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Flashcards in Clinical Examination Deck (15):
1

Findings on the skin

Yellow fingernails (nicotine, tar, fungus)
Cyanosis
Eczema with atopic disease
Erythema nodosum (sarcoidosis, TB)
Lupus pernio & cutaneous sarcoidosis

2

Hand changes

Clubbing
Cyanosis
Palmar erythema (aspiration pneumonia)

3

Causes of clubbing

Bronchial carcinoma
Fibrosing alveolitis
Lung suppuration (bronchiectasis, lung abscess, empyema)
Cyanotic congenital heart disease
Infective endocarditis
Malabsorption States (UC, Crohn's, cirrhosis of the liver)
Congenital
Idiopathic

4

Eye signs

Horner's syndrome
- small pupil
- Ptosis
- Enophthalmos
- unilateral loss of sweating

Due to interruption of cervical chain
- Pancoast's tumour
- cervical lymphadenopathy

Uveitis
- sarcoidosis/TB

Dilated retinal veins/papilloedema
- chronically raised CO2

Chordal tubercles in disseminated TB

5

Regions of lymph nodes on the neck

Sub mental (under chin)
Sub madibular (under jaw bone)
Pre auricular (in front of ear)
Post auricular (behind ear)
Occipital (back of head)
Supra clavicular
Anterior triangle
Posterior triangle

6

Presentation of Cor pulmonae

Cyanosis
Raised JVP
Pitting oedema
Para sternal heave
Loud P2

7

Inspection of the chest

Kyphoscoliosis
Pectus excavatum
Hyperinflation (emphysema)
Scars
Asymmetry
Expansion
Respiratory abdomen movement

8

Presentation of pectins excavatum

Pulmonary artery flow murmur
Right lower lobe CXR changes mimicking pulmonary infiltrate
Diminished basal lung volumes lead to diminished lung sounds.

9

Signs on palpation

Tracheal deviation
- towards collapse
- towards consolidation
- away from effusion

Crepitation
- surgical emphysema
- chest wall trauma
- iatrogenic (chest drains)
- ruptured oesophagus

Chest expansion

10

Causes of reduced chest expansion

Unilateral - pneumothorax
Effusion blocked centra, bronchus, diaphragm palsy
Bilateral - restrictive lung disease, hyperinflation (emphysema)

11

Signs on percussion

Hyperesonant (emphysema, pneumothorax)
Impaired resonance (consolidation, pleural thickening, raised hemi diaphragm)
Stony, dull to percuss = pleural effusion

12

Signs heard on auscultation - breath sounds

Normal - vesicular - muffled transmitted bronchial sounds

Reduced - effusion, collapse, bronchial obstruction, emphysema (obesity)

Transmitted - bronchial - consolidation with patent bronchial system (e.g. Pneumonia, pulmonary fibrosis)

13

Signs heard on auscultation - added sounds

Wheeze - air passing through narrowed airways
Localised - e.g. large airway tumour
Generalised - polyphonic - smal airway obstruction (asthma, bronchitis)
Squeaks (& crackles too) - bronchiolitis
Crackles - due to explosive reopening of small airways blocked by exudate (inflammation or fibrosis)
Fine crackles - pulmonary fibrosis (late inspiratory)
Moderate/coarse (pulmonary oedema, consolidation, bronchiectasis)
Pleural rub - pneumonia, PE, viral or autoimmune pleurisy
Pleural click = pneumothorax

14

Signs heard on auscultation - vocal sounds

Reduced
- effusion
- collapse
- bronchial occlusion
- pneumothorax
- emphysema

Increased
- with consolidation (e.g. pneumonia)

Whispering pectoriloquy - transmitted - consolidation without bronchial obstruction

15

General look at patient

Respiratory distress
Strider
Cyanosis
State of nutrition