Western+Diagnosis+-+Respiratory+System

Common Cold Influenza Pleurisy Pneumothorax Tuberculosis Pneumonia Asthma Bronchitis COPD Lung Cancer Respiratory Distress, Respiratory Failure

Pertussis (Whooping Cough) Cystic Fibrosis Diphtheria Croup

Classification
A. Lungs -main function is to exchange gas between inspired air and venous blood -air - bronchi -aveoli -aveolar membrane - gas exchange - passive diffusion - pulmonary cappilaries B. Projections -larynx: thyroid cartilage, epiglottis, cricoid cartilage -trachea to sternal angle (T4) -then bronchi & lungs -2-4cm. superior to medial 1/3 of clavicle - 6-8-10; one rib lower in inspiration C. Primary lung disorders -Pneumonia D. Secondary to systemic -PSS -CV disease E. metastatic F. Common signs: dyspnea, chest pain, cough, expectoration, wheezing, hemoptysis

History
A. Family -asthma, cystic fibrosis -TB, Heart disease B. Occupation -exposure to inhalants C. Residence -current & previous D. Tobacco use, Recreational drug use (esp. inhaled) E. Any problems with breathing, frequent colds, cough, sputum (color & quality), dyspnea (SOB), chest pain (pain & breathing), wheezing, asthma, bronchitis, emphysema, pneumonia, TB, last chest x-ray (if known)

Physical Exam
A. inspection: deformities, ribs B. Palpation -Tenderness -Fremitus -whispering "99" C. Percussion 1. Wrist movement of one finger striking another -notes - flat, dull, resonant, hyperresonant, tympanic -diaphragmatic excursion D. Auscultation 1. Stethoscope down back as in percussion while patient breathes through mouth slightly ddeper than normal fr one full breath in each location 2. Quality and intensity of breath sounds -Vesicular (upper): inspiration>expiration, most of lung -Bronchial (lower): expiration>inspiration, trachea -Broncho-vesicular: inspiration=expiration, between upper scapula 3. Adventitious or abnormal sounds: rales, rhonchi, friction rubs -rales - crackles, usually inspiration -rhonchi - wheezes -friction rub - rackling, grating sound (usually pleurisy) 4. Vocal sounds - use "99"" -bronchophony: increased clarity & intensity of speech -egophony: nasal bleating - "ee" to "ay" -whispered pectoriloquy: clarity of whispers E. do all in anterior chest esp. just lateral to right distal sternum

Lab
A. Blood gases 1. PaO2, PaCO2

Imaging
A. Chest x-rays: pa, lateral B. MRI C. Ultrasound - esp. of pleural space D. CT scan

Pulmonary Function Testing
A .Spirometry: measures air flow

Other Procedures
A. Bronchoscopy -direct physical exam of larynx and tracheobronchial tree -sampling of secretions, biopsy B. Thoracentesis - sample of pleural fluid C. Thoracotomy

Emergencies
A. Any acute chest pains primary evaluation -must be differentiated from cardiac and other causes -most non-cardiac chest pain from pleura or chest wall -often accompanied by dyspnea (difficulty breathing) B. Pneumonia, bronchitis, emphysema, asthma may be emergenciess C. Hemoptysis -Coughing up blood due to bleeding in respiratory tract -Blood streaked sputum not emergency - more or equal to 600ml. blood in 24 hours or less (kidney basinful) -Differentiate from hematemesis (vomiting blood) and blood dripping from nose, mouth, nasopharynx: patient may be able to feel where bleeding is coming from -history, px, chest x-rays, bronchoscopy