NB: signs are on side of lesion unless otherwise stated.

Pulmonary fibrosis

• Oxygen therapy
• Dry cough
• Tachypnoea
• Reduced expansion
• Fine end-inspiratory crepitations

COPD

• Bedside inhalers/nebulisers
• Accessory muscle use
• Tar-stained fingers
• Tachypnoea
• Lip pursing
• Reduced cricosternal distance (<3 fingers)
• Tracheal tug
• Indrawing of lower intercostal muscles on inspiration
• Hyper-resonance (with obliterated cardiac and hepatic dullness)
• Quiet breath sounds/wheeze/prolonged expiratory phase

Pneumonectomy

• Unilateral chest flattening
• Thoracotomy scar
• Tracheal deviation (towards)
• Reduced expansion
• Dull percussion note
• Reduced breath sounds
• Bronchial breathing in upper zone (due to deviated trachea)

Lobectomy

• Thoracotomy scar
• May be no other signs due to compensatory hyperexpansion of the remaining lobes
• May be some reduced expansion, dullness to percussion and reduced air entry

Pleural effusion

• Reduced expansion
• Stony dull percussion note
• Reduced breath sounds
• Reduced tactile fremitus and vocal resonance

Bronchiectasis

• Productive cough
• Inspiratory clicks
• Clubbing
• Coarse, late expiratory crepitations

Kyphoscoliosis

• Increased thoracic forward curvature or lateral curvature of the spine
• Reduced spine flexion/extension
• Rib hump
• Reduced chest expansion

Lung cancer

• Cachexia
• Clubbing
• Tar-stained fingers
• Hard irregular lymphadenopathy
• Radiation burns

Lung transplant

• Mid-sternotomy/bilateral thoracotomy scar

Try some questions to test your knowledge

Now try some OSCE stations

1. Pneumonectomy exam
2. Pulmonary fibrosis
3. Pleural effusion
4. There’s lots more!