RESPIRATORY SYSTEM
- Introduction
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Education: Occupation: Religion: Informant: Reliability: - Chief Complaints (in chronological order)
- HOPI
- Cough Onset, Dry/Wet, Day/Night/ Postural/seasonal variation, associated with, aggravated by / relieved by, present status
- Expectoration Color, Consistency, Quantity, Smell, Diurnal/ Postural variation, More in the early morning, Aggravated by / Relieved by, Present status
- Hemoptysis Color, Quantity, Frequency, Postural variation, Associated with, Last episode, Postural symptoms, Aggravated by / Relieved by, Present status
- Dyspnoea Onset, Progression (describe wrt activities), Associated with, Aggravated by / Relieved by, Present status, MMRC grading (0-4), PND, Orthopnoea
- Wheeze Duration, Periodicity, Seasonal/Diurnal variation, Associated allergic features like allergic rhinitis, urticaria, recurrent sneezing, Aggravated by / Relieved by, Present status
- Chest pain-(OLD CAARTS) Onset, Location, Duration, Character, Associated features, Aggravating and Relieving factors, Radiation, Time, Severity
- Fever Grade, Max Temp, Type, Associated with chills& rigors, Diurnal variation, Evening rise of temp., night sweats, relieved by, present status
- Anorexia
- Weight loss Quantified/Unquantified, Intentional /Unintentional, Significant/insignificant
- Hoarseness of voice
- Ptosis
- Recurrent respiratory infection
- History suggestive of Collagen Vascular Disease-Joint pain/rash/oral ulcers/seizures/excessive hairfall
- Palpitation /Easy fatiguability
- Bladder / Bowel symptoms
- Swelling of face/ edema
- CNS symptoms-LOC/Head ache/weakness/vomiting
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- Past History
DM/HTN/TB/Bronchial asthma/IHD
Childhood infection
Jaundice/Blood Txn
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Trauma/Surgeries/ similar illness in the past - Personal History
Smoking - pack years/smoking index/ Chula smoking
Alcohol/Tobacco
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Marital status/Children/Menstrual history in detail
High risk behavior/Bladder/Bowel/Sleep
Immunization history
Socio-economic status/ over crowding - Family history
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TB/Similar illness in the family - Treatment history
- Summary at the end of the history
- Impression/DD
General physical examination
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- 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- BCG scar
- 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
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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
- Respiratory movements - equal / decreased
- 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
- Apical impulse
- Dilated veins/Scars/Sinuses/Visible pulsations/Skin
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Palpation
- Inspiratory findings confirmed
- Tracheal position
- Apical impulse
- Rib crowding
- Chest wall tenderness/ Crepitus / SC emphysema/ Nodules / LNE
- Harrison's sulcus / Hoover's sign
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Measurements
Chest Circumference | Expansion | Hemithorax | Hemithorax expansion | Spino Scapular Distance | Antero-Posterior Diameter | Transverse Diameter | |
---|---|---|---|---|---|---|---|
Right | |||||||
Left |
Supra Clavicular | Infra Clavicular | Mammary | Axillary | Infra Axillary | Supra Scapular | Inter Scapular | Infra Scapular | |
---|---|---|---|---|---|---|---|---|
Respiratory Movement | ||||||||
Rt | ||||||||
Lt | ||||||||
Percussion | ||||||||
Rt | ||||||||
Lt |
Kronig's Isthmus | Rt | |
Lt | ||
Percussion over clavicle | Rt | |
Lt | ||
Percussion over Traube Space | ||
Liver Dullness, Tidal Percussion |
Auscultation
Supra Clavicular | Infra Clavicular | Mammary | Axillary | Infra Axillary | Supra Scapular | Inter Scapular | Infra Scapular | ||
---|---|---|---|---|---|---|---|---|---|
Air Entry | Rt | ||||||||
Lt | |||||||||
VF, VR | Rt | ||||||||
Lt | |||||||||
VBS | Rt | ||||||||
Lt | |||||||||
Bronchial Breathing | Rt | ||||||||
Lt | |||||||||
Wheeze/ Rhonchi | Rt | ||||||||
Lt | |||||||||
Crackles | Rt | ||||||||
Lt | |||||||||
Whispering Pectroloquy | |||||||||
Aegophony | |||||||||
Pleural Rub |
Cardio-Vascular System
- Apical Impulse
- Precardial bulge, Parasternal heave
- Palpable sounds, Thrill
- S1,S2,S3,S4
- Murmurs
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Abdomen
- Symmetry/Distension
- All quadrants moves with respiration
- Soft, Tenderness, Liver, Spleen, Any mass, Bowel sounds, Hernial orifices
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Central Nervous System
- Consciousness,Orientation
- FND, Horner's Syndrome, Planters
Summary after Examination
Diagnosis/DD
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Investigation
Treatment
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