Table of Contents
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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