Important respiratory presentations Flashcards
Pneumonia: inspection
Look for sputum pot at bedside. Tachypnoeic, tachycardia, or hypotensive? Warm peripheries. Bounding pulse. Sweaty and clammy.
Pneumonia: palpation
Reduced expansion on the affected side.
Increased tactile vocal fremitus if consolidation.
Pneumonia: percussion
Dull.
Pneumonia: auscultation
Coarse crackles, localised. Bronchial breathing (possible). Whispering pectoriloquy. Reduced air entry. Increased vocal resonance.
Lobar collapse: palpation
Mediastinal shift towards the abnormality.
Potentially decreased chest wall movement locally.
Lobar collapse: percussion
Dullness to percussion restricted to affected lobe.
Lobar collapse: auscultation
Decreased breath sounds usually.
Pleural effusion: inspection
Reduced chest expansion unilaterally (if large).
Pleural effusion: palpation
Trachea may be pushed away from the effusion.
Apex beat: a large right effusion will displace the cardiac apex to the left; a large left effusion may make the apex beat difficult to palpate.
Pleural effusion: percussion
‘Stony dull’.
Pleural effusion: auscultation
Markedly reduced breath sounds.
Reduced vocal resonance.
Collapsed or consolidated lung above the effusion may produce an overlying region of bronchial breathing.
Pneumothorax: inspection
No mediastinal shift (only occurs with tension pneumothorax).
Chest wall asymmetry may be evident with a large pneumothorax (greater volume on affected side).
Pneumothorax: percussion
Hyper-resonant.
Pneumothorax: auscultation
Reduced breath sounds on affected side.
Reduced vocal resonance on affected side.
Interstitial fibrosis: inspection
Patients may be cyanosed.
There may also be signs of connective tissue disease or skin changes of radiotherapy.
Clubbing is common.
Interstitial fibrosis: palpation
Trachea may move towards the fibrosis in upper lobe disease.
Normal or reduced chest wall movement.
Interstitial fibrosis: percussion
Normal percussion note.
Interstital fibrosis: auscultation
Normal breath sounds.
Normal vocal resonance usually, may be increased if dense fibrosis.
Fine velcro crackles.
COPD: inspection
Inhalers at the bedside.
Sputum pot?
Thin skin with bruising (use of steroids).
Use of accessory muscles/ brace position.
Tachypnoea.
No mediastinal shift.
Chest hyper-expanded with little additional excursion.
Prolonged expiration and pursed lip breathing.
COPD: percussion
May be globally hyper-resonant to percussion.
COPD: auscultation
Reduced breath sounds globally, may be additional polyphonic wheeze.
Reduced vocal resonance usually in the upper lobes (where bullae are commonest).
Heart sounds often quiet.
Bronchiectasis: inspection
Often copious sputum (usually purulent, may contain blood).
Digital clubbing may be present.
Low BMI.
Bronchiectasis: palpation
No mediastinal shift.
Chest wall expansion equal.
Bronchiectasis: percussion
Percussion resonant.
Bronchiectasis: auscultation
Mixed, predominant coarse crackles.
Often additional polyphonic wheeze.
Vocal resonance normal.
Neuromuscular insufficiency: respiratory inspection
Non-respiratory signs of neuromuscular illness (e.g. altered phonation, limited mobility).
Rapid shallow breathing, sometimes with abdominal paradox.
Neuromuscular insufficiency: respiratory palpation
Chest wall expansion equal but limited excursion.
Neuromuscular insufficiency: respiratory percussion
Percussion note resonant.
Neuromuscular insufficiency: respiratory auscultation
Breath sounds normal.
Basal crackles common from atelectasis (impaired cough).
