Medical Semiology Guide of the Respiratory System

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MEDICAL SEMIOLOGY GUIDE OF THE RESPIRATORY SYSTEM
Copyright
About the Author
	MANUELA STOICESCU
Motto
Thank you all my students!
Scientific Activity
	ACCOMPLISHMENTS
		Publications 51
	BOOKS 7
	PUBLICATIONS 56
		CONFERENCES 2018
		CONFERENCES 2019
Introduction
	The History of the Patient
	1 PERSONAL DATA
	2 PLACE OF BIRTH AND HOME (ADDRESS)
	3 ALLERGY?
	4 THE REASON FOR HOSPITALIZATION
		4 Example No. 1
		4 Example No. 2
		4 Example No. 3
		4 Example No. 4
	5 THE HISTORY OF THE CURRENT DISEASE
	6 FAMILY HISTORY
	7 PERSONAL PATHOLOGICAL HISTORY
	8 PERSONAL PHYSIOLOGICAL ANTECEDENTS
	9 LIFE CONDITIONS
		A The housing conditions
		B Eating
		Toxic consumptions
			C Alcohol consumption
			C Smoking
			C Coffee
			C Drugs
	10 WORKING CONDITIONS
	11 GENERAL MANIFESTATIONS
1 - Questionnaire
2 - The Main Symptoms of the Respiratory Diseases
	2.1 Pleural Pain—Stabbing Pain
	2.2 Stabbing Pain in Pleural Diseases
	2.3 Dyspnea
	2.4 Cough
	2.5 Sputum (Expectoration)
		2.5.1 The Macroscopic Exam of the Sputum
		2.5.2 The Quantity of Expectoration
	2.6 Vomica
		2.6.1 The Appearance and Color of Sputum
		2.6.2 The Smell and Taste of Sputum
		2.6.3 The Microscopic Examination of Sputum
		2.6.4 The Bacteriological Examination of Sputum
	2.7 Hemoptysis
		Hemoptysis
		Hemoptysis
		The Chest X-Ray
3 - The Objective Examination
	3.1 Typical Faces in the Respiratory Diseases
		3.1.1 The Vultuous (Red) Face—In Pneumonia
			3.1.1.1 Red Faces
			RED FACES
			3.1.1.2 Herpes on the Upper and Lower Lip Appears in Fever—Pneumonia
		3.1.2 The Two Types of Face in Chronic Obstructive Pulmonary Disease
			3.1.2.1 Faces in Pulmonary Emphysema—Type A
				Pink Puffer
			3.1.2.2 Faces in Chronic Bronchitis Blue Bloater–Type B
				Blue Bloater
				3.1.2.2.1 Blue Bloater Faces Left Lateral View
				3.1.2.2.2 Cyanosis of the Lips and Tongue
				3.1.2.2.3 Type B of COPD Bronchitis Blue Bloater
				3.1.2.2.4 Type B of COPD Bronchitis Blue Bloater
				3.1.2.2.5 Type B of COPD Bronchitis; Blue Bloater
				3.1.2.2.6 Blue Bloater Faces Type B—Bronchitis of COPD
		3.1.3 Doll Face
		3.1.4 Faces in Claude Bernard–Horner Syndrome
4 - The Objective Examination of the Thorax
	4.1 The Clinical Topography of the Anterior Chest
	4.2 The Clinical Topography of the Lateral Chest
	4.3 The Clinical Topography of the Posterior Chest
	4.4 The Inspection of the Thorax
		4.4.1 Normal Shape of Thorax—Anterior View
		4.4.2 Normal Shape—Posterior View
		4.4.3 Global Symmetric Deformations
			4.4.3.1 Barrel Chest, Rounded or Bulging Chest—Anterior View
				4.4.3.1.1 Barrel Chest, Rounded or Bulging Chest—Posterior View
				4.4.3.1.2 Barrel Chest, Rounded or Bulging Chest—Left Lateral View
