Observation
General obs: Shortness of breath, colour, dentition, wheeze, stridor, repiratory rate |
Face: Horner's syndrome (pancoast tumour), cynanosis of the lips/tongue (central cyanosis), pursed lips (COPD), signs of anaemia (Glossitis of the tongue, pale conjunctiva, angular stomatitis at the corners of the mouth |
Hands: Cyanosis, clubbing, signs of anaemia (spooning of the nails, pale palmar creases), nicotine stains |
Chest: Scarring , barrel chest, caving chest, pigeon chest |
Respiratory rate (RR) : measures severity of breathlessness
- Measure movements of the chest
- Normal = 12-18 breaths per minute
- Can be raised due to breathlessness, COPD, infection, anxiety
Palpation
- Tracheal deviation/apex beat deviation for mediastinal shift |
- Chest expansion |
- Lymph node & Thyroid exam |
- Percussion of the lungs along rib interspaces and clavicles - Pneumothorax = hyperresonant sound, - Pneumonia = solid areas - Fluid = dull sound |
- Auscultation |
Horner's syndrome
- Disruption of the sympathetic nerves supplying the eye
- Ipsilateral Miosis (small pupil), Ptosis (drooping eyelid), Anhydrosis (No sweating), Enopthalmos (Sunken eyes)
- Apical lung tumour/infection
Anaemia
- Signs of anaemia
- Left to right: Spooning of the nails, Glossitis, Angular stomatitis
Cyanosis
- Cyanosis of the tongue and fingers
Clubbing
Clubbing of the fingers and test for clubbing
- The finger would not be able to do the test or have no diamond sign(Schamnroth's window)
Causes:
- Bronchial Cancer
- Chronic Suppurative lung disease such as:
Bronchiectasis
Empyema (abscess of the lung)
TB
Cystic Fibrosis
-
Chest Shapes
1 = Barrel chest - COPD
2 = Pidgeon Chest/Pectus carinatum - poorly controlled severe childhood asthma
3 = Accessory muscles of respiration - COPD
4 = Pectus Excavatum = depression of the sternum
Percussion/Ascultation
- Where to tap or listen to the chest
Breath Sounds
- Vesicular Breathing: Normal breathing - Inspiration longer than expiration - No pause between inspiration/expiration |
- Bronchial Breathing: Consolidation/collapsed/compressed lung (effusion) - Inspiration equally long as expiration - Pause between inspiration/expiration - much harsher sounds |
- Wheezes: - Arises from the bronchi (usually expiratory) - Long and uninterrupted - Can be low/high pitched - Caused by partial obstruction (Asthma, COPD, Tumour) |
- Crackles: - Arises from the alveoli/bronchi - Discontinuous, bubbling - Best heard at the start of inspiration (harsh/fine) - Due to fluid/secretions (Pulmonary oedema/pneumonia (like a crisp packet being rustled) |
- Stridor: - Arise from the Larynx/trachea (usually inspiratory) - Partial/large airway obstruction (tumour, swelling of mucosa) |
- Friction Rub: - Arise from the pleura - Creaking/rubbing - Unchanged by coughing - Pleurisy (pneumonia/pulmonary embolism) |
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