Name / Age / Sex / Occupation / Address

Chief Complaints: H/o dyspnea

H/o cough with expectoration
History of presenting illness:
H/o sputum
H/o Cough with expectoration H/o hemoptysis
H/o chest pain
Duration H/o fever
H/o night sweats
Mode of onset H/o weight loss
H/o palpitation
Paroxysmal H/o syncope
H/o leg swelling
Dry / productive

Postural / Diurnal variation

Aggravating factors

Relieving factors

Associated factors – chest pain, syncope Cardiac etiology

H/o Sputum
Green & yellow - bacterial inf
Duration Rusty - pneumococcal pneumonia
Colour and odour Red currant jelly - klebsiella pneumonia.
Black colour - coal worker pnuemoconiosis .
Amount Pink - pulmonary edema
Character – mucoid/serous, purulent,mucopurulent

With/without blood

Postural / Diurnal variation

Bacterial inf.
H/o Hemoptysis

Duration

Episodes

Amount of blood

Fresh or altered blood

Associated with purulent sputum or food particles

H/o Breathlessness

Duration H/ o : Duration
Onset Onset
Minutes
Progression
• Pulmonary thromboembolism Aggravating factor
• Pneumothorax
• Asthma
Relieveing factor
• Inhaled foreign body Orthopnea
Pnd
 • Acute left ventricular failure
Hours to days
• Pneumonia
• Asthma
• Exacerbation of COPD
Weeks to months
• Anemia
• Pleural effusion
• Respiratory neuromuscular disorders
Months to years
• COPD
• Pulmonary fibrosis
• Pulmonary tuberculosis

Grade
Grade 0: strenuous exercise
Medical Research Council (MRC) breathlessness scale
Grade 1 Breathless when hurrying on the level or walking up a
slight hill
Grade 2 Breathlessness when walking with people of own age or
on level ground
Grade 3 Walks slower than peers, or stops when walking on the
flat at own pace
Grade 3 4 Stops after walking 100 meters, or a few minutes, on the
level
Grade4 5 Too breathless to leave the house
(Grade 5b) Too breathless to wash or dress

Progression

Aggravating factors

Relieving factors

Postural variation

Orthopnea
Paroxysmal nocturnal dyspnea
Trepopnoea
Platypnoea
Timing of the day – Myasthenia gravis, COPD, bronchial asthma, cardiac failure
H/o Chest pain

Duration (Socrates ) Seen in pleuritis / cardiac cause

Site

Mode of onset

Nature/ Character – pricking /stabbing

Grade / severity

Radiation

Postural variation

Changes with respiration

Diurnal variation

Aggravating factors

Relieving factors

Associated with food intake

Associated with nausea sweating

Associated with other symptoms

H/o Wheeze

Duration

Onset

Diurnal variation

Aggravating factors

Relieving factors

H/o Halitosis

H/o Fever with evening rise of temperature TB

H/o Loss of weight

Tumor / TB
H/o Loss of appetite

H/o Night sweats

H/o Pedal edema

H/o Abdomen distension

H/o Right hypochondrial pain

H/o Facial puffinenss

H/o Palpitations

H/o Syncope

H/o Oliguria

H/o Abdomen tenderness

H/o Hoarseness of voice

H/o Dysphagia

Mode of onset

Duration

Progression

Solids/liquids

PAST HISTORY

H/o similar episodes in the past

H/o BA / any known allergies

H/o HTN/DM/CAD/Epilepsy TB

H/o PTB

Any contact /age / treatment if any

H/o Pneumonia

Aspiration

Exanthemous fever

Tooth extraction, tonsillectomy,

H/o Trauma

H/o Exposure to STDS

H/o pulmonary embolism

Acute abdominal distress

Subphrenic abscess / amoebic liver abscess / pancreatitis

H/o Past infections

Measles, whooping cough, recurrent resp tract infections

TREATMENT HISTORY

H/o ATT drugs

H/o ACE inhibitors use

H/o treatment for other systemic illnesses

FAMILY HISTORY

H/o PTB in other family members

H/o known allergies in family members

H/o other systemic illnesses

PERSONAL HISTORY

Smoking in pack years

Alcohol

Betel nut / tobacco abuse

Diet

Sleep habits / bowel and bladder habits

SOCIAL HISTORY / MENSTRUAL HISTORY

Menstrual history / menopausal history

H/o contact with STDs

SUMMARY

EXAMINATION OF THE RESPIRATORY SYSTEM

GENERAL EXAMINATION

Conscious

Oriented

Afebrile / febrile

Comfortable / dyspnoeic at rest

Built / nourishment

Pallor - anaemic —-> breathlessness seen

Icterus

Cyanosis

Clubbing

Lymphadenopathy

Pedal edema

Others:

