Respiratory System Examination Made Easy: A Practical Approach

RS examination involves inspection, palpation, percussion, and auscultation to detect lung and airway diseases.

Mnemonic: "I.P.P.A. = Inspection, Palpation, Percussion, Auscultation"

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1. INSPECTION (LOOK)

Chest Shape Abnormalities (P.K.B.H.)

• P – Pectus Carinatum (Pigeon Chest).
• K – Kyphoscoliosis (Spinal Deformity).
• B – Barrel Chest (Seen in COPD).
• H – Harrison’s Sulci (Seen in Rickets).

Other Signs to Look For:

• Tracheal Position (Midline or Deviated).
• Accessory Muscle Use (Nasal Flaring, Intercostal Retractions).
• Clubbing (Lung Disease Indicator).
• Skin Rashes (Measles, Atopic Dermatitis).

Mnemonic: "T.A.C.S. = Trachea, Accessory Muscles, Clubbing, Skin"

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2. PALPATION (FEEL)

Check for:

• Chest Expansion (Symmetry on Both Sides).
• Tracheal Deviation (Indicates Lung Collapse or Effusion).
• Tactile Fremitus (Vibrations Felt When Patient Says '99').

Mnemonic: "C.T.T. = Chest Expansion, Tracheal Deviation, Tactile Fremitus"

• Tactile Fremitus Increased → Consolidation (Pneumonia).
• Tactile Fremitus Decreased → Pleural Effusion or Pneumothorax.

Mnemonic: "I.C.D. = Increased in Consolidation, Decreased in Pleural Disease"

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3. PERCUSSION (TAP)

Percussion Sounds:

• Normal → Resonant Sound.
• Stony Dull → Pleural Effusion.
• Hyperresonant → Pneumothorax, Emphysema.
• Dull → Lung Consolidation (Pneumonia).

Mnemonic: "N.S.H.D. = Normal, Stony Dull, Hyperresonant, Dull"

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4. AUSCULTATION (LISTEN)

Types of Breath Sounds:

• Normal (Vesicular) → Heard in Peripheral Lungs.
• Bronchial → Loud, Tubular, in Consolidation.
• Absent → Pleural Effusion, Pneumothorax.

Mnemonic: "N.B.A. = Normal, Bronchial, Absent"

Added (Adventitious) Sounds:
Crackles (Crepitations):

• Fine → Pulmonary Fibrosis.
• Coarse → Bronchiectasis, LV Failure.

• Wheeze → Asthma, COPD.
• Pleural Rub → Pleurisy.

Mnemonic: "C.W.P. = Crackles, Wheeze, Pleural Rub"

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5. VOCAL RESONANCE (SPEECH TRANSMISSION TESTS)

Tests:

• Bronchophony: Loud Voice Transmission → Pneumonia.
• Egophony: 'E' Sounds Like 'A' → Consolidation.
• Whispering Pectoriloquy: Whispered Words Heard Clearly → Consolidation.

Mnemonic: "B.E.W. = Bronchophony, Egophony, Whispering Pectoriloquy"

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RESPIRATORY RATE (NORMAL & ABNORMAL PATTERNS)

Normal Rate: 12-20 breaths per minute.
Abnormal Rates:

• Tachypnea (>20 bpm) → Fever, Lung Disease.
• Bradypnea (<12 bpm) → Brainstem Injury, Opiates.
• Kussmaul’s (Deep, Fast) → Diabetic Ketoacidosis.
• Cheyne-Stokes (Gradual Increase & Decrease) → Brain Injury, Heart Failure.

Mnemonic: "T.B.K.C. = Tachypnea, Bradypnea, Kussmaul’s, Cheyne-Stokes"

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DISEASE-SPECIFIC FINDINGS

PNEUMONIA:

• Increased Tactile Fremitus & Vocal Resonance.
• Dull Percussion.
• Bronchial Breath Sounds.

Mnemonic: "Pneumonia = I.D.B. (Increased Fremitus, Dull, Bronchial)"

PLEURAL EFFUSION:

• Decreased Tactile Fremitus & Vocal Resonance.
• Stony Dull Percussion.
• Absent Breath Sounds.

Mnemonic: "P.E. = Decreased Fremitus, Stony Dull, Absent Sounds"

PNEUMOTHORAX:

• Decreased Tactile Fremitus & Vocal Resonance.
• Hyperresonant Percussion.
• Absent Breath Sounds.

Mnemonic: "P.T. = Decreased Fremitus, Hyperresonant, Absent Sounds"

ASTHMA:

• Wheeze (Expiratory).
• Prolonged Expiration.
• Decreased Breath Sounds in Severe Cases.

Mnemonic: "A.W.P. = Asthma, Wheeze, Prolonged Expiration"

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HOMOEOPATHIC MANAGEMENT OF RESPIRATORY DISEASES

• For Acute Cough & Bronchitis:
• Antimonium Tart, Bryonia, Hepar Sulph, Spongia.

• For Pneumonia & Lung Infections:
• Phosphorus, Kali Carb, Lycopodium.

• For Asthma:
• Blatta Orientalis, Ipecac, Arsenicum Album.

• For Chronic Lung Diseases (COPD, Bronchiectasis):
• Carbo Veg, Senega, Kali Bich.

Mnemonic: "A.B.H.S. = Antimonium, Bryonia, Hepar, Spongia for Cough"

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FINAL REVISION WITH MNEMONICS

• Examination Steps = "I.P.P.A." (Inspection, Palpation, Percussion, Auscultation)
• Chest Shapes = "P.K.B.H." (Pectus Carinatum, Kyphoscoliosis, Barrel Chest, Harrison’s Sulci)
• Palpation = "C.T.T." (Chest Expansion, Tracheal Deviation, Tactile Fremitus)
• Percussion = "N.S.H.D." (Normal, Stony Dull, Hyperresonant, Dull)
• Auscultation = "N.B.A." (Normal, Bronchial, Absent Sounds)
• Adventitious Sounds = "C.W.P." (Crackles, Wheeze, Pleural Rub)
• Vocal Resonance = "B.E.W." (Bronchophony, Egophony, Whispering Pectoriloquy)
• Respiratory Patterns = "T.B.K.C." (Tachypnea, Bradypnea, Kussmaul’s, Cheyne-Stokes)
• Pneumonia = "I.D.B." (Increased Fremitus, Dull, Bronchial Sounds)
• Pleural Effusion = "P.E." (Decreased Fremitus, Stony Dull, Absent Sounds)
• Pneumothorax = "P.T." (Decreased Fremitus, Hyperresonant, Absent Sounds)
• Asthma = "A.W.P." (Asthma, Wheeze, Prolonged Expiration)
• Homeopathy = "A.B.H.S." (Antimonium, Bryonia, Hepar, Spongia for Cough)