The respiratory

System
Physical examination
 COLLECTING COMPLAINS
Specific

Cough
Catarrh
Discharge of sputum
Hemoptysis
Infringements in voice
Dyspnea and pain in the chest
 COUGH
is vital defensive mechanism for lung health. It prevents
 
pulmonary aspiration, promotes ciliary activity and clears
airway debris. 

Dry – sputum is not secreted out of the respiratory tract

Productive – the sputum is secreted outside or swallowed
Superficial pharyngitis)
Deep (during bronchitis 7-8 day of diseaes)
Short –term (hacking) – in pharyngitis, simple bronchitis
onset of disease),tuberculosis
Long-term – obstructive bronchitis, bronchial asthma
Occur at night ( bronchial asthma) or morning (bronchitis)
Pain during cough (dry pleurisy)
Vomiting during the cough - whooping cough
 SPECIFIC COUGH
Pertussis cough (whooping cough)
After a long duration of cough of this kind there is a deep whistling
inspiration. Some dense sputum is excreted during this. After the cough,
vomiting occurs
Barking cough –similar to the sound arising if we blow through a pipe
into an empty bottle and also similar to the sound of the dog barking. It is
a characteristic sing of inflammation in the larynx (acute laryngitis,
stenosis of laryngotrachea, diphtheria)
 CROUP
 False croup develops as result of
infection caused by virus
(stenosis of laryngotrachea) only
in children.
 It based on the anatomic features
of the larynx – the narrowness of
vocal fissure and friability of the
mucous membrane below the
vocal chords.
 During the inflammatory process
it result in edema and stenosis of
the larynx which prevents the
passage of air through it.
 True croup is diphtheria, at which
on vocal chords, the diphtheritic
film is formed, which blocks the
respiratory tract.
 BRASSY COUGH

 During one coughing reflex,  4 year old male, neutered German

Shepherd with history of dyspnea –
two tones are heard bronchoscopy showed a piece of glass
 At the beginning the sound is at tracheal bifurcation.
low, and at the end –high pitch
sound

 Brassy cough is a
pathognomonic attribute of the
diseases accompanied by
irritation in the place of
bifurcation of the trachea
(foreign body, growth in the  4 year old male, with history of dyspnea
lymphatic nodes at – bronchoscopy showed a piece of glass
tuberculosis, lymphadenitis, at tracheal bifurcation.
tumor of mediastinum)
 Running nose
1. Character of the excretion
Aqueous
Mucous
Mucous-purulent
Purulent

2.Color - colorless, yellow, green

3.Quantity – insignificant, moderate,
significant
4.Pathological impurity (for example,
blood)
5. Smell (for example, rotten smell is a
sing of purulent process)
6.Excretion (from one or both nasal
duct)
7. Snaffle
8. Sneezing
 CHANGES OF VOICE
 Horse voise (acute
laryngitis; in severe
diseases may be aphonia
– the absence of voice)

Snuffing – difficulty of
nasal breathing at rhinitis,
maxillary sinusitis,
adenoidal vegetations
 (see image Adenoid type
of face)
 SPUTUM
 Amount
 Consistency (watery, viscous)
 Character

sputum can be mucousm mucopurulent, purulent)

 Smell – stinking (abscess of lung, bronchoextasis)

Hemopthisis Presence of blood in sputum

Tuberculosis, pulmonary hemosiderosis, destructive
pneumonia, cancer of lung

Differentiate with nasal bleeding and with gastro-intestinal

bleeding
DYSPNEA (RESPIRATORY DISTRESS SYMPTOM)
Difficulty of breathing with an changes of frequency, depth and
rhythm
Inspiratory dyspnea - is the result block of upper and media
airways (Stenotic laringotrachitis, diphtheria, foreign body in
trachea)
Expiratory dyspnea - block in lower part of airways
(bronchiolitis, obstructive bronchitis, bronchial asthma)
Mix dyspnea (pneumonia)
Respiratory rate age norm
 Newborn-40-60
 Till 1 year of age – 30-35
 5 years old -25
 10 years old-20 - 25
 More than 12 years old -16 - 20
 Decreases of the respiratory system is usually
characterized by increase in the frequency by more than
10 % - tachypnea
 Every degree more than 37 result in the increase of the
BR up to 10 respiratory movements
 Reduction of the BR by 10% and more is called
bradypnea ( lesion in respiratory center)
 Counting of respiratory rate
 To count the frequency of the contraction of the thorax
visually
 To count the frequency of inhalations holding the
stethoscope at the nostrils of the child.
 To count the frequency of inhalations during the
auscultation of the lungs
 To count the breathing rate movements placing the hand
on the thorax
 Other complains
Pain in the chest (pleurisy)
Sore throat ( pharyngitis)
Pain during swelling acute (tonsillitis)

Non specific complains

Hyperthermia

Weakness

Loss appetite

Headache

Symptoms of intoxication
History diseases
 Onset of diseases
 Where the child was during this period and with
whom he contacted
 The development of symptoms from onset of
diseases till doctor’s examination of child
 The previous treatment and effectiveness
 Previous investigations (X-ray, CBC, Sputum
culture test)
Past history
 Premorbidity background ( malnutrition,
immundeficition, rickets)
 Allergic diseases (atopic dermatitis, urticaria, allergic
rhinitis
 Previous recurrent obstructive bronchitis

 Bronchial asthma

 Heredity diseases in family

 Vaccination

 Contact with tuberculosis

Physical examination
 Inspection
 Palpation of chest

 Percussion of lang

 Auscultation of lung
 INSPECTION
Pale skin color with grayish shade (serious inflammatory
processes of respiratory system (destruction of the lungs,
pleurisy)
Hyperemia of cheek –the pathognomonic sing of croupous
pneumonia, hyperthermia
Signs of respiratory distress syndrome
•cyanosis –nasal flaring

•retraction of intercostal space,

•retraction of supraclavicular fosse

 CLUBBING OR WATCH GLASSES
 Are attributes of series chronic
diseases
 Its development is connected with
excessive hypoxemia( lack of
oxygen in blood vessels) and late
on – lack of oxygen in the tissue

 The symptom of clubbing arising as

result of this is the expansion and
cyanotic color of the distal
phalanxes of the finger.
simultaneously the flattening of the
nails occurs, and they resemble
watch glasses –thus ,it is called the
symptom of watch glasses
THE POSITION OF THE PATIENT
 The compelled sitting position – orthopneic posture
 Arises during the episode of bronchial asthma

 The child sits leaning with the hands against the side of
the bed or on his knees, fixing the girdle of the upper
extremities; in this way, it facilitates the act of breathing,
due to the participation of the auxiliary
 The compelled position on the sick side – during
pleurisy, the respiratory movement is limited and friction
of the visceral and parietal pleura, which reduce pain and
frequency of cough.
 Chest examination
 Type ( asthenic, normosthenic,
hyposthenic)
 Deforming of chest

 Pigeon chest
Barrel chest
 Is based on the increase
in the volume of
pulmonary tissure
(emphysema of the lungs)
 Characterized by barrel
shaped look
 Excessive increase of
inter –costal spaces
Examination of oral cavity
 The mucous membrane
between lips and gums
 The internal surface of cheeks

 Under the tongue

 The walls of the faring,

accurately pressing the base of
the tongue
 At examination ,the
following sings are
determined
 The color of mucous
membrane. In
normally-it is pale pink.
If inflammation –
hyperemia which can  Back wall of faring
be insignificant, Moderate hyperemia

moderate, considerable
redish / or bright
Condition of tonsil glands
 Hyperemia and Hypethrophy  Acute tonsillitis (pus)
of Tonsil glands

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