EXAMINATION OF A EXAMINATION OF A PATIENT WITH PATIENT WITH COUGH COUGH
EXAMINATION OF A EXAMINATION OF A PATIENT WITH PATIENT WITH
COUGHCOUGH
GENERAL EXAMINATIONGENERAL EXAMINATION
Attitude: Sit in a propped up position if Attitude: Sit in a propped up position if dyspnoea presentdyspnoea present
Mental state:Mental confusion,stupor and Mental state:Mental confusion,stupor and flapping tremors…Respiratory failureflapping tremors…Respiratory failure
Recent loss of weight: Recent loss of weight: Pulmonary Pulmonary tuberculosis & Bronchogenic carcinomatuberculosis & Bronchogenic carcinoma
Fever: Tuberculosis & PneumoniaFever: Tuberculosis & Pneumonia
PallorPallor
1.1. Severe haemoptysisSevere haemoptysis
2.2. Tuberculosis:Malnutrition & anaemiaTuberculosis:Malnutrition & anaemia
CyanosisCyanosis
Central: Respiratory failure & CHFCentral: Respiratory failure & CHF
ClubbingClubbing
Tumours Tumours
1.1. Bronchogenic carcinomaBronchogenic carcinoma
2.2. MesotheliomaMesothelioma
Interstitial lung diseaseInterstitial lung disease Chronic pulmonary tuberculosisChronic pulmonary tuberculosis
SepsisSepsis
1.1. BronchiectasisBronchiectasis
2.2. Lung abcessLung abcess
3.3. EmpyemaEmpyema
Pulmonary osteoarthropathyPulmonary osteoarthropathy
Painful clubbing+thickening of Painful clubbing+thickening of periosteum of distal parts of periosteum of distal parts of radius,ulna,tibia,fibula+ painful radius,ulna,tibia,fibula+ painful enlargement of ankles & wristsenlargement of ankles & wrists
Bronchogenic carcinoma Bronchogenic carcinoma
LymphadenopathyLymphadenopathy
Pulmonary tuberculosisPulmonary tuberculosisCarcinomaCarcinomaSarcoidosisSarcoidosis
Scalene nodesScalene nodes
EdemaEdema
RHF secondary to pulmonay diseases is RHF secondary to pulmonay diseases is termed termed COR PULMONALE.COR PULMONALE.
1.1. EmphysemaEmphysema
2.2. Pulmonary fibrosisPulmonary fibrosis
Head to foot examinationHead to foot examination
Subcutaneous nodules raised, firm tender: Subcutaneous nodules raised, firm tender: Metastatic lung cancerMetastatic lung cancer
Erythema nodosum over the shin:Acute Erythema nodosum over the shin:Acute sarcoidosissarcoidosis
VITALS!!!!VITALS!!!!
BPBP
1.1. High BP:COPD , Pulmonary embolismHigh BP:COPD , Pulmonary embolism
2.2. Low BP:Pulmonary edema, ACEI, Low BP:Pulmonary edema, ACEI, Community acquired pneumoniaCommunity acquired pneumonia
(CRB-65)(CRB-65) JVPJVP Raised in cor pulmonaleRaised in cor pulmonale
Examination of oropharynxExamination of oropharynx
Evidence of postnasal dripEvidence of postnasal dripOropharyngeal mucosa erythema or Oropharyngeal mucosa erythema or
cobble stone appearancecobble stone appearance
Movement of accessory muscles of Movement of accessory muscles of respirationrespiration
Examination of neck:Posture,Movement of Examination of neck:Posture,Movement of accessory muscles,Jugular veinsaccessory muscles,Jugular veins
RESPIRATORY SYSTEMRESPIRATORY SYSTEM
INSPECTIONINSPECTIONShape of the chestShape of the chest
Barrel shaped chestBarrel shaped chest
EmphysemaEmphysema
Drooping of the shouldersDrooping of the shoulders
RespirationRespiration
RateRate >15/min+increase ventilatory drive>15/min+increase ventilatory drive
1.1. Acute asthmaAcute asthma
2.2. Exacerbation of COPDExacerbation of COPD
>15/min+decrease ventilatory drive>15/min+decrease ventilatory drive
1.1. PneumoniaPneumonia
>30/min:Community acquired pneumonia>30/min:Community acquired pneumonia
Decrease rate: Respiratory failureDecrease rate: Respiratory failure
Use of accessory muscles of respirationUse of accessory muscles of respiration
Movements of the chestMovements of the chest
