Respiratory exam Flashcards
Causes of clubbing
Lung carcinoma Bronchiectasis IPF, asbestosis CF Other: IE, IBD, coeliac disease, cirrhosis, thyrotoxicosis, familial
Transudative pleural effusion
Pleural:serum protein <0.5
Pleural LDH < 2/3 ULN, pleural:serum LDH <0.6
Causes- CCF, nephrotic syndrome, liver failure, Meig’s syndrome (ovarian fibroma), hypothyroidism
Exudative pleural effusion
Pleural:serum protein >0.5, pleural LDH >2/3 ULN, pleural:serum LDH >0.6
Causes- pneumonia, neoplasm, TB, sarcoidosis, pulmonary infarction, pancreatitis, CT disease, drugs, radiation
Inspiratory wheeze
Asthma
Upper airway extrathoracic obstruction
Expiratory wheeze
Asthma
COPD
Fixed inspiratory monophonic wheeze
Fixed bronchial obstruction- usually due to carcinoma
Tracheal deviation
Upper lobectomy/pneumonectomy
Tension pneumothorax
Massive pleural effusion
Upper mediastinal mass
Upper lobe fibrosis
Silicosis, sarcoidosis Coal worker's pneumoconiosis Histiocytosis Ankylosing spondylitis, ABPA Radiation pneumonitis TB
Lower lobe fibrosis
RA Asbestosis Scleroderma, MTCD Idiopathic pulmonary fibrosis Other drugs- amiodarone, bleomycin, methotrexate, nitrofurantoin
UIP pattern
Seen in IPF Honeycombing Traction bronchiectasis Reticular fibrosis Apical-basal gradient
NSIP pattern
Seen in connective tissue disease, HIV, drugs, hypersensitivity pneumonitis
Ground glass opacity
Traction bronchiectasis
Diffuse sparing
Bronchial breath sounds
Expiratory phase prolonged with blowing quality
Causes- lobar pneumonia, localised fibrosis or collapse, above a pleural effusion, large lung cavity
Causes of reduced breath sounds
Large lung mass
Collapse
Consolidation
Effusion
Pneumothorax
Pneumonectomy
Emphysema
Elevated hemidiaphragm
Causes of pneumonectomy
Lung cancer
COPD
Traumatic chest injury
Chronic infection- TB, bronchiectasis
Causes for unilateral chest scar
Lobectomy/pneumonectomy
Lung transplant
VATS/pleurodesis
Lung biopsy
Pleurectomy
Lung volume reduction
Clinical signs of pleural effusion
Tracheal deviation away from affected side
Reduced chest expansion
Decreased vocal resonance/fremitus
Stony dull percussion
Reduced/absent breath sounds
Bronchial breathing above effusion
Clinical signs of consolidation
Tracheal deviation towards affected side
Reduced chest expansion
Increased vocal resonance/fremitus
Dull percussion
Inspiratoty crackles
Clinical signs of atelectasis
Tracheal deviation towards affected side
Reduced chest expansion
Dull percussion
Reduced breath sounds with nil added
Signs in bronchiectasis
Prolonged expiratory time
Moist cough/sputum mug
Clubbing
Hyper-expanded chest
Coarse crepitations
Signs of pulmonary HTN
Causes of bronchiectasis
CF/congenital
TB
ABPA
Connective tissue disorders
NTM/MAC
Chronic recurrent infections
Immune dysregulation syndromes
Signs in lobectomy
Chest wall scar
Breath sounds still present as remaining lung expands
May have elevated hemidiaphragm