				4.4.3.1.3 Barrel Chest or Emphysematous Chest—Anterior View
				4.4.3.1.4 Barrel Chest—Left Lateral View
				4.4.3.1.5 Barrel Chest—Left Lateral View
				4.4.3.1.6 Barrel Chest—Left Lateral View With Left Arm Up
				4.4.3.1.7 Barrel Chest—Left Lateral View
				4.4.3.1.8 Barrel Chest, Rounded or Bulging Chest—Posterior View
				4.4.3.1.9 Barrel Chest and Asymmetric Gynecomastia—Anterior View
				4.4.3.1.10 Barrel Chest—Posterior View
				4.4.3.1.11 Barrel Chest or Emphysematous Chest—Right Lateral View
				4.4.3.1.12 Barrel Chest and Bilateral Gynecomastia
				4.4.3.1.13 Barrel Chest and Bilateral Gynecomastia
				4.4.3.1.14 Increased Volume of the Right Breast—Close-up Image
				4.4.3.1.15 Gynecomastia—New Patient
			4.4.3.2 Paralytic (Asthenic) Thorax—Anterior View
				4.4.3.2.1 Paralytic (Asthenic) Thorax—Anterior View
				4.4.3.2.2 Paralytic (Asthenic) Thorax—Posterior View
				4.4.3.2.3 Paralytic (Asthenic) Thorax
				4.4.3.2.4 Paralytic (Asthenic) Thorax
				4.4.3.2.5 Paralytic (Asthenic) Thorax—Anterior View
				4.4.3.2.6 Paralytic (Asthenic) Thorax—Anterior View—Close-up Image
			4.4.3.3 Pigeon Chest or Pectus Carinatum—Anterior View
				4.4.3.3.1 Pigeon Chest or Pectus Carinatum—Left Lateral View
				4.4.3.3.2 Pigeon Chest or Pectus Carinatum—Right Lateral View
				4.4.3.3.3 Pigeon Chest or Pectus Carinatum—Left Oblique View
			4.4.3.4 Funnel Chest or Pectus Excavatum—Anterior View
				4.4.3.4.1 Funnel Chest—Pectus Excavatum—Right Lateral View
				4.4.3.4.2 Pectus Excavatum
				4.4.3.4.3 Funnel Chest—Pectus Excavatum
				4.4.3.4.4 Funnel Chest—Pectus Excavatum Anterior View
				4.4.3.4.5 Funnel Chest—Pectus Excavatum Left Lateral View
				4.4.3.4.6 Funnel Chest Pectus Excavatum—Top View
				4.4.3.4.7 Funnel Chest Pectus Excavatum—Top View
				4.4.3.4.8 Funnel Chest Or Pectus Excavatum—Top View
				4.4.3.4.9 Funnel Chest or Pectus Excavatum—Top View—Closer View
				4.4.3.4.10 Funnel Chest or Pectus Excavatum—Anterior View
				4.4.3.4.11 Funnel Chest or Pectus Excavatum—Left Lateral View
				4.4.3.4.12 Funnel Chest or Pectus Excavatum—Left Lateral View
				4.4.3.4.13 Pectus Excavatum
				4.4.3.4.14 Pectus Excavatum
				4.4.3.4.15 Funnel Chest or Pectus Excavatum—Upper View
				4.4.3.4.16 Posterior View of the Thorax
				4.4.3.4.17 Posterior Left Lateral View of the Thorax
		4.4.4 Asymmetric Global Deformations—Kyphoscoliosis
			4.4.4.1 The Kyphoscoliosis—Posterior View Unilateral Deformations
				4.4.4.1.1 The Kyphoscoliosis—Left Oblique Posterior View
				4.4.4.1.2 The Kyphoscoliosis—Posterior View
				4.4.4.1.3 The Previous Patient With Kyphoscoliosis—Anterior View
				4.4.4.1.4 The Spine Kyphoscoliosis—Posterior View
				4.4.4.1.5 Posterior View
