Table of Contents Pulmonary fibrosisCOPDPneumonectomyLobectomyPleural effusionBronchiectasisKyphoscoliosisLung cancerLung transplantTry some questions to test your knowledge Now try some OSCE stations NB: signs are on side of lesion unless otherwise stated. Pulmonary fibrosis Oxygen therapy Dry cough Tachypnoea Reduced expansion Fine end-inspiratory crepitations Advanced signs Advanced signs 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 Advanced signs Advanced signs 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) Advanced signs Advanced signs Signs of aetiology: cachexia/clubbed/tar-stained fingers (lung cancer) Thoracotomy scarCushing’s facial appearanceTelangiectasiaPeripheral cyanosisClubbingTar staining 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 Advanced signs Advanced signs 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 Advanced signs Advanced signs 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 Advanced signs Advanced signs 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 Advanced signs Advanced signs Signs of complications: pain and swelling of wrists (hypertrophic pulmonary arthropathy), ptosis/meiosis/anhidrosis (Horner’s syndrome) Lung transplant Mid-sternotomy/bilateral thoracotomy scar Advanced signs Advanced signs 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. How would you clinically differentiate bronchiectasis and pulmonary fibrosis? Oops! This section is restricted to members. What is the difference between a pneumonectomy and a lobectomy? List some possible indications. Oops! This section is restricted to members. How would you differentiate between a transudative and exudative pleural effusion? List some causes of each. Oops! This section is restricted to members. 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. Now try some OSCE stations Pneumonectomy exam Pulmonary fibrosis Pleural effusion There’s lots more!
