Page 17: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/17.jpg)
![Page 18: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/18.jpg)
The Laying on of HandsPalpation
• The NeckScalene lymph nodesJVP – jugular venous pressureTrachea
CentralTracheal tug
Thyroid• Skin
Erythema nodosumMetastatic carcinoma nodulesLupus pernio
![Page 19: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/19.jpg)
Chest wall• Symmetry of chest wall movements during
tidal and deep breathing• Chest expansion (2-4 cms) Two levels ?• Significance of reduced chest wall
movements• Anteropostero:lateral diameter = 5:7• Pectus excavatum / Carinatum /
kyphoscholiosis• Thoracic operations / thoracoplasty
![Page 20: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/20.jpg)
Chest wall
![Page 21: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/21.jpg)
• Significance of reduced chest wall movements
• Pleural Effusion: reduced unilateral• Consolidation : reduced unilateral• Collapse of lobe: reduced unilateral• Pneumothorax: reduced unilateral• COPD:reduced bilateral• Asthma: reduced bilateral• Pulmonary fibrosis: reduced bilateral
![Page 22: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/22.jpg)
PercussionWhere to percuss
How to percuss - technique
• Normal: Resonant• Impaired: consolidation / collapse / fibrosis• Dull: consolidation / collapse / pleural thickening• Stony dull: fluid = pleural effusion• Hyperresonant : pneumothorax• Typanic: hollow viscus
• Vocal tactile fremitus• Vocal resonance
![Page 23: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/23.jpg)
Percussion
![Page 24: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/24.jpg)
Auscultation
• Normal breath sounds produced by air through larynx / vocal cords vibrations
• Vibrations transmitted through airways to the chest wall rustling sound = Vesicular
• Diminished: airflow obstruction / pneumothorax / pleural effusion
• Bronchial breath sounds: consolidation, fibrosis or collapse: resemble breath sounds heard over larynx
![Page 25: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/25.jpg)
Auscultation
Added sounds
Wheezes – passage of air through narrow bronchi
Usually expiratoryIf inspiratory – mucosal oedema clear with coughDescribe siteFixed low pitch – STRIDOR – upper
airflow obstruction
![Page 26: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/26.jpg)
Added soundsCrackles
Explosive reopening of small airways occluded during expiration
Fine crackles: pulmonary oedema / consolidation – usually inspiratory
Course crackles: pulmonary fibrosis / bronchiectasis
Plueral rub / pleural click
![Page 27: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/27.jpg)
Interstitial Lung Disease – CFA Bilateral course / velcro bibasal crackles
![Page 28: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/28.jpg)
![Page 29: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/29.jpg)
![Page 30: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/30.jpg)
Pleural Effusion
• Chest expansion - reduced
• Percussion - stony dull
• Breath sounds - absent or decreased
• Added sounds - none
• Vocal resonance - absent or decreased
![Page 31: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/31.jpg)
Consolidation
©2002 UpToDate®
![Page 32: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/32.jpg)
Consolidation
• Chest expansion - reduced
• Percussion - dull
• Breath sounds - bronchial
• Added sounds - crackles
• Vocal resonance - increased (whispering pectorilouy)
![Page 33: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/33.jpg)
ATAELECTASIS - Total right lung collapse
![Page 34: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/34.jpg)
![Page 35: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/35.jpg)
Collapse left lower lobe – The Sail Sign
![Page 36: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/36.jpg)
Collapse / Atelectasis lobe or lung
• Chest expansion - reduced
• Percussion note - dull
• Breath sounds - absent or diminished
• Added sounds - none / crackles or wheeze
• Vocal resonance - absent / decreased
![Page 37: The Respiratory System Examination Dr Mike Henry Dr Claire Bowker Dept of Respiratory Medicine Leeds General Infirmary](https://reader035.vdocument.in/reader035/viewer/2022062304/56649cf85503460f949c88f5/html5/thumbnails/37.jpg)
Pneumothorax
• Chest expansion - reduced
• Percussion - hyperresonant
• Breath sounds - absent or decreased
• Added sounds - none, occasionally click
• Vocal resonance - decreased