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lung disease

History: 1) social history - smoking - occupational exposure - exposure to infected persons or animals - hobbies - pets 2) family history 3) review of systems a) malignancies b) systemic (non-pulmonary disease) c) immune status - corticosteroids - chemotherapy - HIV d) history of trauma 4) previous laboratory studies - chest radiographs - thoracic CT - pulmonary function testing Physical examination: 1) inspection a respiratory rate b) hoarseness of voice c) respiratory rhythm d) accessory muscle use occurs with FEV1 < 30% of normal e) postural dyspnea - orthopnea - platypnea - trepopnea f) paradoxical movement of abdomen & diaphragm g) cough/sputum h) wheezes are often audible without stethoscope i) pursed lip breathing in patients with COPD j) cyanosis - central - peripheral k) conjunctival suffusion (hypercarbia) l) clubbing m) kyphoscoliosis n) trachea position: midline vs deviated o) signs/symptoms of superior vena cava syndrome p) asterixis q) signs of cor pulmonale - jugular venous pressure - pedal edema 2) palpation a) lymphadenopathy b) tibial tenderness (hypertrophic pulmonary osteoarthropathy) c) expiratory to inspiratory chest excursion & symmetry d) chest wall tenderness - costrochondritis - rib fracture - pulmonary embolism e) tracheal deviation or tenderness f) tactile (vocal fremitus) 7) subcutaneous emphysema g) succussion splash (effusion, air-fluid level in thorax) 3) percussion - thoracic cage: dullness vs resonance - diaphragm excursion: normal is 5-7 cm - upper abdomen, especially liver 4) auscultation - bronchial breath sounds - expiratory slowing - crackles - wheezes - pleural rub - mediastinal crunch - heart sounds

Related

age-associated changes in pulmonary function hospice guidelines for determining prognosis, pulmonary disease lung pulmonary pulmonary function test (PFT)

Specific

acute sickle cell chest syndrome; chest crisis; pulmonary sickle crisis allergic bronchopulmonary aspergillosis; allergic bronchopulmonary mycosis (ABPA) atelectasis bronchial disease bronchial fistula broncholithiasis bronchopulmonary dysplasia bullous lung disease cardiopulmonary disease chronic lung disease hantavirus pulmonary syndrome hemoptysis hepatopulmonary syndrome hypertrophic pulmonary osteoarthropathy (Bamberger-Marie syndrome) interstitial lung disease; diffuse parenchymal lung disease (DPLS, ILD) lung injury lung neoplasm lymphangioleiomyomatosis lymphocytic interstitial pneumonitis obstructive lung disease occupational lung disease paragonimiasis pleural disorder pleural fistula pneumonia (PNA) pneumonitis pulmonary alveolar phospholipoproteinosis; alveolar proteinosis; pulmonary surfactant metabolism dysfunction; inborn error of pulmonary surfactant metabolism pulmonary alveolitis pulmonary aspiration; foreign body aspiration pulmonary bulla pulmonary capillary hemangiomatosis pulmonary contusion pulmonary edema (pulmonary congestion, PE) pulmonary esosinophilia pulmonary hemorrhage pulmonary hypoplasia pulmonary infarction pulmonary infection pulmonary nodule pulmonary siderosis pulmonary vascular disease pulmonary-renal syndrome respiratory failure restrictive lung disease rheumatoid lung disease right middle lobe syndrome Severe Acute Respiratory Syndrome (SARS) unilateral hyperlucent lung syndrome (Swyer-James or Macleod syndrome) Weil's syndrome yellow nail syndrome (lymphedema & yellow nails)

General

lower respiratory tract disease

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 722
  2. Akgun KM, Crothers K, Pisani M. Epidemiology and management of common pulmonary diseases in older persons. J Gerontol A Biol Sci Med Sci. 2012 Mar;67(3):276-91 PMID: 22337938