Occupational lung disease physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Patients with occupational lung disease usually appear fatigued and short of breath. Physical examination of patients with occupational lung disease is usually remarkable for bronchial breathing, increased vocal resonance, and fine crepitations.
Physical Examination
Appearance of the Patient
Patients with occupational lung disease usually appear fatigued and short of breath.[1][2][3]
Vital Signs
- Low grade fever may be noted
- Tachypnea
- Pulsus paradoxus
- Pulse wave volume decreases with inspiration
Skin
- Tar staining on fingers from cigarettes
- Joint swelling and tenderness
- Features of rheumatological disease
- Scarring on chest wall may be noted from previous operations
- May be in mid-axillary line and indicates a chest tube placement, or horizontal postero-lateral scars from lobectomy
HEENT
- Conjunctival pallor
- Inflamed nares
Neck
Lungs
- Increased chest expansion
- Barrel chest suggests COPD
- Lungs are hyperresonant
- Fine crackles upon auscultation of the lung bases or apices, unilaterally or bilaterally
- Rhonchi
- Bronchial breath sounds
- Expiratory wheezing with normal or delayed expiratory phase
- Wheezing may be present
- Egophony present
- Bronchophony present
- Increased tactile fremitus
Heart
- Cardiovascular examination of patients with occupational lung disease is usually normal
- Right ventricular heave may be noted in cor pulmonale
Neuromuscular
Horner's syndrome may be noted, and may indicate malignancy
Extremities
References
- ↑ Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE, Kondoh Y, Myers J, Müller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schünemann HJ (2011). "An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management". Am. J. Respir. Crit. Care Med. 183 (6): 788–824. doi:10.1164/rccm.2009-040GL. PMC 5450933. PMID 21471066.
- ↑ Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK, Hirani N, Hubbard R, Lake F, Millar AB, Wallace WA, Wells AU, Whyte MK, Wilsher ML (2008). "Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society". Thorax. 63 Suppl 5: v1–58. doi:10.1136/thx.2008.101691. PMID 18757459.
- ↑ Steele MP, Speer MC, Loyd JE, Brown KK, Herron A, Slifer SH, Burch LH, Wahidi MM, Phillips JA, Sporn TA, McAdams HP, Schwarz MI, Schwartz DA (2005). "Clinical and pathologic features of familial interstitial pneumonia". Am. J. Respir. Crit. Care Med. 172 (9): 1146–52. doi:10.1164/rccm.200408-1104OC. PMC 2718398. PMID 16109978.