Examination of the chest and lung Complaints Physical

Examination of the chest and lung Complaints Physical examination 1. Inspection 2. Palpation 3. Percussion 4. Auscultation

Complaints • Chest pain • Cough • Shortness of breath - dyspnea

Chest pain • Important questions: • Is it related to? – Breathing? – Movements? (muscle, bone, nerves) – Physical activity? • Localisation – Pain receptors • larynx, trachea, main bronchi, pleura • Duration? • Type?

Chest pain • Sudden onset pain – Pulmonary embolism – Pneumothorax

Cough • Improductive – dry viral pneumonia • Productive – White, foamy pulmonary oedema – Mucoid bronchial asthma – Purulent lung abscess – Brownish pneumonia – Blood-streaked sputum hemoptysis

Hemoptysis – Lung cancer – Tuberculosis – Pulmonary embolism – Coagulation disorder

Cough • Purulent sputum – 24 hr collection – Three layers – Foul-smelling putrid

Shortness of breath Dyspnea • Subtypes – Exspiratory – Inspiratory • Severity – Dyspnea on exertion – Dyspnea at rest

Dyspnea • Episodic (paroxysmal) dyspnea – What is the causative factor? asthma

Physical examination

Inspection • Shape of the chest 1. Symmetrical 2. Asthenic

Inspection • Deformities – Pectus carinatum or pigeon chest sternal protrusion – Pectus excavatum or funnel chest

Inspection • Deformities of the vertebral column – Kyphosis – Scoliosis – lateral curvature – Kyphoscoliosis – Gibbus • Retractio thoracis

Inspection • Cyanosis • Chest expansions

Palpation • Breasts • Lymph nodes • Lesions in the chest wall – Masses, tender areas – Bone, muscle, nerve lesions • Chest expansion • Tactile fremitus

Tactile fremitus normal = symmetrical

Tactile fremitus Pleural effusion, Scar, etc.

Tactile fremitus Pneumonia

Percussion

Percussion

Percussion

Percussion • 1. Topographic percussion

Percussion • Lower border of the lung – Paravertebral XI. vertebra – Scapular line IX. rib – Midaxillary line VIII. rib – Midclavicular line VI. rib

Percussion the level and excursion of the diaphragm

Percussion • Comparative percussion Krőnig’s space

Percussion • 2. Comparative percussion • Percussion notes – Resonance - normal lung

Percussion • Percussion notes – Tympany large pneumothorax – Resonance – normal lung

Percussion • Percussion notes – Tympani pneumothorax – Hyperresonance emphysema – Resonance normal

Percussion • Percussion notes – Tympany pneumothorax – Hyperresonance emphysema – Resonance normal – Absolute dull or flatness pleural fluid (effusion)

Percussion • Percussion notes – Tympany pneumothorax – Hyperresonance emphysema – Resonance normal – Relative dull pneumonia – Absolute dull pleural fluid

Auscultation

Auscultation • Lung (or breath) sounds – Vesicular – Bronchovesicular – Bronchial • Adventitious (added) sounds

Auscultation – Adventitious (added) sounds • 1. Extrapulmonary pleural friction rub pleuritis • 2. Intrapulmonary – A. Wheezes and rhonchi asthma, COPD – B. Crackles or rales bronchitis, left heart failure • Fine crackles • Coarse crackles – C. crepitation pneumonia

Bronchophony – transmitted voice sound Pleuralis effusion - decreased Pneumonia - increased