Chronic Respiratory Conditions – Possible Signs NB: Signs Are on Side of Lesion Unless Otherwise Stated

Chronic Respiratory Conditions – Possible Signs NB: signs are on side of lesion unless otherwise stated

Pulmonary fibrosis Pleural effusion  Oxygen therapy  Reduced expansion  Dry cough  Stony dull percussion note  Tachypnoea  Reduced breath sounds  Reduced expansion  Reduced tactile fremitus and vocal resonance  Fine end-inspiratory crepitations Signs of aetiology: hand deformity (RA), clubbing Signs of aetiology: hand deformity (RA), clubbing (idiopathic pulmonary (mesothelioma/bronchogenic CA), butterfly rash (SLE), fibrosis), sclerodactaly/telangiectasia/microstomia (systemic sclerosis), lymphadenopathy (malignancy), radiation marks, signs of chronic liver butterfly rash (SLE), lupus pernio (sarcoid), radiation burns, kyphosis disease (cirrhosis), pulmonary/peripheral oedema (heart failure) (ankylosing spondylitis) Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension) Bronchiectasis  Productive cough COPD  Inspiratory clicks  Clubbing  Bedside inhalers/nebulisers  Coarse, late expiratory crepitations  Accessory muscle use  Nicotine stains Signs of aetiology: young and thin (CF), curved yellow nails and  Tachypnoea lymphedema (yellow nail syndrome), lymphadenopathy (malignancy),  Lip pursing dextrocardia (Kartagener’s syndrome)  Reduced cricosternal distance (<3 fingers)  Tracheal tug  Indrawing of lower intercostal muscles on inspiration Kyphoscoliosis  Hyper-resonance (with obliterated cardiac and hepatic  Increased thoracic forward curvature or lateral dullness) curvature of the spine  Quite breath sounds/wheeze/prolonged expiratory  Reduced spine flexion/extension phase  Rib hump  Reduced chest expansion Signs of complications: cushingoid/bruising (steroid use), loud P2/RV heave (pulmonary hypertension) Lung cancer Pneumonectomy  Cachexia  Unilateral chest flattening  Clubbing  Thoracotomy scar  Nicotine stains  Tracheal deviation (towards)  Hard irregular lymphadenopathy  Reduced expansion  Radiation burns  Dull percussion note Signs of complications: pain and swelling of wrists (Hypertrophic  Reduced breath sounds pulmonary arthropathy), ptosis/meiosis/anhidrosis (Horner’s syndrome)  Bronchial breathing in upper zone (due to deviated trachea

Signs of aetiology: cachexia/clubbed/nicotine stains (lung cancer), wet Lung transplant cough/clubbed/coarse crepitations (bronchiectasis), signs of COPD (bullectomy)  Mid-sternotomy/thoracotomy scar

Signs of aetiology: signs of COPD, clubbing (CF/IPF) Signs of complications: cushingoid/bruising (steroid use) Lobectomy  Thoracotomy scar only

Signs of aetiology: cachexia/clubbed/nicotine stains (lung cancer), wet cough/clubbed/coarse crepitations (bronchiectasis), signs of COPD (bullectomy)

Examination findings in common respiratory conditions Pneumothorax Pneumonia Pleural effusion Collapse Trachea displacement Away None Away (if large) Towards collapse Expansion All reduced ipsilaterally Percussion resonance Increased Decreased ‘Stony-dull’ Decreased Breath sounds Reduced/absent Bronchial Reduced/absent Reduced/absent breathing + coarse crepitations

Pectus excavatum: sunken chest. May be congenital or develop Nail clubbing at puberty

Peripheral cyanosis

Pectus carinatum: protrusion of sternum. Horner’s syndrome: ptosis, miosis, anhidrosis May be congenital, Nautiyal A, Singh S, DiSalle M, O'Sullivan J (2005) Painful Horner Syndrome as a Harbinger of Silent post-surgical or Carotid Dissection. PLoS Med 2(1): e19 doi:10.1371/journal.pmed.0020019 develop at puberty

Tar staining

© 2017 Dr Christopher Mansbridge at www.oscestop.com, a source of free OSCE exam notes for medical students finals OSCE revision Images licensed under Creative Commons Attribution-Share Alike License (sourced from Wikipedia)