Handbook on Clinical Approach to Respiratory Medicine K Surendra Menon, R Pajanivel
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abdomen, acute 15
Accessory muscles 12
Acid-fast bacilli 82
staining 82
Acquired immunodeficiency syndrome 42
Adenopathy 113f
Admission, criteria for 125
Aegophony sign 79
Allergic disorders 32
Allergy 18
testing 83
American Thoracic Society 74
Amphoric breathing 72
Anatomic shunts 39
Anatomical principles 1
Angina 29
Angiotensin-converting enzyme 21, 33
Angle of Louis 1, 2
Anthropometry 37
Antinuclear antibody 85
Aortic arch 110
Aortic knuckle 110
Aortopulmonary window 110
Apical impulse 54
position of 52
Apical region 55
Apneustic breathing 52
Appetite, loss of 31
Arterial blood gas 126
Arterial oxygen saturation, decreased 39
Asbestos bodies 82
Aspergilloma 24
Aspiration pneumonia 32, 33
Asthma 32
acute severe 124
history of 34
life-threatening 124
moderate exacerbation of 123
near-fatal 124
severe 126
Ataxic breathing 52
Auscultation, principles of 71
Axillary area 4
Axillary line, posterior 7
B
Bacteroides 24
Barrel chest 48
Bell tympany 80
Bilateral coarse miliary shadows 118f
Bilateral cystic lesions 120f
Biot's breathing 52
Blood
gases 126
pressure 38
routine 81
tests 89
Bony cage 100
Bony landmarks 104f
Branding scars 38
Breast
implant 103f
tissue, absence of 101f
Breath sound, normal 72, 73f
Breathing
disorders, sleep-related 84
tubular 71, 72
types of 51
Breathlessness 18, 26
severe 125
Bronchial arterial embolization 135
Bronchial asthma 82, 84
acute exacerbation of 123
Bronchial breath 72
sounds 72, 73f
Bronchiectasis 44, 120f
Bronchophony 79
Bronchopulmonary segments 11, 11t
Budesonide 130
Bulbar conjunctiva 39
Bullous emphysema 78
C
Carboxyhemoglobinemia 40
Carcinoembryonic antigen 85t
Cardiac dullness 69
Cardiophrenic angles 111f
Cardiothoracic ratio, causes of increased 111
Cardiothoracic surgery 81
Cardiovascular system 44
Cavernous breathing 72
Cellulitis 29
Central cyanosis 39, 40
causes 39
Central pneumonia 80
Central tendon 14
Certain important tests 84t
Cervical rib, left 105f
Chest
expansion, measurement of 57, 57f
pain 18, 29
shape of 47
size of 47
topography 3, 4f, 6f
type of 47
Chest wall
anterior 6f, 60f
expansion 56f
lateral 7f
posterior 6f, 60f
right 102f
subcutaneous calcifications, left 102f
symmetry 48
Chest X-ray 100f102f, 105f, 106f, 111f113f, 115f120f, 126
cardiac size in 110f
interpretation 121
lateral view 93f
mediastinal compartments in 107f
normal 104f
over penetrated 98f
reading of 89, 98
standard posteroanterior view 92f
systematic reading of 96, 97
underpenetrated 99f
Cheyne–Stokes breathing 52
Chronic obstructive pulmonary disease, acute exacerbation of 130
Clavicular fracture 104
Clavicular percussion 65
Clubbing 38
causes of 44
differential 45
unidigital 45
Cobbler's chest 48
Coin test 80
Common respiratory symptoms 18, 19
Compensatory emphysema 66
Constitutional symptoms 18, 30
Costal angle 16
Costochondritis 29
Costophrenic angles 111f
Cough 18, 19
barking 20
bovine 20
brassy 20
causes of 21t
characteristics of 21t
dry 20
paroxysmal 20
types of 20
with expectoration 22
COVID-19, tests for 82
Cracked pot resonance 67
Crackles 75
midinspiratory 76
production of 75
Cricoid cartilage 1
Crura tendon 14
Curschmann's spirals 82
Cyanosis 38, 39
Cystic fibrosis 84
Cystic lesion, well-defined 119f
Cysts and cavities 115
D
D'espine sign 80
Dark lung fields 98f
Diabetes
history of 34
mellitus 32
Diagnose tension pneumothorax 133
Diagnostic skin tests 89
Diaphragm 13, 13f, 111
Differential cyanosis 40
causes 40
Direct percussion 65
Distal phalangeal depth 43, 44f
Dysphagia 18, 30
Dyspnea 18, 2628
chronic 27
grading of 27
on exertion 28
subacute 27
E
Ear, nose, and throat 81
Early inspiratory crackles 76
Ectopic endometrial tissue 33
Emphysema 48, 66, 120f
Empyema 44
