bronchitis bronchial asthma bronchiectasis pneumonia tuberculosis emphysema abscess
bronchitis bronchial asthma bronchiectasis pneumonia tuberculosis emphysema abscess cancer pneumothorax hydrothorax
COMPLAINTS cough q dyspnoea q bloody expectoration q chest pain q
Cough is a complicated reflex act which is actually a defence reaction aimed at clearing the larynx, trachea, or bronchi from mucus or foreigh material Cough dry moist
laryngitis DRY COUGH pleurisy compression of the main bronchi by the lymph nodes
MOIST COUGH ü the amount of sputum expectorated during one fit and during entire day ü time of the day during which the sputum is expectorated ü position of the body in which cough is provoked ü the colour, odour, and other properties of sputum
Morning cough Øbronchiectasis Ø lung abscess Cough during entire day Øpneumonia Øbronchitis "Night" cough Øtuberculosis Ø malignant newgrowths Permanent cough Periodic cough
HAEMOPTYSIS is expectoration of blood with sputum during cough origin of haemoptysis amount and character of expectorated blood
ORIGIN OF HAEMOPTYSIS • tuberculosis • cancer • bronchiectasis • actinomycosis • some heart diseases which causes congestion of blood in lesser circulation • thrombosis of the pulmonary arteries
The amount of blood expectorated with sputum thin streaks diffuse red colouration of the sputum jelly-like tumor • tuberculosis • actinomycosis • heart diseases lung haemorrhage foamy lung oedema • tuberculosis • bronchiectases • degrading tumour
Dyspnoea is the feeling of difficult or laboured breathing Subjective Inspiratory § hysteria § thoracic radiculitis Objective Expiratory Physiological Pathological Mixed
Heavy dyspnoea, often followed by asphyxia, is called suffocation Asphyxia arising as a sudden attack is asthma • bronchial asthma
Pain in the chest location intensity irradiation duration character origin connection with the respiratory movements, cough, and posture
CHEST PAIN Pleura • dry pleurisy • tumour metastasis into the pleura • spontaneous pneumathorax Heart • myocarditis • myocardial infarction Aorta • aneurism • aortitis Abdominal organs • acute pancreatitis • peptic ulser Thoracic wall injury of the skin: • trauma • erysipelas • herpes zoster muscles: • trauma • myositis intervertebral nerves: • thoracic radiculitis bones: • fracture of ribs • periostitis • spondylarthrosis
Secondary complaints higher fever common complaints • weakness • loss of appetite • deranged sleep • decreased work capacity
Common inspection orthopnea cyanosis dyspnoea lung failure
EXAMINATION OF THE CHEST STATIC DYNAMIC
STATIC EXAMINATION n symmetry of the chest position of the clavicles n expression of the supra- and subclavicular fossae n direction of the ribs n n width of the intercostal spaces n epigastric angle position of the shoulder blades q direction of the spine n
SHAPE OF THE CHEST normal - normosthenic (conical) - hypersthenic - asthenic pathological - emphysematous (barrel-like) - paralytic - rachitic (keeled or pigeon) - funnel - foveated
DEFORMATIONS OF THE SPINE - lateral curvature of the spine - scoliosis - backward curvature of the spine - kyphosis - excessive backward curvature of the spine with formation of the gibbus - forward curvature of the spine - lordosis - combination of the lateral and back curvature of the spine - kyphoscoliosis
ASYMMETRY OF THE CHEST ENLARGEMENT - hydrothorax DIMINISH - pleural adhesion - pneumosclerosis - pneumothorax - resection of a part or the entire lung - atelectasis
DYNAMIC EXAMINATION - type of breathing - rhythm of breathing - frequency of breathing - depth of breathing - symmetry of the respiratory movements of the left and right shoulder
Type of breathing thoracic (costal) abdominal mixed
RESPIRATION RATE 16 to 20 per minute • bradypnoe • tachypnoe • apnoe
ACCELERATED RESPIRATION physiological pathological physical load emotional excitement after heavy meals decrease respiratory surface of the lungs: - pneumonia - atelectasis decreased elasticity of the lung: - emphysema superficial respiration: - dry pleurisy - acute myositis - intercostal neuralgia - rib fracture - ascites, meteorism pregnancy
DECELERATION OF THE RESPIRATORY RATE pathological physiological sleep inhibition of the respiratory centre: - increased intracranial pressure: - cerebral tumour toxic effect on the - meningitis respiratory centre: - cerebral haemorrhage - uraemia - brain oedema - hepatic or diabetic coma - acute infectious diseases
RESPIRATION DEPTH is the volume of the inhaled and exhaled air at rest Superficial (shallow) breathing accelerated respiration Deep breathing accelerated decelerated respiration: respiration - high fever - marked anaemia - sharp inhibition of the respiratory centre - sharp narrowing of the vocal slit or the trachea
NORMAL KUSSMAUL'S RESPIRATION deep coma
RESPIRATORY RHYTHM rhythmic arrhythmic BIOT'S RESPIRATION - meningitis - agony - disorder of cerebral circulation
CHEYNE-STOKES' RESPIRATION - insufficiency of cerebral circulation - heavy poisoning - Pekweek syndrome
UNDULANT (WAVE-LIKE) GROCCO'S RESPIRATION early stages of the same pathological processes which are responsible for Cheyne-Stokes respiration
LUNG PROJECTION ON THE CHEST right Up. IV Lov. Up. III Up. IV Mid. VI Mid VI left Lov. l. axil. ant. l. axil. post. Up. IV Lov. VI Lov. l. axil. post. l. axil. ant.
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