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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)

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