Endemic hemoptysis 26
Eosinophils 81
Epilepsy, history of 34
Erythrocyte sedimentation rate 81
Expiration, muscles of 12
F
Fever 30
types of 31
Fissure, horizontal 114
Fluticasone 130
Forced expiratory volume 123, 125
Formoterol 130
Foul-smelling sputum 24
Fusobacterium 24
G
Garland's triangle 70
Gastroesophageal reflux disease 21, 29
Gastrointestinal system 45
Grocco's triangle 70
H
Hacking dry cough 20
Hamman sign 78
Headache 18
Heart 108
Heart border
percussion of
left 69
right 69
right 108
Hematemesis 26t
Hemoglobin 39
abnormality 40
Hemoptysis 18, 24, 25, 26t, 134
assessment 135
management of 135
minimal 25
moderate 25
position 135
Hepatopulmonary syndrome 28
Herpes 29
Hilar enlargement, bilateral 113f
Hilum 17, 111
Hoover's sign 52
Human immunodeficiency virus 81, 118f
Hypertension 32
history of 34
treatment for 33
Hypertrophic pulmonary osteoarthropathy 43
I
Icterus 38, 39
Idiopathic pulmonary arterial hypertension 19
Immunological tests 84
Implantable cardioverter defibrillator 38
Infra-axillary area 4
Inspiration 58
Intensive care unit 91
Intercostal neuralgia 29
Interferon-gamma release assays 85
Interphalangeal depth 43, 44f
Interscapular area 4
Interstitial lung disease 21, 116f
Interstitial reticular densities, bilateral diffuse 116f
Ipratropium bromide 127, 130
combination of 130
J
Jugular venous pulse 38, 46
causes of increased 46
K
Kronig's isthmus 8, 66
Kussmaul breathing 52
Kyphosis 50f
L
Larynx, lower border of 1
Late inspiratory crackles 76
Left costophrenic angle 112f
Left upper lobe 9
bronchus 11
Light-emitting diode 82
Lingula 11
Liquid bridge hypothesis 76
Liver
dullness 69
function testing 83
Lobe
surface anatomy of 8
upper 9, 10
Lordotic view 93
Lovibond's angle 42, 42f
Lower lobe
left 9, 10
pneumonia 115f
right 9, 10, 115f
Lower respiratory tract 47, 85
Lung
abscess 21, 44
carcinoma 117f
diseases, radiological patterns of 114, 115t
fields 114
left 8, 10f
lobes 9f, 10f
malignancy of 41
markings, prominence of 99f
secondaries 116f
surface anatomy of 8
tissue, wedge of 11
volumes 115, 120f
Lymphadenopathy 38, 41
Lymphangioleiomyomatosis 19
Lymphocytes 81
Lymphomas 42
M
Marfan syndrome 48
Massive hemoptysis 25
Mastectomy, right 101f
Mastitis 29
Mediastinal crunch 78
Mediastinitis 29
Mediastinum 14, 15f, 104, 107
inferior 14, 108
lower 108
superior 107
upper 107
Menorrhagia 39
Metallic cough 20
Methemoglobinemia 40
Midaxillary line 7
Middle and lower regions 55
Monophonic wheeze 74
Muscular fibers 13
Myalgia 29
Myocardial infarction 29
Myotatic irritability 66
N
Nebulizer solutions available 130
Nodular densities, bilateral 116f
N-terminal pro-brain natriuretic peptide 85
O
Obstructive airway diseases 12
Obstructive pulmonary disease, chronic 19, 39
Oral cavity 47
Orthodeoxia 28
Orthopnea 28
Ortner's syndrome 29
Over penetrated film 97
Oxygen 126
saturation 125
P
Pallor 38
Palpation 53, 85
Parasitic infestation 101f
Paratracheal stripes 106f
Parietal pleura 15
Paroxysmal nocturnal dyspnea 28
Patent ductus arteriosus 40
Peak expiratory flow 125
Pectus carinatum 48, 49f
Pectus excavatum 48f
Pedal edema 38, 45
Pedigree chart 32f
Peptostreptococcus 24
Percussion 61
anterior 62, 62f
cardinal rules of 63
lateral 63
note, types of 66
posterior 63, 63f
Peripheral cyanosis 40, 41
causes 40
Pigeon chest 48
Platypnea 28
Pleura 15
sac 15
Pleural diseases 115
Pleural effusion 71, 112f
right 94f, 121f
Pleural rub 77
Pleuritic pain 29
Pleurodesis 134
Pleximeter finger 64
middle phalanx of 64f
Plexor finger 64f
Pneumomediastinum 78, 134
Pneumonia 21
Pneumothorax 66, 71
left-sided 78
small 93
Polymerase chain reaction 82
Polyphonic wheeze 75
Positive end-expiratory pressure 129
Post-tussive suction 79
Premenstrual pain 29
Primary ciliary dyskinetic syndromes 84
Principal muscles 12
Profile sign 44
Pseudoclubbing 45
Pseudohemoptysis 26
