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8/8/2019 Respiratory Disease Investigation
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Investigations Respiratory System
Vd. Santhosh B
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Objective
To highlight some of the important
basic investigations pertaining to
diseases of respiratory system
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Introduction
One third of the deaths in world
caused by respiratory diseases
Emergency management needed
Diagnosis Prognosis
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Principal Symptoms
1. Cough
2. Sputum production
3. Haemoptysis
4. Chest pain
5. Breathlessness
6. Wheeze
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Sound
Feeble non-explosive : respiratory muscle weakness
: lung cancer
Prolonged wheezy : severe airflow obstruction
(Asthma or COPD)
Harsh barking : laryngeal infection
Moist : bronchiectasis
Dry : tracheitis and pneumonia
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Circumstance
Nocturnal Asthma
During and after swallowing liquids
neuromuscular disease of oropharynx
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Amount
Large volume of purulent sputum
bronchiectasis
Sudden large purulent rupture of lung
abscess
Large watery sputum with pink tinge
pulmonary oedema
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Colour
Clear/mucoid COPD without active infection
Yellowish acute LRTI (live neutrophils)
Green chronic infection (dead neutrophils)
Rusty red pneumo-coccal pneumonia
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Amount and Appearance
Streaking of clear sputum with blood or the
presence ofblood clots in the sputum for
more than a week is suggestive of lung cancer
Haemoptysis with purulent sputum suggests
an infective cause such as bronchiectasis
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Pleural Pain
It is sharp, stabbing and always intensified by
inspiration or coughing
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Chest Wall Pain
Indicate respiratory or musculoskeletal
disease
Patients with COPD or asthma usually develop
this pain
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Mediastinal Pain
Typically central, retrosternal and unrelated to
respiration or cough
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Variability
Left ventricular failure and respiratory muscle
weakness commonly present with breathlessness
when lying flat
COPD waking in the morning (3am 5am) due to
breathlessness
Breathlessness that improves at the weekend or on
a holiday is suggestive of occupational asthma
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Nature
Wheeze on exercise is a common symptom of
asthma and COPD
Wheezing that cause night wakening
Asthma
Wheeze after wakening in the morning
COPD
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General examination
Inspection (abnormalities in shape of chest)
Palpation (chest expansion)
Percussion (resonant note)
Auscultation (normal breath sounds)
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Percussion Note
Resonant - Normal
Hyperresonant - Pneumothorax
Dull - Pulmonary consolidation
Pulmonary collapse
Pulmonary fibrosis
Stony dull - Pleural effusionHaemothorax
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Chest X-ray
Lung fields (equal translucency)
Lung apices (look for masses, cavitation)
Heart (normal shape)
Diaphragm (hyperinflation)
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Sputum Examination
Patients with unexplained haemoptysis or
suspected lung cancer, sputum is sent for
CYTOLOGICAL EXAMINATION
In LRTI symptoms microbiological culture
Pneumonia Gram stain is used
Gram positive pneumococcus or staphylaococcus
Gram negative Haemophilus influenza
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Oximetry
Spectrophotometric device
Measures arterial oxygen saturation (SaO2)
Helps in oxygen therapy
SaO2
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Arterial blood gas analysis
PaO2 , PaCO2 and pH
Respiratory Acidosis ( PaCO2 pH)
Respiratory Alkalosis ( PaCO2 pH)
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Spirometry
Forced expiratory volume in one second
Forced vital capacity
Ratio > 75% (Adult)
If it is < 75%, it indicates air way obstruction
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Summary
Disease condition can be predicted by the
symptoms only
It can be solidified by the investigations
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Conclusion
Oxygen is the foremost thing required for life
Alarm of the respiratory disease is given by
the symptoms
Investigations confirm them and help in
treatment and restoring the life
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Further clarification
Macleods Clinical Examination: 11th
edition: pp 124-147
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