Clinical Examination Flashcards
Findings on the skin
Yellow fingernails (nicotine, tar, fungus) Cyanosis Eczema with atopic disease Erythema nodosum (sarcoidosis, TB) Lupus pernio & cutaneous sarcoidosis
Hand changes
Clubbing
Cyanosis
Palmar erythema (aspiration pneumonia)
Causes of clubbing
Bronchial carcinoma Fibrosing alveolitis Lung suppuration (bronchiectasis, lung abscess, empyema) Cyanotic congenital heart disease Infective endocarditis Malabsorption States (UC, Crohn's, cirrhosis of the liver) Congenital Idiopathic
Eye signs
Horner’s syndrome
- small pupil
- Ptosis
- Enophthalmos
- unilateral loss of sweating
Due to interruption of cervical chain
- Pancoast’s tumour
- cervical lymphadenopathy
Uveitis
- sarcoidosis/TB
Dilated retinal veins/papilloedema
- chronically raised CO2
Chordal tubercles in disseminated TB
Regions of lymph nodes on the neck
Sub mental (under chin) Sub madibular (under jaw bone) Pre auricular (in front of ear) Post auricular (behind ear) Occipital (back of head) Supra clavicular Anterior triangle Posterior triangle
Presentation of Cor pulmonae
Cyanosis Raised JVP Pitting oedema Para sternal heave Loud P2
Inspection of the chest
Kyphoscoliosis Pectus excavatum Hyperinflation (emphysema) Scars Asymmetry Expansion Respiratory abdomen movement
Presentation of pectins excavatum
Pulmonary artery flow murmur
Right lower lobe CXR changes mimicking pulmonary infiltrate
Diminished basal lung volumes lead to diminished lung sounds.
Signs on palpation
Tracheal deviation
- towards collapse
- towards consolidation
- away from effusion
Crepitation
- surgical emphysema
- chest wall trauma
- iatrogenic (chest drains)
- ruptured oesophagus
Chest expansion
Causes of reduced chest expansion
Unilateral - pneumothorax
Effusion blocked centra, bronchus, diaphragm palsy
Bilateral - restrictive lung disease, hyperinflation (emphysema)
Signs on percussion
Hyperesonant (emphysema, pneumothorax) Impaired resonance (consolidation, pleural thickening, raised hemi diaphragm) Stony, dull to percuss = pleural effusion
Signs heard on auscultation - breath sounds
Normal - vesicular - muffled transmitted bronchial sounds
Reduced - effusion, collapse, bronchial obstruction, emphysema (obesity)
Transmitted - bronchial - consolidation with patent bronchial system (e.g. Pneumonia, pulmonary fibrosis)
Signs heard on auscultation - added sounds
Wheeze - air passing through narrowed airways
Localised - e.g. large airway tumour
Generalised - polyphonic - smal airway obstruction (asthma, bronchitis)
Squeaks (& crackles too) - bronchiolitis
Crackles - due to explosive reopening of small airways blocked by exudate (inflammation or fibrosis)
Fine crackles - pulmonary fibrosis (late inspiratory)
Moderate/coarse (pulmonary oedema, consolidation, bronchiectasis)
Pleural rub - pneumonia, PE, viral or autoimmune pleurisy
Pleural click = pneumothorax
Signs heard on auscultation - vocal sounds
Reduced
- effusion
- collapse
- bronchial occlusion
- pneumothorax
- emphysema
Increased
- with consolidation (e.g. pneumonia)
Whispering pectoriloquy - transmitted - consolidation without bronchial obstruction
General look at patient
Respiratory distress
Strider
Cyanosis
State of nutrition
