Examen físico del Aparato Respiratorio | Semiología | FCM UNR

Takeaways

• 🔍 The physical examination of the respiratory system involves inspection, palpation, percussion, and auscultation, focusing on the lower airways which include the bronchi and alveoli.
• 📐 Key anatomical landmarks of the thorax, such as the sternum, clavicles, and angle of Louis, are essential for the respiratory examination and for counting ribs and intercostal spaces.
• 👀 The lungs are divided into lobes, with the right lung having three lobes and the left lung having two, and the heart's position affects the size of the left lung due to compression.
• 🏃‍♂️ Observation of the thorax's static and dynamic characteristics is crucial, including the shape, dimensions, and respiratory mechanics during rest and effort.
• 💡 The frequency of respiration in adults normally ranges from 12 to 20 breaths per minute, and deviations from this range can indicate conditions like bradypnea or tachypnea.
• 🤲 Palpation of the thorax can reveal tender areas, indicating potential issues like costal neuralgia or rib fractures, and can also detect vibrations from pleural friction.
• 👂 Auscultation allows for the identification of normal and abnormal respiratory sounds, such as vesicular murmurs, bronchovesicular sounds, and added sounds like rhonchi or wheezes.
• 🌡️ Percussion of the thorax helps to identify the borders of lung fields and underlying organs, with different sounds indicating solid organs, air-fluid interfaces, or air-filled spaces.
• 📏 The diaphragmatic excursion is assessed by percussing the base of the lungs and noting the movement during deep inspiration, which should be 4 to 6 cm in normal conditions.
• 👃 Auscultation of vocal resonance can be increased in conditions like pneumonia with a patent bronchus or decreased in cases of atelectasis, pneumothorax, or obesity.
• 🚑 In the absence of abnormal findings, the respiratory examination should note normal bilateral air entry with preserved vesicular murmurs and no added sounds.

Q & A

What is the main focus of the physical examination of the respiratory system as described in the script?

The main focus of the physical examination of the respiratory system in the script is on the lower airways, specifically the portion of the respiratory system that includes the bronchi and their ramifications up to the respiratory bronchioles and alveoli where gas exchange occurs.

What anatomical landmarks are important to know before examining the lower airways?

Important anatomical landmarks to know before examining the lower airways include the sternum with its three parts (manubrium, body, and xiphoid process), the suprasternal notch, the clavicles on both sides, the angle of Louis, and the costal cartilages of the second ribs.

How many lobes does the right lung have and what are they?

The right lung has three lobes: superior, middle, and inferior, along with two fissures, the major and the minor fissure.

What is the significance of the diaphragmatic dome height difference between the right and left sides?

The significance of the diaphragmatic dome height difference is that the right dome is always higher than the left, which can be attributed to the heart's position and orientation towards the left, compressing the left lung and making it smaller than the right lung.

What are the two types of respiratory movements observed during dynamic inspection of the thorax?

The two types of respiratory movements observed during dynamic inspection are costoabdominal respiration, which is common in males, and costal (upper) respiration, which predominates in females.

What is the normal respiratory rate for an adult and what are the terms used to describe deviations from this range?

The normal respiratory rate for an adult is between 12 and 20 respiratory cycles per minute. Deviations from this range are termed bradypnea when the rate is below the normal range and tachypnea when it is above.

What is the clinical significance of observing the use of accessory respiratory muscles during inspiration?

The use of accessory respiratory muscles during inspiration indicates that the patient is experiencing respiratory distress, possibly due to conditions that require increased effort to inhale, such as asthma or other respiratory conditions that obstruct airflow.

How can the mobility of the thorax be assessed during the physical examination?

The mobility of the thorax can be assessed by performing maneuvers such as expansion of the upper and lower zones, where symmetry between both hemithoraxes should be observed during deep inhalation and exhalation.

What are the normal respiratory sounds that can be heard during auscultation of the chest?

The normal respiratory sounds heard during auscultation are the laryngotracheal wheeze, vesicular murmur, and bronchovesicular sound, which are produced by the turbulent airflow in large airways, the distension of alveoli, and the superposition of the two sounds, respectively.

What is the clinical significance of hearing a pleural rub during auscultation?

A pleural rub indicates the presence of inflammation in both pleural leaves, which can be caused by conditions such as pleurisy, and is characterized by vibrations that are more noticeable during inspiration.

What is the clinical significance of hearing a tubular sound during auscultation?

A tubular sound, similar to a laryngotracheal wheeze but less intense, is heard in conditions such as pneumonia where lung consolidation allows the sound from large airways to be transmitted to more distal areas of the pleura.

What are the different types of adventitious sounds that can be heard during auscultation and what do they indicate?

Adventitious sounds include dry rales (like a whistling sound) and moist rales (like bubbling sounds). Dry rales indicate significant airway obstruction, while moist rales suggest the presence of secretions in the bronchioles or alveolar wall collapse and opening.