Pulmonary Examination
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A thorough pulmonary examination is best when broken down into 4 basic parts: Inspection, palpation, percussion, and auscultation.
Loudon RG. The lung exam. Clin Chest Med. 1987 Jun. 8(2):265-72. [Medline].
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Schraufnagel DE, Murray JF. History and physical examination. Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th Ed. New York: Elsevier; 2010. 355-65.
Maitre B, Similowski T, Derenne JP. Physical examination of the adult patient with respiratory diseases: inspection and palpation. Eur Respir J. 1995 Sep. 8(9):1584-93. [Medline].
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Kraman SS. Lung sounds for the clinician. Arch Intern Med. 1986 Jul. 146(7):1411-2. [Medline].
Epler GR, Carrington CB, Gaensler EA. Crackles (rales) in the interstitial pulmonary diseases. Chest. 1978 Mar. 73(3):333-9. [Medline].
Koster ME, Baughman RP, Loudon RG. Continuous adventitious lung sounds. J Asthma. 1990. 27(4):237-49. [Medline].
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Nath AR, Capel LH. Lung crackles in bronchiectasis. Thorax. 1980 Sep. 35(9):694-9. [Medline].
Nath AR, Capel LH. Inspiratory crackles and mechanical events of breathing. Thorax. 1974 Nov. 29(6):695-8. [Medline].
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DeGowin RL. The thorax and cardiovascular system. Degowin & Degowin’s Diagnostic Examination. 6th Ed. New York: McGraw-Hill; 1994. 286-322.
Disorder
Pleural Effusion
Consolidation
Emphysema
Pneumothorax
Mucous Plug (With Collapse)
Examination finding
Tracheal deviation
Contralateral
None
None
Contralateral
Ipsilateral
Fremitus
Decreased
Increased
Decreased
Decreased
Decreased
Percussion
Dull
Dull
Hyper-resonant
Hyper-resonant
Dull
Pectoriloquy
Decreased
Increased
Decreased
Decreased
Decreased
Breath sounds
Decreased
Decreased
Crackles
Decreased
Decreased
Location in Respiratory Cycle
Fine
Coarse
Early inspiratory
Usual interstitial pneumonia
Desquamative interstitial pneumonia
Sarcoidosis
Miliary tuberculosis
Allergic alveolitis
Asbestosis
Chronic bronchitis
COPD
Late inspiratory
Atelectasis
Asthma
CHF
Pulmonary edema
Pneumonia/Consolidation
Scleroderma
Fibrosing alveolitis
Mid-inspiratory and expiratory
Bronchiectasis, which can be secondary to the following:
Necrotizing pneumonia
Environmental exposures
Cystic fibrosis
Alpha-1 antitrypsin disorder
Nazir A Lone, MD, MBBS, MPH, FACP, FCCP Assistant Clinical Professor of Medicine, Department of Medicine Affiliations, Columbia-Bassett Program, Columbia University College of Physicians and Surgeons; Faculty in Pulmonary and Critical Care Medicine, Bassett Medical Center, Bassett Healthcare Network; Pulmonologist, Cobleskill Regional Hospital, O’Connor Hospital, Tritown Regional Hospital
Nazir A Lone, MD, MBBS, MPH, FACP, FCCP is a member of the following medical societies: American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American College of Physicians, International Association for the Study of Lung Cancer, Medical Society of the State of New York, Society of Critical Care Medicine
Disclosure: Nothing to disclose.
Haisam Abid, MBBS Resident Physician, Department of Internal Medicine, Bassett Healthcare Network
Haisam Abid, MBBS is a member of the following medical societies: Pakistan Medical and Dental Council
Disclosure: Nothing to disclose.
Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women’s Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine
Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society
Disclosure: Nothing to disclose.
Nader Kamangar, MD, FACP, FCCP, FCCM Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Medicine, Olive View-UCLA Medical Center
Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: Academy of Persian Physicians, American Academy of Sleep Medicine, American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, Association of Pulmonary and Critical Care Medicine Program Directors, Association of Specialty Professors, California Sleep Society, California Thoracic Society, Clerkship Directors in Internal Medicine, Society of Critical Care Medicine, Trudeau Society of Los Angeles, World Association for Bronchology and Interventional Pulmonology
Disclosure: Nothing to disclose.
Richard S Tennant, MD Hospitalist in Internal Medicine, Olive View-UCLA Medical Center
Richard S Tennant, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.
Joseph Z Springer, MD Resident Physician in Internal Medicine, Olive View-UCLA Medical Center
Disclosure: Nothing to disclose.
Pulmonary Examination
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