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EXAMINATION OF A
  PATIENT WITH
    COUGH
GENERAL EXAMINATION

 Attitude:
         Sit in a propped up position if
  dyspnoea present



 Mental  state:Mental confusion,stupor and
  flapping tremors…Respiratory failure
 Recentloss of weight: Pulmonary
 tuberculosis & Bronchogenic carcinoma



 Fever:   Tuberculosis & Pneumonia
    Pallor
1.   Severe haemoptysis
2.   Tuberculosis:Malnutrition & anaemia
 Cyanosis

Central: Respiratory failure & CHF
Clubbing
    Tumours
1.   Bronchogenic carcinoma
2.   Mesothelioma



    Interstitial lung disease
    Chronic pulmonary tuberculosis
    Sepsis
1.   Bronchiectasis
2.   Lung abcess
3.   Empyema
Pulmonary osteoarthropathy
   Painful clubbing+thickening of
    periosteum of distal parts of
    radius,ulna,tibia,fibula+ painful
    enlargement of ankles & wrists
   Bronchogenic carcinoma
Lymphadenopathy
 Pulmonary   tuberculosis
 Carcinoma
 Sarcoidosis


 Scalene   nodes
Edema
    RHF secondary to pulmonay diseases is
     termed COR PULMONALE.

1.   Emphysema
2.   Pulmonary fibrosis
Head to foot examination
 Subcutaneous  nodules raised, firm tender:
 Metastatic lung cancer

 Erythema nodosum over the shin:Acute
 sarcoidosis
VITALS!!!!
    BP
1.   High BP:COPD , Pulmonary embolism
2.   Low BP:Pulmonary edema, ACEI,
     Community acquired pneumonia
      (CRB-65)
    JVP
    Raised in cor pulmonale
Examination of oropharynx
 Evidence  of postnasal drip
 Oropharyngeal mucosa erythema or
  cobble stone appearance
 Movement     of accessory muscles of
 respiration

 Examination
            of neck:Posture,Movement of
 accessory muscles,Jugular veins
RESPIRATORY SYSTEM
INSPECTION
 Shape   of the chest
Barrel shaped chest
Emphysema

Drooping    of the shoulders
Respiration
    Rate
    >15/min+increase ventilatory drive
1.   Acute asthma
2.   Exacerbation of COPD

    >15/min+decrease ventilatory drive
1.   Pneumonia
 >30/min:Community     acquired pneumonia

 Decrease   rate: Respiratory failure



 Use   of accessory muscles of respiration
Movements of the chest
 Intercostalrecession:Indrawing of
 intercostal spaces with respiration…
 Severe airway obstruction..laryngeal ds or
 tumours of trachea
PALPATION
    Position of trachea
1.   Deviation to same side:Fibrosis
2.   Deviation to opp side:Pneumothorax,
     Pleural effusion
   Apex beat
   Palpation of the chest for any tenderness
   Expansion of the chest
               Decrease expansion in
    consolidation,emphysema
 Vocal fremitus
 Decrease in bronchial obstrn,emphysema
 Increase in pneumonic consolidation &
  neoplasms

 Rhonchial fremitus
 Palpable rhonchi
PERCUSSION
 Hyperresonant  in emphysema
 Tympanic in a superficial cavity of lung
 Dullness in consolidation
 Cracked  pot sound:percussion note over
 cavities which communicate with bronchus

 Cardiac
       dullness obliterated in
 emphysema
AUSCULTATION
 Breath   sounds
    Decreased intensity
1.   Collapse & Fibrosis
2.   Bronchial obstruction

    Bronchial breathing
    Pneumonic consolidation
Added sounds
    Wheezes are musical sounds assoc.
     with airway narrowing.

1.   Polyphonic wheezes heard in expiration:
     asthma & COPD
2.   Monophonic wheezes in localised
     narrowing of bronchus & tumour or
     foreign body
    Stridor is a harsh croaking inspiratory
     noise aagravated by cough
    Should be investigated always.
1.   Foreign body
2.   Tumour occluding larynx,trachea or a
     bronchus
    Crackles are short,explosive sounds
     often described as bubbling or clicking

1.   U/L early inspiratory:bronchial infn or
     pneumonia
2.   B/L basal:pulmonary edema
 Bronchiectasis:   coarse crackles

 Diffuseinterstitial fibrosis:fine crackles but
 late inspiratory

 COPD:crackles   at the beginning of
 respiration
Vocal resonance
 Increasedin pneumonic consolidation
 Whispering pectoriloquy present




 Decreased   in emphysema
Position   VF       Percussio VR
          of trachea          n




Pneumoni No shift   increse   dull     increase
c
consolidat
ion


Emphyse No shift    decrease hyperreso decrease
ma                           nant
Also examine…
 CVS
 Cor pulmonale
 Pulmonary edema
Examination cough

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Examination cough

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