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Respiratory Examination – Hemoptysis

Respiratory Examination – Hemoptysis

Definition: Expectoration of blood or bloody sputum
Classification:

Mild: <100 ml/day
Moderate: 100-150 ml/day
Severe: 150-200 ml/day
Massive: >500 ml/day or rate >150 ml/hr or >100 ml/day for 3 days (Pulmonary infarction, Carcinoma)

Causes:

Infection: TB, Lung abscess, Bronchiectasis, Pneumonia, Fungal
Neoplasm: Carcinoma, adenoma, Metastatic
Congenital: Bronchial cyst, Sequestration of lung
Traumatic, Iatrogenic, Bleeding disorder
Cardiovascular: Mitral stenosis, Pulmonary HTN, Aortic aneurysm, AV malformation, PE
Collagen Vascular Disease: Vasculitis, Wegner’s granulomatosis, Good …

Respiratory Examination – Relevant Anatomy and Physiology

Respiratory Examination – Relevant Anatomy and Physiology

1. Division of Airway:

Extrathoracic (Upper) airway: Nose to Upper trachea
Intrathoracic (Lower) airway: Lower trachea to Alveoli and lungs

Note: Vocal fold is also regarded as the demarcating line between upper and lower respiratory tract
2. Angle of Louis: Junction of body of sternum to manubrium (2nd costal cartilage anteriorly and T4/5 posteriorly)

2nd rib joins manubrium (Start counting ribs)
Bifurcation of trachea
Beginning and …

Respiratory Examination – Noisy Breathing

Respiratory Examination – Noisy Breathing

GRUNTING 
Definition: A short, explosive, moaning or crying sound heard on expiration (Child and neonates)
Cause: Any cause of respiratory distress
Mechanism: In attempt to increase FRC which helps to keep narrowed or collapsing airways open, creating a longer time for alveolar gas exchange

STERTOR
Definition: Non-musical, low pitched, snoring sound
Cause: Supra-laryngeal obstruction
STRIDOR
Definition: Loud, intense, monophasic sound with constant pitch
Cause: Upper airway obstruction at …

Respiratory Examination – Dyspnea

Respiratory Examination – Dyspnea

Definition: Breathlessness inappropriate to the level of physical exertion or even occurring at rest (subjective and not a sign)
Mechanisms:
Chemoreceptors:
Peripheral: Carotid and aortic bodies (to pO2, pCO2 and H+)
Central: Medulla (to pCO2, not pO2, change in pH of CSF)
a. Increased work of breathing:

Airflow obstruction: Bronchial asthma, COPD, Tracheal obstruction
Decreased pulmonary compliance: Pulmonary edema, fibrosis, allergic alveolitis
Restricted chest expansion: Ankylosing spondylitis, Respiratory …

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