Pneumothorax physical examination: Difference between revisions

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{{Pneumothorax}}
{{Pneumothorax}}
{{CMG}}
{{CMG}}; {{AE}} {{HQ}}, {{FT}}
 
 
==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with primary spontaneous pneumothorax usually appear normal. Physical examination of patients with primary spontaneous pneumothorax is usually remarkable normal. Patients with secondary spontaneous pneumothorax usually appear in distress. Physical examination of patients with secondary spontaneous pneumothorax is usually remarkable for [[dyspnea]], [[chest pain]], and [[Jugular venous pressure|neck vein]] distension. Patients with tension pneumothorax usually appear [[Dyspnea|dyspnic]] and distressed. Physical examination of patients with tension pneumothorax is usually remarkable for [[tracheal deviation]], decreased [[Respiratory examination|chest expansion]], increased [[percussion]] note, decreased [[Breathing|breath]] sounds, and [[Jugular venous pressure|neck veins]] distension.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
Important physical exam findings in a patient with pneumothorax include::<ref name="SharmaJindal2008">{{cite journal|last1=Sharma|first1=Anita|last2=Jindal|first2=Parul|title=Principles of diagnosis and management of traumatic pneumothorax|journal=Journal of Emergencies, Trauma and Shock|volume=1|issue=1|year=2008|pages=34|issn=0974-2700|doi=10.4103/0974-2700.41789}}</ref><ref name="pmid12728149">{{cite journal| author=Henry M, Arnold T, Harvey J, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society| title=BTS guidelines for the management of spontaneous pneumothorax. | journal=Thorax | year= 2003 | volume= 58 Suppl 2 | issue=  | pages= ii39-52 | pmid=12728149 | doi= | pmc=1766020 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12728149  }} </ref>
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with primary spontaneous pneumothorax usually appear normal.
*Patients with secondary spontaneous pneumothorax usually appear in [[Dyspnea|dyspnic]] and in distress.
*Patients with tension pneumothorax usually appear distressed.  


===Vital Signs===
===Vital Signs===
 
*[[Tachycardia]] with regular pulse
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with primary spontaneous pneumothorax is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with primary spontaneous pneumothorax is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*Decreased [[chest]] expansion
OR
*[[Lung|Lungs]] are hyperresonant
* Asymmetric chest expansion / Decreased chest expansion
*[[Egophony]] present
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Circulatory system|Cardiovascular]] examination of patients with pneumothorax is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
* [[Abdomen|Abdominal]] examination of patients with pneumothorax is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* [[Human back|Back]] examination of patients with pneumothorax is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* [[Genitourinary system|Genitourinary]] examination of patients with pneumothorax is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Neuromuscular junction|Neuromuscular]] examination of patients with pneumothorax is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*[[Cyanosis]]
OR
*[[Clubbing]]
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


=== Video ===
{{#ev:youtube|C2eEPyjxczw}}


== References ==
== References ==

Latest revision as of 20:14, 2 March 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Feham Tariq, MD [3]

Overview

Patients with primary spontaneous pneumothorax usually appear normal. Physical examination of patients with primary spontaneous pneumothorax is usually remarkable normal. Patients with secondary spontaneous pneumothorax usually appear in distress. Physical examination of patients with secondary spontaneous pneumothorax is usually remarkable for dyspnea, chest pain, and neck vein distension. Patients with tension pneumothorax usually appear dyspnic and distressed. Physical examination of patients with tension pneumothorax is usually remarkable for tracheal deviation, decreased chest expansion, increased percussion note, decreased breath sounds, and neck veins distension.

Physical Examination

Important physical exam findings in a patient with pneumothorax include::[1][2]

Appearance of the Patient

  • Patients with primary spontaneous pneumothorax usually appear normal.
  • Patients with secondary spontaneous pneumothorax usually appear in dyspnic and in distress.
  • Patients with tension pneumothorax usually appear distressed.

Vital Signs

Skin

  • Skin examination of patients with primary spontaneous pneumothorax is usually normal.

HEENT

  • HEENT examination of patients with primary spontaneous pneumothorax is usually normal.

Neck

Lungs

Heart

  • Cardiovascular examination of patients with pneumothorax is usually normal.

Abdomen

  • Abdominal examination of patients with pneumothorax is usually normal.

Back

  • Back examination of patients with pneumothorax is usually normal.

Genitourinary

  • Genitourinary examination of patients with pneumothorax is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with pneumothorax is usually normal.

Extremities

Video

{{#ev:youtube|C2eEPyjxczw}}

References

  1. ↑ Sharma, Anita; Jindal, Parul (2008). "Principles of diagnosis and management of traumatic pneumothorax". Journal of Emergencies, Trauma and Shock. 1 (1): 34. doi:10.4103/0974-2700.41789. ISSN 0974-2700.
  2. ↑ Henry M, Arnold T, Harvey J, Pleural Diseases Group, Standards of Care Committee, British Thoracic Society (2003). "BTS guidelines for the management of spontaneous pneumothorax". Thorax. 58 Suppl 2: ii39–52. PMC 1766020. PMID 12728149.

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