(7) Respiratory Assessment

Respiratory Tract organzied into…

• UPPER RESPIRATORY TRACT

• LOWER RESPIRATORY TRACT

UPPER RESPIRATORY TRACT

topics

• 1. Sinusitis (Sinus Inflammation) ⭐

• 2. Allergic Rhinitis ⭐

• 3. Pharyngitis (Sore Throat) ⭐

• 4. Lymph Nodes ⭐

LOWER RESPIRATORY TRACT

topics

• 5. Pulmonary Function Tests (PFTs) ⭐

• 6. Respiratory Physical Examination ⭐

• 7. Asthma ⭐

• 8. COPD ⭐

• 9. Pneumonia ⭐

• 10. Sputum & Cough ⭐

Sinusitis

• Viral = Most common cause

• Bacterial = >10 days no improvement, fever ≥39°C + purulent discharge , or double-sickening.

• Classification → Acute <4 weeks, Subacute 4–12, Chronic >12, Recurrent ≥4/year.

• Diagnosis → 2 major OR 1 major + 2 minor symptoms.

  • Major → facial pressure, Purulent discharge, congestion, ↓ smell, fever (acute).

  • Minor → Headache, ear pressure, bad breath, dental pain, cough, fatigue.

• Symptoms

  • Purulent = Thick, colored discharge (not always bacterial).

• Complications → Orbital cellulitis, brain abscess, meningitis.

Allergic Rhinitis

• Classification

  • Intermittent → <4 days/week OR <4 weeks.

  • Persistent → >4 days/week AND >4 weeks.

  • Mild = NO impairment; Moderate–severe = ANY impairment.

• Symptoms → Sneezing, watery nose, itching

• Complications: Rhinitis medicamentosa → Rebound congestion from nasal sprays.

• Physical signs:

  • Allergic shiners → Dark circles.

  • Allergic salute → Rub nose upward.

  • Nasal crease → Line across nose.

  • Allergies → Pale, swollen turbinates

Pharyngitis

• Most common cause → VIRAL.

• Main bacterial cause → Group A Strep (GAS).

  • Group A Strep (GAS)

    • complications →

      • Supportive- Abscess

      • Non-Supportive- rheumatic fever, glomerulonephritis.

      • ⭐ CENTOR = A scoring system to determine if a patient with a sore throat needs testing for Group A Strep (bacterial infection).

        • Each finding = 1 point:

          • C → Cough ABSENT (no cough).

          • E → Exudate (white patches on tonsils).

          • N → Nodes (tender, swollen neck lymph nodes).

          • T → Temperature (fever).

          • Add up the points: 0–2 = No testing; 3–4 = Test for strep.

• Symptoms → Sore throat, painful swallowing, fever, swollen neck nodes.

• Tonsillar exudate → White patches.

• Palatal petechiae → Tiny red spots (suggest GAS).

Lymph Nodes

• Infection → Tender, movable, bilateral.

• HIV → painless, movable, Bilateral,

• Cancer → painless, Hard/fixed,, unilateral

Pulmonary Function Tests

• FEV1/FVC <0.70 = Obstruction.

  • FEV1 = Air exhaled in first second.

  • FVC = Total forcefully exhaled air.

• Know normal ABG values:

  • pH 7.35–7.45

  • CO₂ 35–45

  • HCO₃ 20–30

  • O₂ 90–100

Respiratory Physical Examination

• A test where the doctor listens to the lungs with a stethoscope

  • Egophony - EEE sounds like AY.

  • Bronchophony → "99" sounds CLEAR.

  • Whispered pectoriloquy → Whisper sounds CLEAR.

• Abnormal lung sounds:

  • Crackles → Popping (fluid/infection).

  • Rhonchi → Snoring (mucus).

  • Wheezing → Whistling (asthma/COPD).

  • Friction rub → Scraping/Grating (pleural inflammation).

• Normal breathing (Eupnea) = 12–20/min.

  • Bradypnea → <12/min.

  • Tachypnea → >20/min.

  • Hyperpnea → Increased rate + depth.

  • Apnea → No breathing.

• Barrel chest = Emphysema/air trapping.

• 
  

Asthma

• Variable airflow obstruction

• wheezing, cough, dyspnea.

• Asthma control — 4 questions:

  1. Daytime symptoms >2×/week?

  2. Nighttime awakenings?

  3. Reliever use >2×/week?

  4. Activity limitations?

  • 0 YES = Well-controlled.

  • 1–2 YES = Partly controlled.

  • 3–4 YES = Uncontrolled.

COPD

• Exacerbation = ↑ sputum, cough, dyspnea

• COPD =

  • Chronic bronchitis = Productive cough 3 months/year × 2 years.

  • Emphysema = Alveolar destruction + air trapping.

  • Main risk factor → Smoking.

• GOLD FEV1 thresholds = 80 / 50 / 30.

  GOLD	FEV1	Severity
  1	≥80%	Mild
  2	50–79%	Moderate
  3	30–49%	Severe
  4	<30%	Very severe

• A/B/E = Low symptoms / High symptoms / Exacerbation risk.

Pneumonia

• Fever + productive cough + inspiratory crackles.

• Chest X-ray infiltrate = Key diagnostic finding.

Sputum/Cough

Sputum clues:

Appearance	Possible cause
Clear/mucoid	Viral
Purulent	Bacterial/chronic bronchitis
Rust-colored	Pneumococcal pneumonia/TB
Pink, frothy	Pulmonary edema
Bloody	PE/TB/cancer

Cough clues:

• Nighttime → Sinusitis, heart failure, ACE inhibitors.

• Early morning → Chronic bronchitis.

• Productive → COPD/pneumonia.

• Dry → Viral/ACE inhibitors.

• Barking → Croup.

• Wheezing → COPD/Asthma