Examination cough

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Examination cough

  1. 1. EXAMINATION OF A PATIENT WITH COUGH
  2. 2. GENERAL EXAMINATION Attitude: Sit in a propped up position if dyspnoea present Mental state:Mental confusion,stupor and flapping tremors…Respiratory failure
  3. 3.  Recentloss of weight: Pulmonary tuberculosis & Bronchogenic carcinoma Fever: Tuberculosis & Pneumonia
  4. 4.  Pallor1. Severe haemoptysis2. Tuberculosis:Malnutrition & anaemia
  5. 5.  CyanosisCentral: Respiratory failure & CHF
  6. 6. Clubbing Tumours1. Bronchogenic carcinoma2. Mesothelioma Interstitial lung disease Chronic pulmonary tuberculosis
  7. 7.  Sepsis1. Bronchiectasis2. Lung abcess3. Empyema
  8. 8. Pulmonary osteoarthropathy Painful clubbing+thickening of periosteum of distal parts of radius,ulna,tibia,fibula+ painful enlargement of ankles & wrists Bronchogenic carcinoma
  9. 9. Lymphadenopathy Pulmonary tuberculosis Carcinoma Sarcoidosis Scalene nodes
  10. 10. Edema RHF secondary to pulmonay diseases is termed COR PULMONALE.1. Emphysema2. Pulmonary fibrosis
  11. 11. Head to foot examination Subcutaneous nodules raised, firm tender: Metastatic lung cancer Erythema nodosum over the shin:Acute sarcoidosis
  12. 12. VITALS!!!! BP1. High BP:COPD , Pulmonary embolism2. Low BP:Pulmonary edema, ACEI, Community acquired pneumonia (CRB-65) JVP Raised in cor pulmonale
  13. 13. Examination of oropharynx Evidence of postnasal drip Oropharyngeal mucosa erythema or cobble stone appearance
  14. 14.  Movement of accessory muscles of respiration Examination of neck:Posture,Movement of accessory muscles,Jugular veins
  15. 15. RESPIRATORY SYSTEMINSPECTION Shape of the chestBarrel shaped chestEmphysemaDrooping of the shoulders
  16. 16. Respiration Rate >15/min+increase ventilatory drive1. Acute asthma2. Exacerbation of COPD >15/min+decrease ventilatory drive1. Pneumonia
  17. 17.  >30/min:Community acquired pneumonia Decrease rate: Respiratory failure Use of accessory muscles of respiration
  18. 18. Movements of the chest Intercostalrecession:Indrawing of intercostal spaces with respiration… Severe airway obstruction..laryngeal ds or tumours of trachea
  19. 19. PALPATION Position of trachea1. Deviation to same side:Fibrosis2. Deviation to opp side:Pneumothorax, Pleural effusion
  20. 20.  Apex beat Palpation of the chest for any tenderness Expansion of the chest Decrease expansion in consolidation,emphysema
  21. 21.  Vocal fremitus Decrease in bronchial obstrn,emphysema Increase in pneumonic consolidation & neoplasms Rhonchial fremitus Palpable rhonchi
  22. 22. PERCUSSION Hyperresonant in emphysema Tympanic in a superficial cavity of lung Dullness in consolidation
  23. 23.  Cracked pot sound:percussion note over cavities which communicate with bronchus Cardiac dullness obliterated in emphysema
  24. 24. AUSCULTATION Breath sounds
  25. 25.  Decreased intensity1. Collapse & Fibrosis2. Bronchial obstruction Bronchial breathing Pneumonic consolidation
  26. 26. Added sounds Wheezes are musical sounds assoc. with airway narrowing.1. Polyphonic wheezes heard in expiration: asthma & COPD2. Monophonic wheezes in localised narrowing of bronchus & tumour or foreign body
  27. 27.  Stridor is a harsh croaking inspiratory noise aagravated by cough Should be investigated always.1. Foreign body2. Tumour occluding larynx,trachea or a bronchus
  28. 28.  Crackles are short,explosive sounds often described as bubbling or clicking1. U/L early inspiratory:bronchial infn or pneumonia2. B/L basal:pulmonary edema
  29. 29.  Bronchiectasis: coarse crackles Diffuseinterstitial fibrosis:fine crackles but late inspiratory COPD:crackles at the beginning of respiration
  30. 30. Vocal resonance Increasedin pneumonic consolidation Whispering pectoriloquy present Decreased in emphysema
  31. 31. Position VF Percussio VR of trachea nPneumoni No shift increse dull increasecconsolidationEmphyse No shift decrease hyperreso decreasema nant
  32. 32. Also examine… CVS Cor pulmonale Pulmonary edema

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