				4.4.4.1.6 Anterior View
			4.4.4.2 Kyphosis—Left Lateral View
				4.4.4.2.1 Kyphosis—Posterior View
				4.4.4.2.2 Kyphosis—Left Lateral View
			4.4.4.3 Scoliosis
			4.4.4.4 Malformation of the Thorax After Dislocation of the Clavicle During Delivery
				The Same Patient—Top View
			4.4.4.5 Other Diverse Important Signs During the Inspection of the Thorax
				4.4.4.5.1 Missing the Left Nipple—A Scar After Surgery—The Left Lateral View
				4.4.4.5.2 Oblique Scar on the Left Lateral View of the Thorax After Surgery
				4.4.4.5.3 Chest With Pacemaker—Anterior View
				4.4.4.5.4 Chest With Pacemaker—Left Lateral Oblique View
				4.4.4.5.5 Enlarged Right Breast—Anterior View
				4.4.4.5.6 Enlarged Right Breast—Left Lateral View
				4.4.4.5.7 Hypertrichosis
				4.4.4.5.8 Hypertrichosis
				4.4.4.5.9 Pityriasis Acromial
				4.4.4.5.10 Pityriasis Acromial
				4.4.4.5.11 Lipoma—Posterior Thorax
					4.4.4.5.11.1 Lipoma—Posterior Thorax
					4.4.4.5.11.2 Lipoma—Posterior Thorax
					4.4.4.5.11.3 Lipoma—Posterior Thorax
					4.4.4.5.11.4 Lipoma—Posterior Thorax
					4.4.4.5.11.5 Lipoma—Posterior View
					4.4.4.5.11.6 Lipoma—Lateral View
					4.4.4.5.11.7 Lipoma—Anterior View
					4.4.4.5.11.8 Lipoma—Lateral View
					4.4.4.5.11.9 Lipoma
					4.4.4.5.11.10 Palpation—Soft Consistency
					4.4.4.5.11.11 Deep Palpation—Soft Consistency
					4.4.4.5.11.12 Mobility Present
					4.4.4.5.11.13 Lipoma—Posterior Thorax
					4.4.4.5.11.14 The Palpation of Lipoma—Soft Consistency
					4.4.4.5.11.15 Lipoma
					4.4.4.5.11.16 Lipoma—Posterior View
					4.4.4.5.11.17 Lipoma in the Posterior Region of the Thorax
					4.4.4.5.11.18 Lipoma View Side View
					4.4.4.5.11.19 Lipoma
					4.4.4.5.11.20 Lipoma—On the Base of the Right Hemithorax
					4.4.4.5.11.21 Giant Lipoma on the Posterior Thorax
					4.4.4.5.11.22 Lipoma—Closer View
					4.4.4.5.11.23 Giant Lipoma—Left Lateral View
					4.4.4.5.11.24 Lipoma of the Left Shoulder
					4.4.4.5.11.25 Lipoma—Top View
					4.4.4.5.11.26 Lipoma—Top View
					4.4.4.5.12 Purpura Eruption on the Anterior Chest and Arms
					4.4.4.5.12.1 Purple Rash at the Rear of the Thorax
					4.4.4.5.12.2 Purple Rash at the Level of Posterior Face at the Base of Right Hemithorax
				4.4.4.5.13 Shingles on the Posterior Region of the Thorax
				4.4.4.5.14 Pityriasis Acromial
				4.4.4.5.15 Hemangioma
				4.4.4.5.15.1 Hemangioma
				4.4.4.5.15.2 Hemangioma—Close-up Images
				4.4.4.5.16 Hives
				4.4.4.5.17 Venectasia
				4.4.4.5.18 Depigmented Area
				4.4.4.5.19 Lentigines at the Level of the Anterior Chest
					4.4.4.5.19.1 Lentigines—Close-up Images
					4.4.4.5.19.2 Lentigo—Left Lateral Thorax
					4.4.4.5.19.3 Lentigo—Change to Melanoma—Close-up Image
					4.4.4.5.19.4 Lentigo—Posterior Thorax—Change to Melanoma