Pseudomonas infections 23
Pulled trachea syndrome 73
Pulmonary artery, left 110
Pulmonary edema 21
Pulmonary emergencies, management of 123
Pulmonary function testing 83
Pulmonary squeak 76
Pulmonary tuberculosis 85, 119f
Pulse 37
oximetry 38, 125
Pursed lip breathing 52
Pyopneumothorax 68
R
Radial pulse
left 38
right 38
Rapid shallow breathing 52
Rectus abdominis 12
Renal function testing 83
Respiration
abnormalities in 51
muscles of 11
types of muscles of 11
Respiratory diseases, symptoms of 19
Respiratory evaluation, common investigations in 81
Respiratory failure 136138
classification 136
Respiratory illness, history of 134
Respiratory movements 55
Respiratory rate 38
Respiratory system 44
anatomy of 1
diseases of 17
examination of 37, 47
Retrosternal thyroid 20
Rhonchi 74
Rib 3
cage 12
erosions 29
fracture of 29, 104
fusion of 105f
Rifampicin 33
Right clavicle, bony mass in 106f
Right lateral decubitus film 94f
Right lung 8, 10f
mass lesion 117f
Right middle lobe 9, 10, 115f
bronchus 11
Right upper lobe 9, 10, 96f
bronchiectasis 17
bronchus 11
Roentgenography 89
Rule out artifacts 96
S
Salbutamol 130
Scalene muscles 12
Scapula, spine of 4
Scapular line 7
Schamroth's sign 43, 43f
Scoliosis 51f
Scratch sign 80
Serratia marcescens 26
Serum
angiotensin-converting enzyme 85
bilirubin 39
Shifting dullness 68
percussion for 68
Shock 134
Shoulder, drooping of 50f
Skodaic resonance 67
Sleep
disordered breathing 52
disturbances 18, 30
Smoking index 32
Sneezing, rhinitis 18
Soft tissue 100
bilateral 100f
calcifications 101f
density 103f
Solitary pulmonary nodule 89
Sounds
added 74
adventitious 74
Spinal abnormalities 49
Spinous process 16
Splenic dullness 70
Spurious hemoptysis 25
Sputum collection 82
Sputum malignant cytology 82
Squamous cell carcinoma 85
Sternal percussion 65
Sternocleidomastoid sign 52, 53f
Steroid therapy 127
Stony dull 67
Straight line dullness 68
Stress relaxation quadrupole hypothesis 75
Stridor 18, 30, 52
Succussion splash 78
Suprascapular area 4
Symptomatology 17
T
Tactile vocal fremitus 61
Tension pneumothorax 132
causes 132
examination 133
possible complications 134
prognosis 134
symptoms 133
treatment 133
Thoracic cavity 12, 13
Thoracic movements 52
Thoracic vertebra 114
Tidal percussion 68
Tietze syndrome 29
Trachea 1, 104
palpation of 54f
Tracheal descent 58
Tracheal tug 58
Trail's sign 52, 53f
Transversus abdominis 12
Trapped air increases, amount of 132
Traube's space 3, 70
Trepopnea 28
Tuberculous lymphadenopathy 41
U
Upper airway cough syndrome 24
Upper respiratory tract 1, 47, 85
V
Vena cava, superior 3
Ventilatory respiratory failure 137
Ventilatory support 129
Vertebral line 7
Vesicular breath sound 72
Virchow's node 42
Vital signs 37
Vocal fremitus 58, 60f
examination 61f
Vocal resonance 77
Voice, hoarseness of 18, 29
W
Weight loss 31
significant 31
Wheeze 18, 30, 74
mechanisms of 74
Whispering pectoriloquy 79
X
Xiphisternum 14, 16
×
Chapter Notes

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Handbook on Clinical Approach to Respiratory Medicine
Handbook on Clinical Approach to Respiratory Medicine
SECOND EDITION
K Surendra Menon MD Former Professor and Head Department of Pulmonary Medicine Medical Education Service Government of Kerala Kerala, India R Pajanivel MD FRCP Professor and Head Department of Pulmonary Medicine Mahatma Gandhi Medical College and Research Institute Sri Balaji Vidyapeeth Puducherry, India
Jaypee Brothers Medical Publishers (P) Ltd
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Handbook on Clinical Approach to Respiratory Medicine / K Surendra Menon, R Pajanivel
First Edition: 2017
Second Edition: 2021
9789390595730
Printed at
Our second edition is dedicated to
The Health Professionals
who are fighting coronavirus disease 2019 (COVID-19)
day in and day out.
