Sign up here!
image

Respiratory condition signs

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

Pulmonary fibrosis

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

Signs of aetiology: hand deformity (RA), clubbing (idiopathic pulmonary fibrosis), sclerodactyly/telangiectasia/microstomia (systemic sclerosis), butterfly rash (SLE), lupus pernio (sarcoid), radiation burns, kyphosis (ankylosing spondylitis)

Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension)

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

Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension)

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)

Signs of aetiology: cachexia/clubbed/tar-stained fingers (lung cancer)

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

Signs of aetiology: cachexia/clubbed/tar-stained fingers (lung cancer), wet cough/clubbed/coarse crepitations (bronchiectasis), signs of COPD (bullectomy)

Pleural effusion

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

Signs of aetiology: hand deformity (RA), clubbing/radiation marks (mesothelioma/lung malignancy), butterfly rash (SLE), lymphadenopathy (malignancy), signs of chronic liver disease (cirrhosis), pulmonary/peripheral oedema(heart failure)

Bronchiectasis

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

Signs of aetiology: young and thin (CF), curved yellow nails and lymphoedema (yellow nail syndrome), lymphadenopathy (malignancy), dextrocardia(Kartagener’s syndrome)

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

Signs of complications: pain and swelling of wrists (hypertrophic pulmonary arthropathy), ptosis/meiosis/anhidrosis (Horner’s syndrome)

Lung transplant

  • Mid-sternotomy/bilateral thoracotomy scar

Signs of aetiology: signs of COPD, clubbing (CF/idiopathic pulmonary fibrosis)

Signs of complications: cushingoid/bruising (steroid use)

Try some questions to test your knowledge

Please list some causes of upper and lower zone pulmonary fibrosis

Oops! This section is restricted to members.

Create an account or log in to continue reading.

How would you clinically differentiate bronchiectasis and pulmonary fibrosis?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

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

Oops! This section is restricted to members.

Create an account or log in to continue reading.

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

Oops! This section is restricted to members.

Create an account or log in to continue reading.

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?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

Now try some OSCE stations

  1. Pneumonectomy exam
  2. Pulmonary fibrosis
  3. Pleural effusion
  4. There’s lots more!
image
Join our email list!
For free OSCE tips and updates