				4.4.4.5.20 Collateral Circulation
				4.4.4.5.21 Tattoos
		4.4.5 Respiratory Movements of the Thorax
			4.4.5.1 Changes in the Frequency of Respirations
				4.4.5.1.1 Tachypnea
				4.4.5.1.2 Polypnea
				4.4.5.1.3 Hyperventilation
				4.4.5.1.4 Kussmaul Breathing
				4.4.5.1.5 Bradypnea
			4.4.5.2 Cheyne–Stokes Breathing: Great Periodical Breathing
			4.4.5.3 Biot Breathing
			4.4.5.4 Ataxic Breathing
			4.4.5.5 Apneustic Breathing
			4.4.5.6 Apnea
			4.4.5.7 Respiratory Sounds
	4.5 Method of Palpation of the Thorax—The Apex of the Lungs—Posterior Incidence
		4.5.1 Method of Palpation of the Thorax—The Middle Lobes of the Lungs—Posterior Incidence
		4.5.2 Method of Palpation of the Thorax—The Inferior Lobes of the Lungs—Posterior Incidence
		4.5.3 Method of Palpation of the Thorax—The Apex of the Lungs—Anterior Incidence
		4.5.4 Method of Palpation of the Thorax—The Middle of the Lungs—Anterior Incidence
		4.5.5 Method of Palpation of the Thorax—The Inferior Lobes of the Lungs—Anterior Incidence
		4.5.6 Method of Palpation of the Thorax—Base Lateral Incidence
		4.5.7 The Method of Palpation of the Thorax—Middle Lateral Incidence
	4.6 Method of Percussion of the Thorax
		4.6.1 Method of Percussion of the Posterior Thorax Right Apex
		4.6.2 The Method of Percussion
		4.6.3 Method of Percussion of the Anterior Thorax—Right Apex
		4.6.4 Method of Percussion of the Anterior Thorax—Left Apex
		4.6.5 Percussion of the Clavicles
		4.6.6 Percussion at the Base of the Left Lateral Side of the Thorax
		4.6.7 Percussion of the Base of Right Lateral Side of the Thorax
		4.6.8 Percussion of the Middle Area of the Left Lateral Thorax
		4.6.9 Percussion of the Middle Area of the Right Lateral Thorax
		4.6.10 The Normal Resonant Sound of Thoracic Percussion
		4.6.11 Pathological Sounds After Thoracic Percussion
			4.6.11.1 Hyperresonance
			4.6.11.2 Dullness
				4.6.11.2.1 Pulmonary Consolidation Pneumonia
				4.6.11.2.2 Acute Pulmonary Edema
				4.6.11.2.3 Pus or Blood Inside The Pulmonary Alveoli
				4.6.11.2.4 Atelectasis, Complete Resorption of Air From Pulmonary Alveoli
				4.6.11.2.5 Pleural Effusion
				4.6.11.2.6 Hard Dullness; Massive Pleural Effusion
				4.6.11.2.7 Bilateral Pleural Effusion
				4.6.11.2.8 Bilateral Pleural Effusion
			4.6.11.3 Tympanic
				4.6.11.3.1 Lung Abscess Before Evacuation—Dullness
				4.6.11.3.2 Lung Abscess After Evacuation—Cavern Tympanic
				4.6.11.3.3 Lung Tuberculoma Before and After Evacuation; Dullness—Tympanic
				4.6.11.3.4 Hydatid Cyst in Lung Before and After Evacuation; Dullness—Tympanic
				4.6.11.3.5 Lung Carcinoma Super infected
	4.7 Modifications of the Lower Limit of the Lungs and Active Pulmonary Mobility
