1. 2. 3. 4. 5. 6. (dyspnea) 7. 8.

(orthopnea)

9. 10. 11. 12. (dyspnea), (cyanosis) (cough),

1. 2. (nonproductive), (paroxysmal cough), (barking or brassy

3. (productive), cough) 4.

croup

tracheoesophageal fistula 5. 6.

laryngeal incoordination,

1. 2. 3.

(palpation),

(percussion)

(inspection), (auscultation)

.
1.

(rate) (amplitude)
(rhythm)

1)

40 - 45 1 1-2 3-5 6 - 10 11 - 14 40 - 50 30 - 40 15 - 35 15 - 30 15 - 25

35 - 45 20 - 30 20 - 25 15 - 25 15 - 20 15 - 20

: Kuzemko JA. Respiratory disorders of infants and children. Castle House Pub. 1987:4.

(tachypnea) <2 2 -1 1-5

>60 >40

>50 /

(I:E)

1:1.5 - 1:2

1)

1)

Kussmaul breathing

Cheyne-Stokes breathing

morphine Biot s Ataxic breathing

medulla Periodic breathing

2.

(dyspnea)

subcostal

(Chest wall retraction) suprasternal, supraclavicular, intercostal, xiphisternal subcostal retraction chest indrawing retraction

(accessory muscles of respi-ration) sternocleidomastoids, trapezeii, scalenii (flaring of the alae nasi)

3.

(central cyanosis)

cyanosis)

(peripheral 4.

(chest wall)

spine)

pectus excavatum ( spine), pectus carinatum ( sternum ( 2) ( 2)

sternum

2
diameter

A = pectus carinatum, B = pectus excavatum AP lateral antero-posterior diameter (AP) 1:2 AP diameter (barrel chest) lateral ,

emphysema, bronchiectasis ( 3) ( 3) lateral . AP < lateral . barrel chest AP > lateral 5.

(digital clubings)

4)

4
diameter)

4)

(IPD = interphalangeal diameter, DPD = distal phalangeal

hyponychial angle) abc <180 o

DPD : IPD < 1 abc >195 o

DPD : IPD > 1(abc -

.
1. 2.

supraclavicular suprasternal notch medial 2

sternoclavicular joint

3.

5)

(consolidation)

5)

5
. Upper lobe . Middle lobe . Lower lobe 4. vocal lingula

tactile fremitus

1, 2, 3 2

5.

intercostal space

6) ( 6)

6
resonance consolidation hyperresonance tympany

dull

flat

stethoscope diaphragm

diaphragm 7)

bell (

1) 4 2) Tracheal breath

tracheal, bronchial, bronchovesicular, vesicular ( sound , ,

1.

breath sound tracheobronchial breath sound tubular breath sound Bronchovesicular breath sound tracheobronchial carina ( sternum 7) . tracheal breath sound

bronchial breath sound tracheal breath sound major bronchi

tracheal

scapular

8)

lobe,

lobe (RUL = right upper lobe, RML = right middle lobe, RLL = right lower LUL = left upper lobe, LLL = left lower lobe )

 2
* Tracheal/Bronchial (Tracheobronchial) or Tubular Bronchovesicular

**

inspire expire

trachea major bronchi

inspire expire

sternum scapular

carina

Vesicular * **

inspire expire

8)

 8
vesicular breath sounds Vesicular breath sound

bronchovesicular breath sounds

breath sound 2.

absent 8)

harsh 9,10)

(Adventitious Sounds) (

9)

Adventitious sounds ( 10)

10
adventitious breath sounds . normal breath sounds (Continuous sounds)

1. Stridor stethoscope

bronchi bronchi wheeze

2. Rhonchi bronchioles Sonorous rhonchi

2 sonorous rale low pitch

Sibilant rhonchi bronchiole musical rale . rale 1. Crepitations crackle Fine crepitations

wheeze

bronchus

sibitant rale

(Interrupted sound)

cracking sound bronchioles bubbling sound (large bronchi) gurgling sound bronchi

Medium crepitations Coarse crepitations

2. Pleural friction rub crepitation

fine

3. Vocal Resonance stethoscope vocal resonance

3 4

Breath Sounds Pneumonia Atelectasis Pneumothorax Emphysema Chronic bronchitis Pulmonary fibrosis Congestive heart failure Pleural effusion Asthma Harsh Diminished Diminished Diminished, prolonged expiratory phase Prolonged inspiratory phase Bronchial if consolidate Diminished Absent Diminished

Adventitious Breath Sound Inspiratory crepitations late-inspiratory crepitation

Early-inspiratory crepitation Wheeze, rhonchi, crepitation Inspiratory crepitation Inspiratory crepitation

Wheeze

Croup

Stridor

adventitous breath sound

Crepitations

Discontinuous

Crackles Rales

Wheezes or Wheezing Sonorous rhonchi

High-pitched, continuous Low-pitched, continuous

Sibilant rhonchi Sibilant rales Musical rales Rhonchi Sonorous rales Low-pitched wheeze

1. Bates B. A guide to physical examination. Philadelphia : JB Lippincott Company, 1979. 2. Chernick V, Kendig EL Jr. Kendig s disorder of the respiratory tract in children. 5th ed. Philadelphia : WB Saunders Company, 1990. 3. Wilkins RL, Hodgkin JE, Lopez B. Lung sounds: A practical guide. St. Louis : CV Mosby Company, 1988. 4. Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby s guide to physical examination. 2nd ed. St. Louis : Mosby Year Book 1991. 5. ( . ) 3 2534.