Examination cough
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Transcript of Examination cough
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EXAMINATION OF A EXAMINATION OF A PATIENT WITH PATIENT WITH
COUGHCOUGH
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GENERAL EXAMINATIONGENERAL EXAMINATION
Attitude: Sit in a propped up position if Attitude: Sit in a propped up position if dyspnoea presentdyspnoea present
Mental state:Mental confusion,stupor and Mental state:Mental confusion,stupor and flapping tremors…Respiratory failureflapping tremors…Respiratory failure
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Recent loss of weight: Recent loss of weight: Pulmonary Pulmonary tuberculosis & Bronchogenic carcinomatuberculosis & Bronchogenic carcinoma
Fever: Tuberculosis & PneumoniaFever: Tuberculosis & Pneumonia
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PallorPallor
1.1. Severe haemoptysisSevere haemoptysis
2.2. Tuberculosis:Malnutrition & anaemiaTuberculosis:Malnutrition & anaemia
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CyanosisCyanosis
Central: Respiratory failure & CHFCentral: Respiratory failure & CHF
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ClubbingClubbing
Tumours Tumours
1.1. Bronchogenic carcinomaBronchogenic carcinoma
2.2. MesotheliomaMesothelioma
Interstitial lung diseaseInterstitial lung disease Chronic pulmonary tuberculosisChronic pulmonary tuberculosis
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SepsisSepsis
1.1. BronchiectasisBronchiectasis
2.2. Lung abcessLung abcess
3.3. EmpyemaEmpyema
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Pulmonary osteoarthropathyPulmonary osteoarthropathy
Painful clubbing+thickening of Painful clubbing+thickening of periosteum of distal parts of periosteum of distal parts of radius,ulna,tibia,fibula+ painful radius,ulna,tibia,fibula+ painful enlargement of ankles & wristsenlargement of ankles & wrists
Bronchogenic carcinoma Bronchogenic carcinoma
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LymphadenopathyLymphadenopathy
Pulmonary tuberculosisPulmonary tuberculosisCarcinomaCarcinomaSarcoidosisSarcoidosis
Scalene nodesScalene nodes
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EdemaEdema
RHF secondary to pulmonay diseases is RHF secondary to pulmonay diseases is termed termed COR PULMONALE.COR PULMONALE.
1.1. EmphysemaEmphysema
2.2. Pulmonary fibrosisPulmonary fibrosis
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Head to foot examinationHead to foot examination
Subcutaneous nodules raised, firm tender: Subcutaneous nodules raised, firm tender: Metastatic lung cancerMetastatic lung cancer
Erythema nodosum over the shin:Acute Erythema nodosum over the shin:Acute sarcoidosissarcoidosis
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VITALS!!!!VITALS!!!!
BPBP
1.1. High BP:COPD , Pulmonary embolismHigh BP:COPD , Pulmonary embolism
2.2. Low BP:Pulmonary edema, ACEI, Low BP:Pulmonary edema, ACEI, Community acquired pneumoniaCommunity acquired pneumonia
(CRB-65)(CRB-65) JVPJVP Raised in cor pulmonaleRaised in cor pulmonale
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Examination of oropharynxExamination of oropharynx
Evidence of postnasal dripEvidence of postnasal dripOropharyngeal mucosa erythema or Oropharyngeal mucosa erythema or
cobble stone appearancecobble stone appearance
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Movement of accessory muscles of Movement of accessory muscles of respirationrespiration
Examination of neck:Posture,Movement of Examination of neck:Posture,Movement of accessory muscles,Jugular veinsaccessory muscles,Jugular veins
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RESPIRATORY SYSTEMRESPIRATORY SYSTEM
INSPECTIONINSPECTIONShape of the chestShape of the chest
Barrel shaped chestBarrel shaped chest
EmphysemaEmphysema
Drooping of the shouldersDrooping of the shoulders
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RespirationRespiration
RateRate >15/min+increase ventilatory drive>15/min+increase ventilatory drive
1.1. Acute asthmaAcute asthma
2.2. Exacerbation of COPDExacerbation of COPD
>15/min+decrease ventilatory drive>15/min+decrease ventilatory drive
1.1. PneumoniaPneumonia
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>30/min:Community acquired pneumonia>30/min:Community acquired pneumonia
Decrease rate: Respiratory failureDecrease rate: Respiratory failure
Use of accessory muscles of respirationUse of accessory muscles of respiration