	4.8 The Method of Auscultation of the Lung
		4.8.1 Auscultation of the Anterior Chest
		4.8.2 Auscultation of the Anterior Chest
		4.8.3 Auscultation of the Posterior Thorax
		4.8.4 Auscultation of the Left Lateral Chest
		4.8.5 Basics of Lung Sounds
			4.8.5.1 Vesicular Breath Sound
			4.8.5.2 Bronchial Breath Sound
				4.8.5.2.1 The Suprasternal Area and Posterior Area of the Neck
				4.8.5.2.2 Bronchial Breath Sound
				4.8.5.2.3 The Right and Left Lateral Cervical Area of the Neck
				4.8.5.2.4 Bronchial Breath Sound
			4.8.5.3 Bronchovesicular Sound
			4.8.5.4 The Normal Auscultation of the Lung
		4.8.6 Changes in Intensity of the Vesicular Sound
			4.8.6.1 Vesicular Sound Accentuated
			4.8.6.2 Vesicular Sound Diminished By Thickened Wall of the Thorax
				4.8.6.2.1 Obesity
				4.8.6.2.2 Edema of the Wall and Enlarged Breasts
			4.8.6.3 Abolished Vesicular Sound—Respiratory Silence
				4.8.6.3.1 Massive Left Pleural Effusion
			4.8.6.4 Vesicular Sound With Prolonged Expiration
			4.8.6.5 Pulmonary Emphysema
			4.8.6.6 Crisis—Bronchial Asthma
			4.8.6.7 Interrupted Vesicular Sound
		4.8.7 Bronchial Pathology Breath Sound
			4.8.7.1 Pneumonia in Phase of Consolidation
			4.8.7.2 Pulmonary Infarction
				Left Deep Vein Thrombosis
			4.8.7.3 Infiltrative Tuberculosis
			4.8.7.4 Lung Tumors
		4.8.8 Pleuritic Murmur
			4.8.8.1 Consolidation Area With Pleural Effusion
		4.8.9 Pulmonary Cavity
			4.8.9.1 Cavernous Murmur
			4.8.9.2 Amphora Murmur
		4.8.10 Blower Breathing Broncho Vesicular
		4.8.11 Added Breath Sounds
			4.8.11.1 Crackles—Fine (Rales)
			4.8.11.2 Crackles—Coarse (Rales)
				4.8.11.2.1 Pneumonia Congestive Phase—Crackles
				4.8.11.2.2 Pneumonia Consolidation Phase—Pathologic Bronchial Sound
				4.8.11.2.3 Pneumonia Resorption Phase—Crackles
				4.8.11.2.4 Bronchopneumonia—Crackles and Wheeze
				4.8.11.2.5 Acute Left Ventricular Failure
				4.8.11.2.6 Acute Pulmonary Edema
				4.8.11.2.7 Pulmonary Infarction
					Deep Vein Thrombosis
				4.8.11.2.8 Pulmonary Atelectasis
			4.8.11.3 Rales of Decubitus
			4.8.11.4 Bronchial Rales
				4.8.11.4.1 Bullous Rales
				4.8.11.4.2 Small Bullous Rales (Under Crackles)
				4.8.11.4.3 Medium Bullous Rales
				4.8.11.4.4 Big Bullous Rales
				4.8.11.4.5 Dry Bronchitis Rales
					4.8.11.4.5.1 Wheeze Rales
					4.8.11.4.5.2 Rhonchus Rales
			4.8.11.5 Pleural Rub
5 - The Complementary Investigations
	5.1 The Radiologic Examination
		5.1.1 The Pulmonary Vessels
		5.1.2 Anomalous Pulmonary Parenchyma Transparency
			5.1.2.1 Nodular Opacities
				5.1.2.1.1 Pulmonary Tuberculosis
				5.1.2.1.2 Acute Pulmonary Abscess
				5.1.2.1.3 Pulmonary Abscess
				5.1.2.1.4 Primary Tumors or Metastatsis
				5.1.2.1.5 Lung Metastasis
				5.1.2.1.6 Silicosis
