Ibrahim

2. Presented by:
1. Ibrahim Mohammed
2. Alaa Hassan
3. Omnyia Ali
4. Amal Ahmed
5. Amna Ibrahim
6. Amna Mohammed

3. OBJECTIVE;
 By the end of this lecture the students should be able
to understand;
1. History of respiratory system
2. Physical assessment of respiratory system
3. Methods of investigation in respiratory system

4. History of respiratory system;
 Obtaining accurate information from the patient is
important for identifying the type and severity of
breathing problem.
 Age- gender and race can affect the physical and
diagnostic findings related to breathing
 Many of the diagnostic studies of respiratory (PULMONARY
FUNCTION TEST )
Is used to determined normal values .

5. Important aspects to assess
respiratory system history;
 Smoking history .
 Childhood illnesses ( asthma , pneumonia ,high fever ,
allergies ).
 Adult illnesses (pneumonia , HIV, TB
,AIDIS,DM,HIN,Heart diseases )
 Influenza
 Injury of upper or lower respiratory tract
 Surgery in upper or lower respiratory tract

6. CONT…….
 Night sweats , lung diseases and condition of family
members .
 Date of last chest-x ray , PFT , TB test and others
diagnostic test results.

7. Physical assessment of respiratory
system;
Include ;
1. Inspection; may show important physical signs such
as ; cyanosis and finger clubbing and chest
movement and observe shape of the ribs .
2. Palpation; its performed to assess respiratory
movement and identify areas of tenderness and
detect subcutenuos emphysema

8. CONT….
3-Percussion; involve tapping the chest wall use to assess
for pulmonary resonance and reveal areas dullness E.g;
PF .or hyperresonace eg; pneumothorax .
4- auscultation; detect abnormal breath sound such as
wheezes , crackles or, or a plural fraction rub and it is
provides information about the flow of air and helps to
identify fluid, mucus or obstruction of respiratort
system

9. Methods of investigation;
1- laboratory method ;
1. RBCs count provides data about the transport of
oxygen. ( the HGB molecule found in RBCs and act
to transport oxygen to the tissues )a deficiency of
HGB could cause hypoxia
2. Sputum examination ; obtained by expectrotion or
tracheal suctioning assist in identifying organisms
on abnormal cells such as caner and allergy .
3. Arterial blood gas; is a measurement of how much
oxygen and carbon dioxide and PH in your blood .

10. 2. Imaging method;
Plain CXR
A PA film provide information on the fields, heart ,
mediastinum , vascular sturctures and the thorathic
cage . Additional information can be obtained from a
lateral film .
 Structures of CXRs;
1. Trachea ,that should be central .
2. Mediastinum ; can be wbdend by many diseases like
(retrosternal goiter , lymph nodes enlargement ,
aortic anuerysm .

12. Cont…
3. The diaphragm ; RT side is usually slightly higher than
LT side .
 Causes of raised diaphragm ; collapsed lung ,phenric
nerve palsy and sub phenric absecess
4. Bone and soft tissues
5. Lung field ,shadows canb be divided into ;
a. Nodular shadows;
Neoplasms ,infections(pneumonia) ,granuloma (TB)
b. Retcular shadows; usually due to interstital changes
(cardiac or non cardiac ) eg; pulmonary fibrosis
d. Alveolar shadows ; usually due to pulmonary odema and
smoke inhalation .

13. CT SCAN :
 Its superior to CXR in determining the position and
the size of a pulmonary lesions .
 Its now routinely used in the assessment of patients
with suspected lung cancer and facilitated guided
percutaneuos needle biopsy.
 HRCT(high resolution) that uses thin section to
provide a detail assessment of pulmonary
parenchymal diseases (interstitial lung diseases )

17. Ultra sound of chest cavity ;
• Is sensitive to detect PE may also be used to improve
diagnostic field of pleural biopsy .
ventilation – prefusion scan
;
The value of this technique is to detect pulmonary
thrombi or emobolism .

18.  Positron Emission
Tomography PET scan
In new technology to investigate pulmonary nodules,
staging of mediastinal lymph nodes and distal
metastasis.
CT-pulmonary angiography:
 Is widely available and gold standard to diagnose PE.

19. Endoscopic Examinations:
Laryngoscopy; larynx may be inspected directly with a
mirror or indirectly with a laryngoscope.
Bronchoscopy;
 The trachea, large bronchi and lung segments can all
be inspected by either flexible or rigid bronchoscope.
Diagnostic indication of flexible bronchoscopy;
 Suspected cases of Lung ca,
 - slowly resolving pneumonia,
 pneumonia in the immunocompramised patients,
 interstitial lung disease

22. Cont.....
 Mediastinoscopy:
 Through a small incision at the supra sternal notch
under GA, to get an access to the mediastinum.

24. Other methods of investigation:
 Pulse oximetry
 Allow a non invasive assessment of peripheral 02
saturation, it provides a useful tool for monitoring
those who are acutely ill or at risk of deterioration
 Peak expiratory flow rate (PEF).
 Is measured by a maximum forced expiration through
a peak flow meter, it should be monitored regularly in
asthmatic patients monitor response to therapy and
disease control.

25. Cont...
 Pulmonary function tests PFTs: These tests evaluate
lung function and breathing problems . These tests
include lung volumes ,capacity,flow rates , diffusion
capacity,airway resistance and distribution of
ventilation .The results are interpreted by comparing
the patient's data with expected findings for age,
gender, race, height, weight, and smoking status.

26. Cont...
 Skin tests :
Skin tests are used with other diagnostic data to identify
vari- ous infectious diseases (e.g., tuberculosis), viral
diseases (e.g.. mononucleosis, mumps), and fungal
diseases (e.g., coccidioi domycosis, histoplasmosis).
Allergies and the status of the immune system also can
be checked through skin testing.