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©-© KEY FEATURES ON EXAMINATION OF COMMON RESPIRATORY CONDITIONS

Chronić obstructive pulmonary disease    Pulmonary fibrosis

Hyperinflated barrel' chest

Heart sounds loudest in epigastrium -

Use of accessory muscles

Auscultation Reduced breath sounds ± wheeze

Pursed lip breathing Central cyanosis Prolonged expiration

Reduced cricostemal distance

Intercostal indrawing during inspiration

Cardiac apex not palpable Loss of cardiac dullness on percussion

Inward movement of lower ribs on inspiration (Iow fiat diaphragm)

Central cyanosis Tachypnoea

Smali lungs

Reduced

expansion

Seealso Fig. 19.53

Fine inspiratory crackles at bases

Duli percussion at bases (high diaphragm)

Also: raised JVP, peripheral oedema if cor pulmonale

Also: finger dubbing common in idiopathic pulmonary fibrosis; raised JVP and peripheral oedema if cor pulmonale

Right middle lobe pneumonia

Right upper lobe collapse

Febrile ± rigors In pain (if pieurisy) Purulent sputum

Obscures R heart border on X-ray (Fig. 19.33)

Inspection

Tachypnoea

Central cyanosis (if severe) Palpation •lExpansion on R Percussion

Duli R midzone and axilla Auscultation Bronchial breath sounds and tvocal resonance over consolidation Pleural rub if pieurisy

Inspection

iVolume R upper zonę Palpation

Trachea deviated to R iExpansion R upper zonę Percussion Duli R upper zonę Auscultation

iBreath sounds with central obstruction

X-ray

Deviated trachea (to R)

Elevated horizontal fissure iVolume R hemithorax Central (hilar) mass may be seen

Left pneumothorax

Large right pleural effusion

Tension’ pneumothorax also causes Deviation of trachea to opposite side Tachycardia and hypotension

Inspection

Tachypnoea (pain, deflation reflex)

Palpation •lExpansion L side Percussion

Resonant or hyper-resonant on L

Auscultation

Absent breath sounds on L

Inspection Tachypnoea Palpation •lExpansion on R Trachea and apex may be moved to L Percussion Stony duli

R mid- and lower zones Auscultation

Absent breath sounds and vocal resonance R base Crackles above effusion

© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com