2. System review

   1. Respiratory System

SPECIAL INSPECTION

Voice: not changed (sonorous) quiet hoarseness aphonia muteness

Breath: through nose mouth

Nose external configuration normal abnormal (pinched, saddle nose)

septum in the midline deviation (right, left) perforation

congestion discharge polyps

breath through the nose: free difficult absent

tenderness of paranasal sinuses: present absent frontal maxillary

Trachea: position (midline or deviated), tracheal tug.

Chest

Shape epigastric angle <90° =90° >90°

Physiological normosthenic asthenic hypersthenic

Pathological emphysematous/barrel-shaped paralytic keeled/pigeon funnel scaphoid kyphoscoliotic

Symmetry of the chest

Chest wall deformity places of retraction expansion

Symmetry of halves of the chest enlargement reduction right left half

clavicles are at the same various level

shoulder blades are at the same various level

supraclavicular fossae are expressed equally uneven from both sides

subclavicular fossae are expressed equally uneven from both sides

reduction smoothness of intercostal spaces

Chest wall movements decreased increased normal

both halves of thorax equally unequally participate in breathing

Sites and description of any abnormality _________________________________

____________________________________________________________________

____________________________________________________________________

Respiration rate is _____ per minute

Rhythm rhythmical arrhythmic

Type of respiration thoracic abdominal mixed

Depth of respiration normal superficial deep

Involvement of the accessory respiratory muscles in the breathing act

mm. sternocleidomastoideus trapezius pectoralis major pectoralis minor

Girth of chest: on quiet breathing _____ cm

on deep breathing in _____ cm

on breathing out _____ cm

Respiratory excursion of the chest is _____ cm.

PALPATION

Painless tenderness local profuse of the chest

Elastic rigid

Vocal (tactile) fremitus

not changed equal unequal on symmetrical points of chest surface

Pleural friction

Sounds of fluid in the pleural cavity

Sites and description of any abnormality _________________________________

____________________________________________________________________

PERCUSSION

Comparative percussion

Resonant/clear/pulmonary tympanic dull blunted bandbox percussion note over the entire lung surface

Area of any abnormality ________________________________________________

____________________________________________________________________

____________________________________________________________________

Topographic percussion

The position of upper levels of lung apices:

	Anteriorly	Posteriorly
Right	___ cm above clavicle	at the level of spinous process of the _____ th cervical vertebra
Left	___ cm above clavicle	at the level of spinous process of the _____ th cervical vertebra

The width of the right Kronig’s isthmus is ___ cm

the width of the left one is ___ cm.

The position of lower borders of lungs:

Topographical lines	Right lung	Left lung
Parasternal line	lower edge of the _____ th rib	-
Midclavicular line	lower edge of the _____ th rib	-
Anterior axillary line	lower edge of the _____ th rib	lower edge of the _____ th rib
Midaxillary line	lower edge of the _____ th rib	lower edge of the _____ th rib
Posterior axillary line	lower edge of the _____ th rib	lower edge of the _____ th rib
Scapular line	lower edge of the _____ th rib	lower edge of the _____ th rib
Paraspinal line	at the level of spinous process of the _____ th thoracic vertebra	at the level of spinous process of the _____ th thoracic vertebra

The respiratory mobility of the lower border of lungs:

Topographical lines	Right	Left
Midclavicular line	_____ cm	-
Midaxillary line	_____ cm	_____ cm
Scapular line	_____ cm	_____ cm

AUSCULTATION

Character and intensity of basic breath sounds:

Vesicular bronchovesicular bronchial

Vesicular diminished increased puerile harsh cogwheel absence

Bronchial physiological in the parts of its auscultation

pathological increased decreased amphoric stenotic metallic

Relative duration of inspiration and expiration

Sites of any abnormality ________________________________________________

____________________________________________________________________

Adventitious sounds not auscultated

Dry rales sibilant sonorous

Moist (humid) rales crackles crepitation coarse/large bubbling medium fine/small consonating/sonorous non-consonating/non-sonorous

Sites of any abnormality ________________________________________________

____________________________________________________________________

Pleural friction rub

Vocal resonance not changed equal unequal on symmetrical points

intensified decreased absent

Sites and description of any abnormality ________________________________

____________________________________________________________________

FUNCTIONAL TESTS OF RESPIRATION DELAY

Timed inspiratory capacity (Shtange test) _______ sec

Timed expiratory capacity (Gencha test) _______ sec