				5.1.2.1.7 Lobar Pneumonia in Phase of Condensation
				5.1.2.1.8 Consolidation Syndrome
				5.1.2.1.9 Lobar Pneumonia in Phase of Condensation
				5.1.2.1.10 Pulmonary Atelectasis
				5.1.2.1.11 Atelectasis
				5.1.2.1.12 Apical Opacity—Atelectasis
		5.1.3 Pleural Abnormalities
			5.1.3.1 Pleural Effusion in Very Small Quantity
			5.1.3.2 Pleural Effusion in a Small Quantity
			5.1.3.3 Pleural Effusion in Medium Quantity
			5.1.3.4 Massive Pleural Effusion
			5.1.3.5 Encapsulation Pleural Effusion
			5.1.3.6 The Pneumothorax
		5.1.4 Mediastinal Abnormalities
			5.1.4.1 Aneurysm of the Aortic Arch
			5.1.4.2 Thymoma—Tumor of the Thymus
		5.1.5 Hilar Lymphadenopathy
			5.1.5.1 Asymmetrical Hilar Lymphadenopathy
			5.1.5.2 Symmetrical Hilar Lymphadenopathy
			5.1.5.3 Symmetrical Hilar Enlargement; Pulmonary Stasis
		5.1.6 Pericarditis or Dilated Cardiomyopathy
		5.1.7 Pulmonary Emphysema
		5.1.8 Hydropneumothorax
		5.1.9 Interstitial Pulmonary Fibrosis
		5.1.10 Pneumonia in the Phase of Condensation
			5.1.10.1 Pneumonia in the Phase of Condensation
			5.1.10.2 Pneumonia the Phase of Condensation
			5.1.10.3 Pneumonia in the Phase of Condensation
		5.1.11 Nodular Formation
			5.1.11.1 Nodular Formation
			5.1.11.2 Nodular Formation
			5.1.11.3 Nodular Formation
	5.2 The Pleural Puncture
	5.3 The Respiratory Functional Tests
		5.3.1 Spirometry
		5.3.2 Blood Gas Analysis
6 - Respiratory Clinical Cases
	Pleural Effusion
	Clinical Case No. 1
		Pachypleuritis
	Clinical Case No. 2
		Pneumothorax
	Clinical Case No. 3
		Hydropneumothorax
	Clinical Case No. 4
		Hemothorax
	Clinical Case No. 5
		Lung Consolidation
	Clinical Case No. 6
		Atelectasis of the Lung
		Complete Obstruction of the Bronchi
		Atelectasis of the Lung
	Clinical Case No. 7
		Cavern of the Lung
	Clinical Case No. 8
		Abscess of the Lung Before Evacuation
		Abscess After Evacuation
	Clinical Case No. 9
		Bronchial Asthma
	Clinical Case No. 10
		Acute Bronchitis
	Clinical Case No. 11
		Chronic Bronchitis
	Clinical Case No. 12
		Bronchiectasis
	Clinical Case No. 13
		Pulmonary Emphysema
	Clinical Case No. 14
		COPD
	Clinical Case No. 15
		COPD Type A—Pink Puffer
		COPD Type B—Blue Bloater
		The Chest X-Ray—COPD
			Bronchopulmonary Neoplasm
	Clinical Case No. 16
	Clinical Case No. 17
	Clinical Case No. 18
		Pulmonary Emphysema
	Clinical Case No. 19
		Inspection of the Thorax
		Palpation—Normal Tactile Fremitus
		Percussion—Resonance
		Auscultation—Tight Sound and Crackles at the Base of the Left Lung
		Normal Alveoli and Alveolar Congestion
	Clinical Case No. 20
		Herpes Eruption on the Upper Lip
		Auscultation of the Left Base of the Lung
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	V
	W
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