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Movements of the chestMovements of the chest
Intercostal recession:Indrawing of Intercostal recession:Indrawing of intercostal spaces with respiration… intercostal spaces with respiration… Severe airway obstruction..laryngeal ds or Severe airway obstruction..laryngeal ds or tumours of tracheatumours of trachea
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PALPATIONPALPATION
Position of tracheaPosition of trachea
1.1. Deviation to same side:FibrosisDeviation to same side:Fibrosis
2.2. Deviation to opp side:Pneumothorax, Deviation to opp side:Pneumothorax, Pleural effusionPleural effusion
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Apex beatApex beat Palpation of the chest for any tendernessPalpation of the chest for any tenderness Expansion of the chestExpansion of the chest
Decrease expansion in Decrease expansion in consolidation,emphysemaconsolidation,emphysema
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Vocal fremitusVocal fremitusDecrease in bronchial obstrn,emphysemaDecrease in bronchial obstrn,emphysema Increase in pneumonic consolidation & Increase in pneumonic consolidation &
neoplasmsneoplasms
Rhonchial fremitusRhonchial fremitus Palpable rhonchiPalpable rhonchi
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PERCUSSIONPERCUSSION
Hyperresonant in emphysemaHyperresonant in emphysemaTympanic in a superficial cavity of lungTympanic in a superficial cavity of lungDullness in consolidationDullness in consolidation
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Cracked pot sound:Cracked pot sound:percussion note over percussion note over cavities which communicate with bronchuscavities which communicate with bronchus
Cardiac dullness obliterated in Cardiac dullness obliterated in emphysemaemphysema
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AUSCULTATIONAUSCULTATION
Breath soundsBreath sounds
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Decreased intensityDecreased intensity
1.1. Collapse & FibrosisCollapse & Fibrosis
2.2. Bronchial obstructionBronchial obstruction
Bronchial breathingBronchial breathing Pneumonic consolidationPneumonic consolidation
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Added soundsAdded sounds
Wheezes are musical sounds assoc. with Wheezes are musical sounds assoc. with airway narrowing.airway narrowing.
1.1. Polyphonic wheezesPolyphonic wheezes heard in expiration: heard in expiration: asthma & COPDasthma & COPD
2.2. Monophonic wheezesMonophonic wheezes in localised in localised narrowing of bronchus & tumour or narrowing of bronchus & tumour or foreign bodyforeign body
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Stridor is a harsh croaking inspiratory Stridor is a harsh croaking inspiratory noise aagravated by coughnoise aagravated by cough
Should be investigated always.Should be investigated always.
1.1. Foreign bodyForeign body
2.2. Tumour occluding larynx,trachea or a Tumour occluding larynx,trachea or a bronchusbronchus
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Crackles are short,explosive sounds Crackles are short,explosive sounds often described as bubbling or clickingoften described as bubbling or clicking
1.1. U/L early inspiratory:bronchial infn or U/L early inspiratory:bronchial infn or pneumoniapneumonia
2.2. B/L basal:pulmonary edemaB/L basal:pulmonary edema
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Bronchiectasis:Bronchiectasis: coarse crackles coarse crackles
Diffuse interstitial fibrosis:fine crackles but Diffuse interstitial fibrosis:fine crackles but late inspiratorylate inspiratory
COPD:crackles at the beginning of COPD:crackles at the beginning of respirationrespiration
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Vocal resonanceVocal resonance
Increased in pneumonic consolidationIncreased in pneumonic consolidation Whispering pectoriloquy presentWhispering pectoriloquy present
Decreased in emphysemaDecreased in emphysema
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Position Position of tracheaof trachea
VFVF PercussioPercussionn
VRVR
PneumoniPneumonic c consolidatconsolidationion
No shiftNo shift increseincrese dulldull increaseincrease
EmphyseEmphysemama
No shiftNo shift decreasedecrease hyperresohyperresonantnant
decreasedecrease
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Also examine…Also examine…
CVSCVSCor pulmonaleCor pulmonalePulmonary edemaPulmonary edema
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