Paediatric-History taking & Physical examination of patient with abnormal audible respiratory sound

Paediatric-History taking & Physical examination of patient with abnormal audible respiratory soundCreated OnApril 24, 2020Last Updated OnApril 24, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of patient with abnormal audible respiratory sound < All Topics Table of Contents Wheezes: Musical sounds associated with airway narrowing Monophonic wheezing: Single musical note starting & ending at the different times Due to bronchial obstruction by tumour, bronchostenosis by inflammation, mucus accumulation/ foreign body In inspiratory & expiratory phase Polymorphic wheezing: Multiple musical notes starting & ending at same time Due to airway narrowing (e.g. asthma) Confined to expiratory phase Stridor: Loud, high pitch musical sound heard over upper airway Mainly inspiratory Usually loudest over trachea Serious condition requiring investigation & management Heard in children with croup Rhonchi: Dull & low pitch (different from wheeze, in which wheezes are squeaky & high pitch) Have a snoring, gurgling quality More prominent on expiration Crackles : Interrupted non-musical sound Fine crackles: Sounds like rubbing fingers through hair next to your ear Occurred in pulmonary oedema/ interstitial fibrosis Coarse crackles: Sounds like pouring water out of the bottle Occurred in bronchiectasis/ resolving pneumonia Pleural rub: Sounds like walking on fresh-fallen snow bending stiff leather Occurred when inflamed parietal & visceral pleura move over one another The membrane usually coated in protective fluid -> if pleural inflammation -> the membranes stick together Associated with pleuritic pain Patient tends to resist breathing to relieve the pain Similar to pericardial rub (can be differentiated by asking the patient to hold his breath -> if the rubbing sound still present -> pericardial rub) History taking: Ask about patient’s identification Name Age Early childhood – structural abnormalities (eg laryngomalacia), viral induced wheeze, foreign body Late childhood or adolescent – vocal cord dysfunction Gender Ask about the chief complaint Describe what patient experience or what parents hear / demonstrate with audio recording Ask about history of presenting illness Onset of symptom Acute – foreign body Slowly progressive – extraluminal compression by lymph node or mass Frequency – intermittent or persistent Persistent wheeze – congenital or structural anomalies Intermittent wheeze- suggest asthma Pattern of symptoms Age of onset Duration Severity Progression Associated symptoms Associated with respiratory illness (coryza, cough, respiratory distress) – viral induced wheeze Associated with cough Wet cough – excessive mucus production in bronchiectasis, cystic fibrosis, primary ciliary dyskinesia Dry cough – foreign body, vascular ring Associated with feeding or vomiting – impaired swallowing/gastroesophageal reflux Associated with difficulty or drooling of saliva Aphonia with stridor – complete airway obstruction Fever – infection Seasonal variation – asthma Ask about precipitating event Feeding or crying Positioning – prone, supine, sitting History of choking and cough – foreign body Poor weight gain, recurrent ear or sinus infection – cystic fibrosis, ciliary...

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