1. EXAMINATION OF A
PATIENT WITH
COUGH

2. GENERAL EXAMINATION
 Attitude:
Sit in a propped up position if
dyspnoea present
 Mental state:Mental confusion,stupor and
flapping tremors…Respiratory failure

3.  Recentloss of weight: Pulmonary
tuberculosis & Bronchogenic carcinoma
 Fever: Tuberculosis & Pneumonia

4.  Pallor
1. Severe haemoptysis
2. Tuberculosis:Malnutrition & anaemia

5.  Cyanosis
Central: Respiratory failure & CHF

6. Clubbing
 Tumours
1. Bronchogenic carcinoma
2. Mesothelioma
 Interstitial lung disease
 Chronic pulmonary tuberculosis

7.  Sepsis
1. Bronchiectasis
2. Lung abcess
3. Empyema

8. Pulmonary osteoarthropathy
 Painful clubbing+thickening of
periosteum of distal parts of
radius,ulna,tibia,fibula+ painful
enlargement of ankles & wrists
 Bronchogenic carcinoma

9. Lymphadenopathy
 Pulmonary tuberculosis
 Carcinoma
 Sarcoidosis
 Scalene nodes

10. Edema
 RHF secondary to pulmonay diseases is
termed COR PULMONALE.
1. Emphysema
2. Pulmonary fibrosis

11. Head to foot examination
 Subcutaneous nodules raised, firm tender:
Metastatic lung cancer
 Erythema nodosum over the shin:Acute
sarcoidosis

12. VITALS!!!!
 BP
1. High BP:COPD , Pulmonary embolism
2. Low BP:Pulmonary edema, ACEI,
Community acquired pneumonia
(CRB-65)
 JVP
 Raised in cor pulmonale

13. Examination of oropharynx
 Evidence of postnasal drip
 Oropharyngeal mucosa erythema or
cobble stone appearance

14.  Movement of accessory muscles of
respiration
 Examination
of neck:Posture,Movement of
accessory muscles,Jugular veins

15. RESPIRATORY SYSTEM
INSPECTION
 Shape of the chest
Barrel shaped chest
Emphysema
Drooping of the shoulders

16. Respiration
 Rate
 >15/min+increase ventilatory drive
1. Acute asthma
2. Exacerbation of COPD
 >15/min+decrease ventilatory drive
1. Pneumonia

17.  >30/min:Community acquired pneumonia
 Decrease rate: Respiratory failure
 Use of accessory muscles of respiration

18. Movements of the chest
 Intercostalrecession:Indrawing of
intercostal spaces with respiration…
Severe airway obstruction..laryngeal ds or
tumours of trachea

19. PALPATION
 Position of trachea
1. Deviation to same side:Fibrosis
2. Deviation to opp side:Pneumothorax,
Pleural effusion

20.  Apex beat
 Palpation of the chest for any tenderness
 Expansion of the chest
Decrease expansion in
consolidation,emphysema

21.  Vocal fremitus
 Decrease in bronchial obstrn,emphysema
 Increase in pneumonic consolidation &
neoplasms
 Rhonchial fremitus
 Palpable rhonchi

22. PERCUSSION
 Hyperresonant in emphysema
 Tympanic in a superficial cavity of lung
 Dullness in consolidation

23.  Cracked pot sound:percussion note over
cavities which communicate with bronchus
 Cardiac
dullness obliterated in
emphysema

24. AUSCULTATION
 Breath sounds

25.  Decreased intensity
1. Collapse & Fibrosis
2. Bronchial obstruction
 Bronchial breathing
 Pneumonic consolidation

26. Added sounds
 Wheezes are musical sounds assoc.
with airway narrowing.
1. Polyphonic wheezes heard in expiration:
asthma & COPD
2. Monophonic wheezes in localised
narrowing of bronchus & tumour or
foreign body

27.  Stridor is a harsh croaking inspiratory
noise aagravated by cough
 Should be investigated always.
1. Foreign body
2. Tumour occluding larynx,trachea or a
bronchus

28.  Crackles are short,explosive sounds
often described as bubbling or clicking
1. U/L early inspiratory:bronchial infn or
pneumonia
2. B/L basal:pulmonary edema

29.  Bronchiectasis: coarse crackles
 Diffuseinterstitial fibrosis:fine crackles but
late inspiratory
 COPD:crackles at the beginning of
respiration

30. Vocal resonance
 Increasedin pneumonic consolidation
 Whispering pectoriloquy present
 Decreased in emphysema

31. Position VF Percussio VR
of trachea n
Pneumoni No shift increse dull increase
c
consolidat
ion
Emphyse No shift decrease hyperreso decrease
ma nant

32. Also examine…
 CVS
 Cor pulmonale
 Pulmonary edema