Download MBBS Important Topics Respiratory System

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Important Topics Respiratory System for MBBS 1st Year Important Topics, MBBS 2nd Year Important Topics, MBBS 3rd Year Important Topics & MBBS Final Year Important Topics.

RESPIRATORY SYSTEM
Introduction
Name: Age: Sex: Handedness: Resident of:
Education: Occupation: Religion: Informant: Reliability:
Chief Complaints (in chronological order)
HOPI
1) Cough- Onset, Dry/Wet, Day/Night/ Postural/seasonal variation, associated
with, aggravated by / relieved by, present status
2) Exgectora?orr Color, Consistency, Quantity, Smell, Diurnal/ Postural variation,
More in the early morning, Aggravated by / Relieved by, Present status
3) Hemoptysis- Color, Quantity, Frequency, Postural variation, Associated with,
Last episode, Postural symptoms, Aggravated by / Relieved by, Present status
4) Dyspnoea Onset, Progression (describe wrt activities), Associated with,
Aggravated by / Relieved by, Present status, MMRC grading (0-4), PND,
Orthopnoea
5) Wheeze- Duration , Periodicity, Seasonal/ Diurnal variation, Associated allergic
features like allergic rhinitis, urticaria, recurrent sneezing, Aggravated by /
Relieved by, Present status
6) Chest pain-( OLD CAARTS) Onset, Location, Duration, Character, Associated
features, Aggravating and Relieving factors, Radiation, Time, Severity
7) Fever- Grade, Max Temp, Type, Associated with chills& rigors, Diurnal
variation, Evening rise of temp., night sweats, relieved by, present status
8) Anorexia
9) Weight losss Quantified/Unquantified, Intentional ~ /Unintentional,
Significant/insignificant
10) Hoarseness of voice

11) Ptosis
12) Recurrent respiratory infection
13) History suggestive of Collagen Vascular Disease-Joint pain/rash/oral
ulcers/seizures/excessive hairfall
14) Palpitation /Easy fatiguability
15) Bladder / Bowel symptoms
16) Swelling of face/ edema
17) CNS symptoms-LOC/Head ache/weakness/vomiting
IV. Past History
DM/ HTN/ TB/ Bronchial asthma/IHD
Childhood infection
Jaundice/ Blood Txn
Allergies/ FB inhalation
Trauma/ Surgeries/ similar illness in the past
V. Personal History
Smoking - pack years/smoking index/ Chula smoking
Alcohol / Tobacco
Veg / Non veg
Marital status/ Children/Menstrual history in detail
High risk behavior/Bladder/Bowel/Sleep
Immunization history
Socio-economic status/ over crowding
VI. Family history
TB/ Similar illness in the family
VIl. Treatment history
VIII. Summary at the end of the history
IX. Impression/ DD
General physical examination

Conscious/oriented/comfortable
Ht- Weight- BMI- Temp-
Pulse- (Rate, Rhythm, Volume, Character, Peripheral pulses. R-R/ R-F delay, Pulse
deficit, Vessel wall, Carotid bruit)
BP- mmHg, Respiration - Rate, Rhythm, Type (Abdomino-Thoracic /
Thoraco-Abdominal)
SpO2- BCGscar
P/J/Cy/CI/LNE/PE/JVP/rash/facial plethora/neck veins/puffiness of face/ Pemberten
sign /Lt supra clavicular LN /Voice/asterixis
Signs of Malnutrition- Temporal / Buccal fat wasting, Hollowness of supraclavicular -
infraclavicular fossae, Emaciated look
Nicotine stain- lips, Nail, teeth, gums, Vitamin deficiencies
Spine - Kyphosis / Scoliosis /Gibbus, Skull
Peripheral signs of TB / Sarcoid / HIV
Marfanoid features, Thyroid, Testes, Low hair line, Horners Features, Congenital
anomalies
Systemic Examination
Respiratory System:
Upper Respiratory Tract
Ear, Nose ( polyps, postnasal drip, DNS)
Throat ( tonsils, oral hygiene, nicotine stain )
Inspection
Chest symmetry, Pectus excavatum/ Carinatum
Shape of chest

e Respiratory movements - equal / decreased
e Tracheal position / Trail sign
? Signs of volume loss - shoulder droop/wasting ( supra/infra clavicular)/Nipple position/
Spino scapular distance/ Rib crowding/ Intercostal spaces
* Intercostal space indrawing / Hoover?s sign/Respiratory paradox/ Respiratory alternans
? Accessary muscles of respiration
e Apical impulse
? Dilated veins/Scars/Sinuses/Visible pulsations/Skin
Palpation
* Tracheal position
* Apical impulse
e Rib crowding
Inspiratory findings confirmed
? Chest wall tenderness/ Crepitus / SC emphysema/ Nodules / LNE
* Harrison?s sulcus / Hoover?s sign





















Lt







Measurements
. Spino Antero-Po
| Chest Expansion | Hemithorax Hemlthc.>raX Scapular sterior Tr?nsverse
Circumferance expansion . . Diameter
Distance | Diameter
Right
Left
Supra Infra . Infra Supra Inter Infra
X A Mammary | Axillary .
Clavicular | clavicular Axillary | Scapular | Scapular | Scapular
Respiratory | Rt
Movement | |t
. Rt
Percussio

n












Kronig?s Rt
Isthmus Lt
Percussion | Rt
over
; Lt
clavicle


Percussion over Traube Space

Liver Dullness, Tidal Percussion


























Auscultation
Supra Infra . Infra Supra Inter Infra
X A Mammary | Axillary .
Clavicular | clavicular Axillary | Scapular | Scapular | Scapular
Rt
Air Entry
Lt
Rt
VF, VR
Lt
Rt
VBS
Lt
Bronchial Rt
Breathing [ |t
Wheeze/ Rt
Rhonchi Lt
Rt
Crackles
Lt
Whispering
Pectroloquy
Aegophony
Pleural Rub


Cardio-Vascular System
e Apical Impulse
e Precardial buldge, Parasternal heave
e Palpable sounds, Thrill
e S1,52,S3,54
e Murmurs

Abdomen
e Symmetry/Distension
e All quadrants moves with respiration
e Soft, Tenderness, Liver, Spleen, Any mass, Bowel sounds, Hernial orifices
Central Nervous System
e Consciousness,Orientation
* FND, Horner?s Syndrome, Planters
Summary after Examination
Diagnosis/DD
Investigation
Treatment