{"id":2063,"date":"2020-05-20T17:21:44","date_gmt":"2020-05-21T00:21:44","guid":{"rendered":"https:\/\/up.physicaldiagnosispdx.com\/up\/?page_id=2063"},"modified":"2021-01-16T12:47:23","modified_gmt":"2021-01-16T20:47:23","slug":"pulmonology-tutorial","status":"publish","type":"page","link":"https:\/\/up.physicaldiagnosispdx.com\/up\/pulmonology-tutorial\/","title":{"rendered":"Pulmonology Tutorial"},"content":{"rendered":"
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Lung exam<\/strong><\/span><\/h1>\n

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Inspection<\/strong><\/span><\/h2>\n

Start with the patient\u2019s general appearance – do they look sick or well? Is their breathing comfortable or labored? If labored, are they using accessory muscles to help their breathing? \u00a0Are they breathing through pursed lips? Patients may also find that a tripod position (leaning forward with elbows on thighs) helps with breathing, thought to be due to improved use of accessory muscles (particularly the rib cage muscles) in that position. Over time they may develop rough patches or calluses above their knees, termed Dahl\u2019s sign. How are their teeth?\u00a0 Poor dentition and gingivitis can support the growth of oral anaerobic bacteria. Do they have Horner\u2019s syndrome? The triad of ptosis, meiosis and anhidrosis can be seen with superior sulcus tumors of the lung (ie, pancoast tumors) from compression of the sympathetic ganglion. Do they have redness and swelling of their face, with engorged veins on their chest? This can be seen in SVC syndrome from lung tumors or infections, or these days from intravenous catheters that have become obstructed (catheters for dialysis or chemo or antibiotics). What is the movement of their abdomen when they are breathing? Normally when we inhale, our chest and abdomen both move outwards, as the diaphragm pushes downwards and the ribs are moved upwards. In severe neuromuscular disease, patients may develop what is termed paradoxical breathing, or abdominal paradox, where the abdomen moves inwards on inspiration, due to a weak or paralyzed diaphragm. This is a sign of impending respiratory failure in an unstable patient.<\/span><\/p>\n

Can you hear any audible breath sounds from across the room? How is the patient\u2019s color, including their lips and digits? Do they have a bluish hue of cyanosis, or a yellow-brown discoloration from chronic tobacco use? Do they have clubbing of their digits? Do you see any signs of chronic corticosteroid use, such as thinning or bruising of the skin, or redistribution of fat to their trunks and face? These are Cushingoid features, signs of Cushing\u2019s syndrome, from excess corticosteroids, frequently given for chronic obstructive pulmonary disease.<\/span><\/p>\n

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Palpation<\/strong><\/span><\/h2>\n

Palpation of the chest may reveal areas of pain, rattling, or wheezing from secretion or airway obstruction, or the characteristic popping from subcutaneous emphysema (air tracking under the skin from rupture of an air filled structure).<\/span><\/p>\n