The hands HPO Periosteal inflammation Clubbing marked Distal end of long bones,wrists,metacarpal,metatarsal bones, knees, ankles Swelling/Tenderness The hands 2. Staining
Cigarette smoking 3. Wasting and weakness Wasting small muscles Weakness abduction Infiltration of brachial plexus by lung CA The hands 5. 4.
Flapping Pulse rate tremor(Asterixis) Pulse rate Pulsus paradoxus Dorsiflex hands Systolic BP drop > 10mmHg CO2
retention (COPD) The face 1. Horners syndrome Constricted pupil Partial ptosis Loss of sweating Apical lung tumour Compression of sympathetic nerves
The face 2. Skin changes Connective tissue diseases The face 3. URTI Look inside mouth
4. Sinuses Look inside mouth 5. SVC obstruction Facial plethora or cyanosis The trachea Position
Tracheal COPD tug The chest Inspection Palpation Percussion Auscultation The chest: Inspection
1. Shape and symmetry of chest shape shaped chest BarrelHarrisons sulcus chest Pigeon
Kyphosis, scoliosis, kyphoscoliosis Funnel Lesionschest of chest wall Movement of chest wall The chest: Inspection Barrel- shaped chest
Increased AP diameter Severe asthma/COPD Normal elderly people The chest: Inspection Funnel Pigeon chest(pectus excavatum) carinatum) Developmental Outward bowingdefect
sternum/costal cartilages Depression lower end of sternum childhood resp Chronic Severe: decreased lunginfectons capacity Rickets The chest: Inspection Harrisons
sulcus Linear depression lower ribs just above costal margins Severe asthma in childhood Rickets The chest: Inspection Kyphosis, scoliosis, kyphoscoliosis
Severe: reduced lung capacity The chest: Inspection Lesions of chest wall Scars Previous surgery Previous ICD Radiotherapy Erythema
Subcutaneous emphysema Prominent veins SVC obstruction The chest: Inspection Movement of chest wall Expansion Upper lobes From behind
Look down at clavicles Lower lobes From behind Unilateral Localized fibrosis, consolidation, collapse, pleural effusion Bilateral COPD, diffuse pulmonary fibrosis The chest: Inspection Movement of chest wall
Asymmetry Paradoxical inward movement abdomen during inspiration Diaphragm paralysis The chest: Palpation 1. Chest expansion Thumbs move symmetrical 5cm on inspiration
Lower lobe From back Upper lobe From front The chest: Palpation Impalpable 2. Apex beat COPD: hyperinflation Displacement Towards side of lesion
Collapse lower lobe Localized fibrosis Away from lesion Pleural effusion Tension pneumothorax The chest: Palpation 4. 3. Vocal fremitus Ribs
Localized Palm of hand pain Trauma, metastases, prolonged coughing 99 Differences Increased: Consolidation Same as vocal resonance The chest: Percussion The chest: Percussion
1. Symmetrical Ant/Post/Lat Supraclavicular fossa over lung apex Clavicle with finger The chest: Percussion The chest: Percussion 2.
Interpretation Stony dull Resonant Fluidfilled area (pleural effusion) Normal Hyperresonant Dull Over structures Solid hollow
Decreased Upper level COPD 5th / 6th rib MCL Asthma If lower: hyperinflation The chest: Auscultation 1. Breath sounds 2.
Vocal resonance The chest: Auscultation 1. Breath sounds General Quality of breath sounds Intensity of breath sounds Added sounds
The chest: Auscultation(Breath sounds) General Diaphragm of stethoscope Compare sides Axilla Bell of stethoscope above clavicles Lung apices The chest: Auscultation(Breath sounds) Quality
of breath sounds p125 Normal breath sounds (vesicular) Bronchial breath sounds Amphoric breath sounds The chest: Auscultation(Breath sounds) Normal breath sounds (vesicular)
Most of chest Breath through mouth Inspiration Longer and louder than expiration No gap between inspiration and expiration The chest: Auscultation(Breath sounds) Bronchial breathing
Hollow, blowing sound Audible in expiration Gap between inspiration and expiration Expiration Higher intensity than inspiratory Normal posteriorly over upper chest CONSOLIDATION The chest: Auscultation(Breath sounds) Amphoric
breathing Exaggerated bronchial quality Very hollow (blowing over bottle) LARGE CAVITY The chest: Auscultation(Breath sounds) Intensity of breath sounds
Normal or reduced Reduced COPD Pleural effusion Pneumothorax Pneumonia Large neoplasm Pulmonary collapse The chest: Auscultation(Breath sounds) Added
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