IVC obstruction

Halitosis

Horners syndrome

Troisers sign

Markers of pulmonary malignancy

Acanthosis nigricans

Gynaecomastia

Clubbing / HPOA

Markers of sarcoidosis

Tonsillar enlargement
 Hepato splenomegaly

Eye: iritis, iridocyclitis, choroid retinitis

Skin: SC nodules, erythematous plaques, erythema nodosum

Parotitis

Nasal polyps

Markers of TB

Phlycten, choroids, tubercles

Scars / sinuses in the neck

Scrofula – s/c lymphadenitis in the neck

Lupus vulgaris

Erythema nodosum

Cold abscess / collar stud abscess

Tinea versicolor

Gynaecomastia – INH / bronchogenic Ca

Markers of HIV

Hairy leukoplakia

Oral candidiasis

Molluscum contagiosum

Premature greying of hair

Long eye lashes [trichomegaly]

Herpetic infections

Generalized lymphadenopathy

VITAL SIGNS

PULSE

Rate / rhythm / character / volume / condition of the vessel wall

Felt in all peripheral vessels

Radio radial / radio femoral delay

BLOOD PRESSURE

Mm of hg / limb / posture
 RESPIRATION MAT - Male Abdomino - thoracic
FTA - Female thoracic-abdominal
Rate /rhythm / type

TEMPERATURE
It
JUGULAR VENOUS PULSE

EXAMINATION OF THE RESPIRATORY SYSTEM

Small air ways ( bronchioles) + alveoli
INSPECTION duct + alveoli sac
UPPER RESPIRATORY TRACT Consolidation - pneumonia
So infection ( cough + sputum , yellow fever)
Nasal septum Chest pain on same side of affected area.
Sinus tenderness

Polyps

Tonsils

Oral hygiene

Halitosis

Post nasal drip

CHEST
Pleural effusion - sternum shift
Symmetry to opp side
Shape –

Normal

Long flat chest

Alar chest [pterygoid chest/winged chest}

Pigeon chest / chicken breast / pectus carinatum /keel chest

Rachitic chest

Barrel chest Copd

Funnel chest / pectus excavatum / cobblers breast

[s/I marfan syndrome, straight back syndrome}

Phthinoid chest [pre tuberculous chest, paralytic thorax}

Visceroptic chest

Gutter breast
 Fissured chest

Scaphoid chest

Scorbutic rosary

Flail chest / stove in chest

Shield chest [s/I Turners, Noonan’s syndrome}

Bilaterally contracted chest

Bilaterally expanded chest

Costochondral bending – rachitic rosary / scorbutic rosary

Movement with respiration

Tracheal position with trail sign

Tracheal movement during inspiration

Apical impulse

Scars / sinuses / discharging sinuses

IC fullness / IC tenderness

Drooping of shoulders

Supraclavicular and infraclavicular hollowing Reduced lung volume

Harrison’s sulcus

Prominence of medial border of the scapula

Use of accessory muscles of respiration

Kyphoscoliosis

Dilated veins over the chest

PALPATION

Tracheal position

Tracheal tug

Apical impulse

AP diameter

Transverse diameter

Ratio AP/ T -1:2 normal

Chest Expansion
 Chest Movements
Anterior Thoracic Movement

Posterior Thoracic Movement

Upper Thoracic Movement

Tenderness over the Chest Wall

Vocal Fremitus

Intercostal tenderness

PERCUSSION

Areas

Anterior Chest Wall

Clavicle

Supraclavicular region

Infraclavicular

Mammary

Lateral Chest Wall

Posterior Chest Wall

Suprascapular

Interscapular region

Infrascapular region

Air bt lung and chest wall

Fluid in air ways and alveoli ( pneumatic)
 Tidal Percussion

Traube’s Space percussion

Straight Line Dullness

Shifting Dullness

AUSCULTATION

Vesicular breath sounds

Bronchial breath sounds

Tubular

Cavernous

Amphoric

Bronchovesicular breath sounds

Absent breath sounds Diminished in effusion

Added sounds

Crepitations / crackles - seen in consolidation

Inspiratory / expiratory / both phases

Fine / medium / coarse leathery

Change after coughing

 Ronchi /wheeze

Inspiratory /expiratory

Pitch

Monophonic /polyphonic

Pleural rub

Post tussive suction

Vocal resonance

Compare both sides

Bronchophony

Aegophony

Whispering pectoriloquy

Others

Succusion splash

Coin test

Stridor

DIAGNOSIS

Acute / chronic

Parenchymal / interstitial / airway / extra pulmonary

[Lung] disease

Side

Structure / areas of the lung involved

Disease process – fibrosis /collapse / cavity /consolidation / effusion

Etiology

With or without signs of right heart failure

With or without skeletal deformities

And other features