Preface to the Second Edition
Handbook On Clinical Approach to Respiratory Medicine is published with the intention of reaching out to the undergraduates, interns, and postgraduates to understand the importance of proper case taking. The authors are happy that this book is well-received and appreciated. This gives us the extra drive to publish the second edition with the addition of chapters like “Interpreting Chest X-rays in a Systematic Way” which is well-illustrated for better understanding and a list of frequently asked questions in clinical examination and viva.
Medicine is all about knowledge and observation. The essential element is the decisional process by probing history, recognition of signs, and clinical reasoning. Hands, ears, and the brain play a major part in diagnosing in spite of the laboratory tools available. As scientists, we are on a mission to alleviate the patients' suffering and have to go deeper into every aspect of the patient's disease process.
The art of history taking and proper examination of the patient is almost becoming extinct. This book confines basically to case taking in respiratory medicine and will give the reader a deeper insight into history taking and examination of the patient. This methodology will help in examining the other systems such as cardiovascular system (CVS), central nervous system (CNS), etc. Without a correct diagnosis, all efforts will be futile to treat the patient.
K Surendra Menon
R Pajanivel
Preface to the First Edition
Handbook on Clinical Approach to Respiratory Medicine is published with the intention of reaching out to the undergraduates, interns and postgraduates to understand the importance of proper case taking. Medicine is all about knowledge and observation. The essential element is the decisional process by probing history, recognition of signs and clinical reasoning. Hands, ears and the brain play a major role in diagnosing in spite of the laboratory tools available. As scientists, we are on a mission to alleviate the patients' sufferings and have to go deeper into every aspect of the patient's disease process.
The art of history taking and proper examination of the patient has become almost extinct. This book confines basically to case taking in respiratory medicine and will give the reader a deeper insight into history taking and examination of the patient. This methodology will help the reader in examining the other systems like CVS, CNS, etc. Without a correct diagnosis, all our efforts will be futile to treat the patient.
K Surendra Menon
R Pajanivel
Acknowledgments
We express our gratitude to our family members, all the faculty, and postgraduate students of the department. It is imperative to thank all the health professionals including our old students who are actively involved in this fight against the coronavirus all over the world.
Introduction
The content of the book emphasizes on the correct way of history taking, examination of the patient, relevant investigations, and arriving at a final diagnosis.
History taking is the time the doctor and the patient get to know each other and the patients' fears and concerns can be understood. The skills in taking history develop with experience, so students are encouraged to take history independently. Difficult diagnostic problems are more often solved by carefully taken history than by a battery of laboratory tests. At the end of history taking, we may be able to come to a few differential diagnoses before touching the patient. Our studies have shown that the correct history taking will make us zero in, onto a possible diagnosis in most of the cases, i.e., about 80%.
All systems are also required to be examined. As an examinee, quick history taking without missing any relevant points is essential and the last minute panic can be avoided, especially while appearing for the examination. It is advisable to finish the history taking in 10–12 minutes. But remember, this pattern has to be followed after graduation also to become a successful clinician.
Symptoms narrated by the patient should be carefully listened to and as a “medical detective” pertinent questions should be asked as some patients may go off the track. Patient's complaints should be documented and analyzed. Like a perfect diplomat, we should show tactfulness and patience when the subject mentions the complaint.
In the second edition, we are adding two chapters: X-ray of Chest and Commonly Asked Clinical Examination and Viva Voce Questions. The questions cover all the aspects of pulmonary medicine.
All the diagrams and photos are schematic (not to scale).