Obstructive clinical presentation

Question 1

Emphysema clinical presentation

Answer 1

1. Inspection = “PINK PUFFER” (thin and wasted), BARREL CHEST, pursed lip breathing, increased accessory muscle use (30% diaphragm/70% accessory muscle) , 1:3 IE ratio
2. Palpation = decreased tactile fremitus, decreased chest wall expansion
3. Percussion = hyper resonant
4. Auscultation = decreased breath sounds, may have dry crackles
5. ABGs = decreased O2 (moderate), increased CO2
6. Chest XR = increased black area (hyperinflated and decreased lung tissue), flattened diaphragm, flattened ribs

Question 2

Chronic Bronchitis clinical presentation?

Answer 2

1. Inspection = “Blue Bloater” (OBESE AND CYANOTIC) + MUCUS colour can WHITE, YELLOW OR GREEN
2. Palpation = increased tactile fremitus in secretion retention areas + decreased tactile fremitus in air trapping areas
3. Percussion = hyper resonance in air trapping area + dull over secretion areas
4. Auscultation = decreased breath sounds + INSPIRATORY WET CRACKLES+ possible wheezing
5. ABGs = increased CO2, decreased O2
6. Chest XR = CARDIO MEGALY, white haziness

Question 3

Asthma clinical presentation?

Answer 3

1. Inspection = report of CHEST TIGHTNESS and DYSPNEA, PFT pre and post BRONCHODILATOR shows significant IMPROVEMENTS, increased accessory muscle use
2. Palpation = decreased tactile fremitus, decreased chest wall excursion
3. Percussion = hyper resonant
4. Auscultation = WHEEZING, decreased breath sounds, possible crackles
5. ABGs = increase CO2, decrease O2, decreased pH resp acidosis

Question 4

Bronchiectasis clinical presentation?

Answer 4

1. Inspection = thin and fatigued, clubbing (hypoxemia), HUGE AMOUNTS OF MUCUS, SEVERE COUGH
2. Palpation = DECREASED chest wall EXCURSION, tactile fremitus (depends on specific lung changes)
3. Percussion = depends on specific lung changes present
4. Auscultation = decreased breath sounds, WHEEZING
5. Chest XR = flattened diaphragm, dark lung fields in areas of trapping