HISTORY TAKING OF RESPIRATORY SYSTEM

Name/Age/Sex/Address

Occupation (coal/lead/vinyl chloride/asbestos/silica/baggasse/cotton wool/Mouldy hay)

PRESENTING COMPLAINTS:

HISTORY OF PRESENTING COMPLAINTS:

❖ Cough with expectoration:

Cough:

 Duration
 Mode of onset – insidious/sudden

 Dry/productive

 Paroxysmal/persistent

 Postural/diurnal variation

 Aggravating/Relieving factors

 Associated factors – chest pain, syncope

Sputum:

 Duration and mode of onset

 Quantity(scanty/moderate/copious)

 Character(serous/mucoid/mucopurulent)

 Colour of sputum (clear /yellow/pink/ blood )

 Odour of Sputum

 Postural/diurnal variation

❖ Hemoptysis :

 Duration
 Episodes
 Amount (mild/moderate/severe/massive)
 Appearance (Fresh/altered blood)
 Associated with purulent sputum/food particles

#OMC_LEMURIANZ’15
❖ Breathlessness :MMRC

 Duration
 Onset(Gradual/sudden)

 Grade

 Progression

 Aggravating/Relieving factors

 PND/Orthopnea

❖ Chest pain :

 Duration
 Site
 Mode of onset
 Nature – pricking/stabbing
 Severity
 Radiation
 Postural variation
 Aggravating/Relieving factors
 Associated with food intake
 Associated with nausea, vomiting
❖ H/o Halitosis

❖ Symptoms of TB:

 H/o fever(evening rise in temp)

 H/o loss of weight / appetite

 H/o night sweats

❖ Symptoms of cardiac involvement:

 H/o pedal edema

 H/o Abdominal distension

 H/o right hypochondrial pain

 H/o puffiness of face

 H/o palpitation

 H/o syncope

 H/o oliguria

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❖Symptoms suggestive of malignancy:

 H/o hoarseness of voice

 H/o dysphagia

 Mode of onset and duration

 Solid/liquid/both
 Progression
 H/o loss of appetite, loss of weight
History suggestive of PL.EFFUSION:
o Acute Abdominal distress

(Subphrenic abscess,ameobic abscess, pancreatitis, meigs syndrome)

PAST HISTORY:
o H/o previous similar episodes
o H/o HT ,DM ,
EPILEPSY,Asthma
H/o TB :
 Any contact
 Age
 Treatment- if incomplete – why?
H/o suggestive of pneumonia;

 Aspiration
(A-aspiration ,B- booze–C-coma, D – near drowning, E – epilepsy, F – foreign body).
 Exanthematous fever
 Tooth extraction, tonsillectomy, allergy
 Trauma
 Exposure to STD’S.

History of past infections:

o Measles, whooping cough

o Recurrent respiratory tract
infections.
FAMILY HISTORY:
 H/o TB/primary complex
 H/o allergies/pet animals(hairs)/ passive smoker
 H/o infertility/abortions

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PERSONAL HISTORY:

o Smoking (duration, no.of cig/day,,pack yrs,,smoking

index)

o Alcohol

o Diet /sleep

o Exposure –occupational , STD’S elaboration.

o Bladder/Bowel habits – Genitourinary TB

TREATMENT HISTORY:

SUMMARY:
Age/sex/name? Personal history ? Family history? Presenting complaints

other relevant positive findings

Probable system RS:

o Acute(<6 weeks),chronic (>3 months),Rt/Lt/both

o Parenchyma/pleura/Airways
o Obstructive/restrictive
o Suppurative/non suppurative
o Etiology
o With/without complications ? Cor pulmonary

Obstructive lung disease (Hypercapnia)

o Headache
o Drowsiness
Restrictive lung disease

o Tachypnea
o Convulsions (decrease O2 – tetany)
o Extra pyramidal symptoms (decrease O2 of basal
ganglia)
o Muscle wasting

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 Examination of respiratory system
General examination:

o Comfortable
o Conscious
o Oriented
o Built&Nourishment
o Febrile /afebrile
o Pallor
o Icteric/not
o Clubbing
o Cyanosis
o Significant lymadenopathy
o Pedal edema

See for ;

o Halitosis
o Horner’s syndrome (pancoast tumor)–
ptosis,anhydrosis,miosis,enophthalmos,loss of
ciliospinal reflex
o Troisier’s sign –enlargement of left supraclavicular
lymph nodes

Markers of pulmonary malignancy

o Acanthosis nigricans
o Gynaecomastia
o Clubbing , HPOA.

