Medically Fit For Exams
Medically Fit For Exams

Respiratory examination abnormalities

Infection eg pneumonia

  • May be on oxygen, and have IV antibiotics
  • May appear breathless
  • May be using accessory muscles
  • Tachycardia
  • May have asymmetrical chest expansion as a result of consolidation
  • Dull percussion over areas of consolidation
  • Bronchial breathing - loud and blowing breath sounds, inspiration and expiration are similar in sound. Is gap between inspiration and expiration
  • Coarse crackles in affected areas
  • May have pleural rub (crunching fresh snow)
  • Increased conductance in tactile fremitus
  • Audible whispering pectoriloquy

 

Pleural effusion

  • May be on oxygen
  • May appear breathless, and using accessory muscles
  • Possible slow capillary refill if large effusion
  • Tracheal deviation (away from site of effusion) in large pleural effusion
  • May have evidence of surgery or chest drain
  • Decreased chest expansion on affected side
  • Percussion will feel dull or stony dull at the lung bases, the further up the lungs, the larger the effusion, is often symmetrical
  • Decreased or absent breath sounds
  • Pleural rub
  • Bronchial breathing (large effusion compressing lungs)
  • Reduced conductance in tactile fremitus

 

Lung cancer

  • May have weight loss
  • May be on oxygen
  • Clubbing
  • Tar staining
  • May have lymphadenopathy if metastatic spread
  • Asymmetrical pupils and eyelid drooping (ptosis) – Horner’s syndrome – result of apical/Pancoast tumour
  • Tracheal deviation if very large tumour
  • May have asymmetrical chest expansion if very large tumour
  • A very large tumour may feel dull on percussion
  • Reduced breath sounds over very large tumour
  • Coarse crackles if there are secretions from the tumour

 

Acute asthma attack

  • Difficulty breathing, use of accessory muscles
  • Tremor from salbutamol overdose
  • Tachycardia
  • Cyanosis if prolonged and severe
  • Thrush in mouth from steroid use
  • Raised JVP in severe acute attack
  • Reduced chest expansion
  • Wheeze, maybe stridor
  • Possible bronchial breathing
  • Crackles – coarse if pulmonary fibrosis, fine if secretions

 

COPD

  • May be on oxygen
  • Hyperventilation, difficulty breathing, use of accessory muscles
  • May be obviously cyanosed
  • May have obvious cough and wheeze
  • Peripheral cyanosis
  • Slow capillary refill
  • Tar staining
  • CO2 retention flap if very severe
  • May have tachycardia
  • Central cyanosis
  • Raised JVP if cor pulmonale
  • Barrel chest on inspection
  • Percussion may feel hyper-resonant over emphysematous areas
  • Diminished vesicular breathing on auscultation (emphysema)
  • Late phase crackles (fine from fibrosis, coarse from secretions)
  • May have peripheral and sacral oedema from R sided heart failure

 

Pulmonary hypertension

  • Findings are more apparent on cardiovascular exam
  • Pulmonary oedema may lead to:
    • Dullness on percussion
    • Middle phase, medium crackles

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