Respiratory System PE

Respiratory system
physical examination
Dr. Bereketab A. (MD)

Outline of presentation
 Anatomy of respiratory system
 Inspection
 Palpation
 Percussion
 Auscultation
Anterior Chest Landmarks.
ACCORDING TO UNDERLYING LUNGS AND
LOBES
 RIGHT
LEFT LUNG
LUNG
 UPPER
 MIDDLE
LOWER
 LOWER
The Pleurae
FOUR COMPONENTS OF A RESPIRATORY
ASSESSMENT
 Inspection
 Palpation
 Percussion
 Auscultation
INSPECTION
 Shape of the chest and the way in which it moves
 Deformities or asymmetry
 Kyphosis (forward bending) or scoliosis (lateral bending) of the
vertebral column
 Abnormal retraction of the interspaces during inspiration

 Retraction is most apparent in the lower interspaces
 Impaired respiratory movement on one or both
sides
 A unilateral lag (or delay) in movement
 Barrel chest
 Anteroposterior diameter is increased compared with
the lateral diameter
 ↑sed AP diameter indicates hyperinflation
 Seen in patients with sever asthma or emphysema
 Pigeon chest (pectus carinatum)
 Localized prominence (an outward bowing of the
sternum and costal cartilage)
 Develops in rickets and chronic childhood illnesses
 Funnel chest (pectus excavatum)
 Developmental defect involving a localized depression
of the lower end of the sternum
Barrel chest
P.excavatum Pigeon chest
 Harrison sulcus
 Linear depression of the lower ribs just above the
coastal margins at the site of attachment of diaphragm
 Can result from severe asthma in childhood or rickets
 Clubbing
 Swelling of the distal parts of the fingers or toes
 Due to increased in the soft tissues
 Mechanism is suggested to be increased response to
hypoxia → hormonal release that increase vascular
dilitation → interstitial edema and swelling of
subcutaneous tissue
Four grades of clubbing
I. Obliteration of angle of nail bed

II. Fluctuation of nail bed
III. Increased curvature of nail, especially in its long
axis
IV. Drumstick appearance: swelling of pulp of
finger in all its dimensions
PALPATION
 Areas of tenderness
 Tactile fremitus
 Positions trachea should be determined
 Respiratory expansion
 Feel for the trachea by putting the second and
fourth fingers of the examining hand on each
edge of the sternal notch and use the third finger
to assess whether the trachea is central or
deviated to one side
 Tactile vocal fremitus is detected by palpation
 Refers to the palpable vibrations transmitted
through the bronchopulmonary tree to the chest
wall when the patient speaks
 Use either the ball (the bony part of the palm at
the base of the fingers) or the ulnar surface of
your hand
 Palpate and compare symmetric areas of the
lungs
 Identify and locate any areas of increased,
decreased, or absent fremitus
PERCUSSION
 Most important techniques of physical
examination
 helps to establish whether the underlying tissues
are air-filled, fluid-filled, or solid
 Estimate the extent of diaphragmatic excursion by
determining the distance between the level of
dullness on full expiration and the level of dullness on
full inspiration
 Normally about 5 cm or 6cm
AUSCULTATION
 Auscultation involves
 Listening to the sounds generated by breathing
 Listening for any adventitious (added) sounds
 If abnormalities are suspected, listening to the sounds of
the patient’s spoken or whispered voice as they are
transmitted through the chest wall
 Breath Sounds (Lung Sounds)
 Identify patterns of breath sounds by their intensity, their
pitch, and the relative duration of their inspiratory and
expiratory phases
 Normal breath sounds are:
 Vesicular, or soft and low pitched
 Heard through inspiration, continue without pause through expiration,
and then fade away about one third of the way through expiration
 Bronchovesicular, with inspiratory and expiratory sounds about
equal in length, at times separated by a silent interval
Adventitious (Added) Sounds
 Superimposed on the usual breath sounds

 Detection of adventitious sounds—
crackles (sometimes called rales), wheezes, and
rhonchi— is an important part of examination, often
leading to diagnosis of cardiac and pulmonary
conditions
 The pleural rub
 Leathery or creaking sound produced by movement of
the vesceral pleura over the parietal pleura
 Is characteristic of pleural inflammation and usually
occurs in association with pleuritic pain
 Can be felt with the palpating hand as well as being
audible with the stethoscope
 Wheezes are musical sounds associated with
airway narrowing
 Widespread polyphonic wheezes, particularly
heard in expiration, are the most common and
are characteristic of diffuse airflow obstruction,
especially in asthma and COPD
 A fixed monophonic wheeze can be generated by
localized narrowing of a single bronchus, as may
occur in the presence of a tumour or foreign
body
 Pleural effusion
 Consolidation
 Pneumothorax
 atelectasis

Respiratory System PE

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Respiratory system

Dr. Bereketab A. (MD)

 Abnormal retraction of the interspaces during inspiration

I. Obliteration of angle of nail bed

 Superimposed on the usual breath sounds

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