Intercostal recession:Indrawing of Intercostal recession:Indrawing of intercostal spaces with respiration… intercostal spaces with respiration… Severe airway obstruction..laryngeal ds or Severe airway obstruction..laryngeal ds or tumours of tracheatumours of trachea
PALPATIONPALPATION
Position of tracheaPosition of trachea
1.1. Deviation to same side:FibrosisDeviation to same side:Fibrosis
2.2. Deviation to opp side:Pneumothorax, Deviation to opp side:Pneumothorax, Pleural effusionPleural effusion
Apex beatApex beat Palpation of the chest for any tendernessPalpation of the chest for any tenderness Expansion of the chestExpansion of the chest
Decrease expansion in Decrease expansion in consolidation,emphysemaconsolidation,emphysema
Vocal fremitusVocal fremitusDecrease in bronchial obstrn,emphysemaDecrease in bronchial obstrn,emphysema Increase in pneumonic consolidation & Increase in pneumonic consolidation &
neoplasmsneoplasms
Rhonchial fremitusRhonchial fremitus Palpable rhonchiPalpable rhonchi
PERCUSSIONPERCUSSION
Hyperresonant in emphysemaHyperresonant in emphysemaTympanic in a superficial cavity of lungTympanic in a superficial cavity of lungDullness in consolidationDullness in consolidation
Cracked pot sound:Cracked pot sound:percussion note over percussion note over cavities which communicate with bronchuscavities which communicate with bronchus
Cardiac dullness obliterated in Cardiac dullness obliterated in emphysemaemphysema
AUSCULTATIONAUSCULTATION
Breath soundsBreath sounds
Decreased intensityDecreased intensity
1.1. Collapse & FibrosisCollapse & Fibrosis
2.2. Bronchial obstructionBronchial obstruction
Bronchial breathingBronchial breathing Pneumonic consolidationPneumonic consolidation
Added soundsAdded sounds
Wheezes are musical sounds assoc. with Wheezes are musical sounds assoc. with airway narrowing.airway narrowing.
1.1. Polyphonic wheezesPolyphonic wheezes heard in expiration: heard in expiration: asthma & COPDasthma & COPD
2.2. Monophonic wheezesMonophonic wheezes in localised in localised narrowing of bronchus & tumour or narrowing of bronchus & tumour or foreign bodyforeign body
Stridor is a harsh croaking inspiratory Stridor is a harsh croaking inspiratory noise aagravated by coughnoise aagravated by cough
Should be investigated always.Should be investigated always.
1.1. Foreign bodyForeign body
2.2. Tumour occluding larynx,trachea or a Tumour occluding larynx,trachea or a bronchusbronchus
Crackles are short,explosive sounds Crackles are short,explosive sounds often described as bubbling or clickingoften described as bubbling or clicking
1.1. U/L early inspiratory:bronchial infn or U/L early inspiratory:bronchial infn or pneumoniapneumonia
2.2. B/L basal:pulmonary edemaB/L basal:pulmonary edema
Bronchiectasis:Bronchiectasis: coarse crackles coarse crackles
Diffuse interstitial fibrosis:fine crackles but Diffuse interstitial fibrosis:fine crackles but late inspiratorylate inspiratory
COPD:crackles at the beginning of COPD:crackles at the beginning of respirationrespiration
Vocal resonanceVocal resonance
Increased in pneumonic consolidationIncreased in pneumonic consolidation Whispering pectoriloquy presentWhispering pectoriloquy present
Decreased in emphysemaDecreased in emphysema
Position Position of tracheaof trachea
VFVF PercussioPercussionn
VRVR
PneumoniPneumonic c consolidatconsolidationion
No shiftNo shift increseincrese dulldull increaseincrease
EmphyseEmphysemama
No shiftNo shift decreasedecrease hyperresohyperresonantnant
decreasedecrease
Also examine…Also examine…
CVSCVSCor pulmonaleCor pulmonalePulmonary edemaPulmonary edema