Lecture On Clinical Examination of the Respiratory System: History, Physical Exam | MBBS скачать в хорошем качестве

Lecture On Clinical Examination of the Respiratory System: History, Physical Exam | MBBS

Embark on a comprehensive journey through the clinical examination of the respiratory system with this in-depth MBBS lecture from Santiniketan Medical College & Hospital. Tailored for medical students and practitioners, this session covers essential techniques for history taking, physical examination, and the diagnostic approach to conditions like pleural effusion. Key Topics Covered in this Lecture: Effective History Taking [00:00]: Prioritizing chief complaints and present illness over personal, treatment, or family history [00:08]. Formulating a concise diagnosis and summarizing the case effectively [00:49]. Detailed inquiry into symptoms like breathlessness, cough (productive/non-productive, character, timing, aggravating/relieving factors), chest pain (character, radiation), fever, palpitations, and paroxysmal nocturnal dyspnea [03:01]. Importance of quantifying symptoms (e.g., cough expectation in "cups") and using the patient's language in documentation [06:39]. Identifying important negative histories (e.g., hemoptysis, jaundice, skeletal pain, pallor) [09:20]. Past medical history, including childhood respiratory illnesses and allergic tendencies [10:04]. Family history of significant illnesses [10:57]. Crucial role of occupational history in respiratory diseases (e.g., stone quarries, coal mines) [11:18]. Addiction history, specifically tobacco in all its forms (cigarettes, bidis, khaini, pan masala, gudaku) [11:48]. General Physical Examination [12:19]: Assessing patient's general appearance, consciousness, and cooperation [12:32]. Understanding Decubitus of Choice (e.g., lying on the affected side in massive pleural effusion, propped-up position in COPD) [12:47]. Routine checks for anemia, jaundice, cyanosis, clubbing, and edema [14:52]. Examination of lymphadenopathy and thyroid [15:07]. Vital signs: heart rate, respiratory rate, blood pressure, temperature, and SPO2 [15:25]. Observation of hyper/hypopigmentation and hair distribution [15:42]. Systemic Examination (Respiratory System Focus) [16:19]: Upper Respiratory Tract Examination [17:31]: Inspection of nasal septum (deviation, polyps, bleeding points), pharynx, and larynx. Trachea Examination [18:49]: Inspecting for prominence, pulsations, and palpating for midline position and deviation [25:11]. Chest Examination (IPPA - Inspection, Palpation, Percussion, Auscultation) [19:00]: Inspection [19:18]: Chest shape (symmetrical/asymmetrical, deformities like kyphosis, scoliosis, gibbus), abnormal hair distribution, pigmentation, visible pulsations, gynecomastia, and identification of puncture marks or surgical scars [22:38]. Palpation [23:30]: Corroborating inspection findings. Assessing mediastinal position, apical impulse [26:09], and respiratory movements (equal and symmetrical expansion) [27:13]. Vocal fremitus assessment [28:51]. Percussion [30:06]: Technique of percussion, understanding different sounds (resonant, dull, tympanitic) [32:02]. Detecting dullness (e.g., upper border of liver dullness) and shifting dullness (indicating fluid) [32:54]. Auscultation [33:49]: Using diaphragm vs. bell of stethoscope [34:03]. Understanding the generation of breath sounds (tracheal, bronchial, vesicular) [35:09]. Differentiating vesicular, bronchial, and bronchovesicular breath sounds [37:17]. Importance of comparing sounds bilaterally [41:11]. Vocal resonance, egophony, and whispering pectoriloquy [42:02]. Diagnosis & Investigations of Pleural Effusion [45:31]: Clinical findings indicative of pleural effusion (diminished breath sounds, dullness on percussion, tracheal shift) [45:49]. Confirming Pleural Effusion: Routine laboratory investigations (CBC, LFT, KFT, blood sugar) [46:44]. Chest X-ray: identifying fluid (opacity, blunted costophrenic angle, semilunar vs. flat opacity in hydropneumothorax) [47:25]. Diagnostic Thoracocentesis: procedure, fluid volume for diagnosis (minimum 200ml for X-ray detection, 50ml for cellular/biochemical analysis) [49:20]. Therapeutic Thoracocentesis: fluid removal for relief (up to 3% of body weight) and precautions (stopping if patient coughs or has dyspnea) [01:04:43]. Causes of Pleural Effusion [53:07]: Unilateral causes: Pulmonary Tuberculosis, Lobar Pneumonia/Bronchopneumonia, Bronchogenic Carcinoma, Pulmonary Infarction [54:01]. Reactive effusions from subphrenic abscesses, pancreatitis, connective tissue disorders. Bilateral (Hydrothorax) causes: Congestive Cardiac Failure, Nephrotic Syndrome/Kidney Disease, Cirrhosis of Liver/Alcoholic Liver Disease, Hypoalbuminemia due to nutritional causes or malabsorption syndromes [55:25]. SANTINIKETAN MEDICAL COLLEGE & HOSPITAL Real Classroom Demonstration/Lecture On: MEDICINE by Dr. Sujan Sarkar (MBBS Batch: 2023-24) Conducted on: 28-10-25