Markers of sarcoidosis:

o Hilar mediastinal lymph node enlargement

o Tonsillar enlargement
o Hepatosplenomegaly
o Eye : iritis,iridocyclitis,choroid retinitis

o Skin : SC Nodules

o Erythematous skin plaque

o Erythema nodusum

o Parotitis

o Nasal polyp/Joint Pain

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Markers of TB

o Phlycten, choroid ,tubercles

o Scars , sinus in the neck

o Serofula – SC lymadenitis in the neck

o Lupus vulgaris

o Erythema nodusum

o Cold abscess/collar stud abscess

o Tinea vesicular

o Gynaecomastia – INH (Bronchogenic Ca)

Markers of HIV:

o Hairy leukoplakia
o Oral candidiasis
o Molluscum contagiosum
o Premature graying of hair
o Long eye lashes (trichomegaly)
o Herpetic infections
o Generalized lymphadenopathy

VITALS SIGNS ;
o PULSE: elaborate(expect pulses paradoxus)

o Respiratory rate: rate, rhythm , type

o Temperature

o JVP

LOCAL EXAMINATION OF RS

INSPECTION:

 Oral Cavity ; Oral hygiene/dental caries/oral thrush/Tonsils

 Nose ; DNS,Polyp(Wegners granulomatosis,Allergic asthma,ABPA,CF)
 Pharynx ; Postnasal drip,lymphoma deposits

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 Chest:

o Symmetry
(Normal – Elliptical,
HUTCHINSON INDEX( AP : T ) = 5:7
Subcostal angle = 90 degree
o Shape:
 Flat chest(TB,Fibrothorax)
 Barrel chest (Emphysema,Infancy/Old age)
 Pigeon chest(Pectus Carinatum) –
Marfan,Childhood asthma,Rickets
 Funnel chest/Cobblers/Pectus
Excavatum(Marfan’s syndrome)
 Harrison Sulcus
o Costochondral beading
 Rachitic Rosary (Vit D)
 Scorbutic rosary(Vit C)
o Movement with respiration
o Tracheal Position with Trial Sign
o Apical Impulse
o Drooping of shoulders
o Supraclavicular/IC hollowing/subcostal retractions
o Prominence of medial border of scapula
o Kyphoscoliosis
o Crowding of ribs
o Dilated veins over chest(Sarcoid,Malignancy)
o Discharging sinus(TB)
o Intercostal Scar
(drained PE,Pneumothorax,empyema)

PALPATION:
o Tracheal position

o Apical impulse

o Chest movement by palpation (assessing symmetry of

chest expansion – Upper/anterior/posterior)

o Chest expansion measurement - bilateral/Hemithorax

o Tactile fremitus, Friction fremitus

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 o Vocal fremitus(inc.Consolidation/dec.P.Effusion)

o IC Tenderness

o Lymph nodes – cervical, supraclavicular, axillary

PERCUSSION :

SITE RIGHT LEFT

Directly on clavicle +/- +/-
Anteriorly
Supraclavicular(apex) +/- +/-
Infraclavicular +/- +/-
Mammary +/- +/-(Cardiac Dullness)
Axilla
Axillary +/- +/-
Infra axillary +/- +/-
Posterior
Suprascapular +/- +/-
Infrascapular +/- +/-
Interscapular – Upper +/- +/-
Middle +/- +/-
Lower +/- +/-
 Hyperresonant =Pneumothorax,emphysema
 Impaired = Fibrosis
 Dull = Consolidation,Collapse,Pleural Thickening
 Stony dull = P.effusion,empyema,Parenchymal Lung Disorder
+Pl.thickening
 Crackpot Resonance = Large cavity communicates with bronchus
 Percussion Tenderness =Empyema,Parietal Pleural Inflammation
 Normal Percussion in Diseased lung,
(Chronic bronchitis,BA,ILD,Diffuse emphysema)

Tidal percussion ; dull/resonant

Traube’s space – left sixth rib, left 9th anterior axillary line, left costal margin
Shifting dullness ; Hydropneumothorax,P.Effusion

Staightline dullness ; Hydropneumothorax

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AUSCULTATION:

Auscultation in above mentioned areas,

1.Breath sounds

 Normal vesicular breath sounds (harsh/normal)

 Bronchial breath sounds

High pitch tubular

Low pitch cavernous

Low pitch Amphoric

 Broncho vesicular breath sounds

 Absent breath sounds

2.Added sounds

Crepitus/crackles ;
• fine/medium/coarse leathary
• inspiratory/expiratory/both phases.
• change after coughing

Ronchi/wheeze ;
 inspiratory/expiratory/both
 pitch(low/high)
 monophonic/polyphonic
 change after coughing

Pleural rub

Stridor

Post tussive suction

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3.Vocal resonance

o Compare both sides

o Bronchophony

o Aegophony (E to A)

o Whispering pectoriloquy

4.Others
o Succession splash
o Coin test
o De Espine Sign

OTHER SYSTEMS:
CVS: See for RHF, CCF

ABDOMEN: see for liver abscess, tenderness

CNS: See for asterexis

DIAGNOSIS
A ………..Sided……(parenchymal/pleural) disease probably
…….(PE/fibrosis/consolidation/cavitation)probably due to…….etiology ….( with/without
signs of RHF).

INVESTIGATIONS:

TREATMENT:

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