Lecture #57: DPR: History and Physical Exam of the Respiratory System

What are the primary regions examined in the respiratory system?

Nose, mouth, airway, and lungs.

What are the key symptoms in a respiratory history?

Cough, dyspnea, wheezing, chest pain, hemoptysis, snoring, apnea, fever.

What is orthopnea?

Dyspnea that occurs when lying flat and is relieved by sitting up.

What is paroxysmal nocturnal dyspnea?

Sudden nighttime shortness of breath that wakes the patient.

What are important social history elements in respiratory assessment?

Tobacco use, occupational exposures, drug/alcohol use, and exercise habits.

What should be inspected first during a pulmonary exam?

General appearance, breathing effort, accessory muscle use, color, and tracheal alignment.

What are the four main steps of the respiratory physical exam?

Inspection, palpation, percussion, and auscultation.

What is assessed during palpation of the thorax?

Tenderness, crepitus, chest expansion symmetry, and tactile fremitus.

How is tactile fremitus tested?

Using the ulnar surface of the hand while the patient says “99,” comparing both sides for vibration symmetry.

What does increased tactile fremitus indicate?

Lung consolidation (e.g., pneumonia).

What does decreased or absent tactile fremitus suggest?

Pleural effusion, pneumothorax, or obstructed bronchus.

What does a resonant percussion note indicate?

Normal, air-filled lung tissue.

What does a dull percussion note indicate?

Consolidation or fluid (pneumonia, effusion).

What does a hyperresonant percussion note suggest?

Excess air such as in pneumothorax or emphysema.

What is the correct patient positioning for auscultation?

Seated or supine; physician listens to both anterior and posterior chest on the skin.

What are the normal types of breath sounds?

Vesicular, bronchovesicular, and bronchial.

What are the key adventitious (abnormal) breath sounds?

Crackles (rales), wheezes, rhonchi, pleural rub, stridor.

What do crackles indicate?

Air moving through fluid in alveoli (e.g., pneumonia, heart failure).

What do wheezes suggest?

Narrowed airways (e.g., asthma, COPD).

What does rhonchi indicate?

Mucus or secretions in large airways that may clear with cough.

What is a pleural rub?

Low-pitched grating sound from pleural inflammation.

What is stridor?

High-pitched inspiratory sound from upper airway obstruction.

What are transmitted voice sounds used for?

To confirm abnormal lung findings.

What is bronchophony?

Increased clarity of “99” indicating lung consolidation.

What is egophony?

When “E” is heard as “A,” suggesting consolidation.

What is whispered pectoriloquy?

Whispered “99” heard distinctly, indicating dense lung tissue.

What should be inspected on the hands during a respiratory exam?

Cyanosis, clubbing, and edema.

What does clubbing of the fingers suggest?

Chronic hypoxia or lung disease.

What findings suggest pneumonia?

Dullness to percussion, increased tactile fremitus, bronchial breath sounds, and positive egophony.

What findings suggest pleural effusion?

Decreased tactile fremitus, dullness to percussion, diminished breath sounds.

What findings suggest pneumothorax?

Absent breath sounds, hyperresonance, tracheal deviation (if tension type).

What resources are recommended for further review?

Bates’ Guide to Physical Examination (Ch. 8, 15) and Mangione’s Physical Diagnosis Secrets.