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Respiratory condition signs

Clinical examination > Cardiorespiratory

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

Please list some causes of upper and lower zone pulmonary fibrosis

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How would you clinically differentiate bronchiectasis and pulmonary fibrosis?

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What is the difference between a pneumonectomy and a lobectomy? List some possible indications.

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How would you differentiate between a transudative and exudative pleural effusion? List some causes of each.

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If a patient presented with kyphoscoliosis, what would you expect their transfer capacity of the lung for carbon monoxide (TLCO) and transfer co-efficient (KCO) to be?

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Now try some OSCE stations

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

Picture references

Peripheral cyanosis: 2011 James Heilman, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en). Sourced from: https://commons.wikimedia.org/wiki/File:Cynosis.JPG

Clubbing: 2009 Desherinka, licensed under the Creative Commons Attribution-Share Alike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/), 3.0 Unported (https://creativecommons.org/licenses/by-sa/3.0/deed.en), 2.5 Generic (https://creativecommons.org/licenses/by-sa/2.5/deed.en), 2.0 Generic (https://creativecommons.org/licenses/by-sa/2.0/deed.en) and 1.0 Generic license (https://creativecommons.org/licenses/by-sa/1.0/deed.en) and GNU Free Documentation licence 1.2 (https://commons.wikimedia.org/wiki/Commons:GNU_Free_Documentation_License,_version_1.2). Sourced from: https://en.wikipedia.org/wiki/Nail_clubbing#/media/File:Dedos_con_acropaquia.jpg

Tar staining: 2010 James Heilman, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en). Sourced from: https://en.m.wikipedia.org/wiki/File:Nicotine_stains10.JPG

Cushing’s facial appearance: 2012. Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu. Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs. Multidiscip Respir Med. 2012; 7(1): 26. Licenced under Creative Commons Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0). Sourced from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436715/

Cardiorespiratory

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