2. GENERAL EXAMINATION
Attitude:
Sit in a propped up position if
dyspnoea present
Mental state:Mental confusion,stupor and
flapping tremors…Respiratory failure
8. Pulmonary osteoarthropathy
Painful clubbing+thickening of
periosteum of distal parts of
radius,ulna,tibia,fibula+ painful
enlargement of ankles & wrists
Bronchogenic carcinoma
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
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
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