Examination of Chest

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Examination of Chest

• make differential diagnosis
• Cor Pulmonale?

Routine

• Introduction, Exposure
  • sit at 45°
• Observation
  • oxygen / nebulisers / inhalers
  • dyspnoea
  • respiratory rate
  • assymetry of chest movement
  • stridor
  • cachexia
  • accessory muscle use / pursed lips
• Hands
  • Clubbing
  • asterixis
  • tremor
  • tar staining
  • steoridal skin
  • Hypertrophic Pulmonary Osteoarthropathy
• Pulse
  • hyperdynamic
  • tachycardic
• Face
  • central cyanosis
  • Cushing's Syndrome
  • Horner's Syndrome
• Neck
  • trachea
  • Jugular Venous Pressure
• Lymphadenopathy

Chest

• Inspection
• Palpation
  • expansion
  • tactile vocal fremitus
• Percussion
  • Increased resonance
    • pneumothorax
    • emphysema
  • Decreased resonance
    • Pleural
      • effusion
      • thickening
    • Lung
      • fibrosis
      • collapse
      • consolidation
• Auscultation
  • Crackles
    • air space opening
    • early inspiration
      • bronchitis
      • brochiectasis
    • late inspiration
      • fibrosis
      • pneumonia
      • oedema
  • Wheeze
    • monophonic = single bronchus
      • carcinoma
      • stricture
    • polyphonic = expiration, multiple bronchi
      • COAD
      • Bronchitis
      • Asthma
  • Bronchial Breathing
    • harsh, long expiration
    • always with
      • increased tactile vocal fremitus
      • bronchophony
      • whispering pectoriloquy
    • cause
      • pleural effusion
      • lung cavity
      • lung fibrosis
      • lung consolidation
  • Decreased breath sounds
    • ventilation
      • emphysema
    • pleura
      • pneumothorax
      • pleural effusion
• Ankle Oedema
• Extras
  • Temperature chart
  • Sputum pot

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