Idiopathic pulmonary fibrosis physical examination: Difference between revisions

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{{Idiopathic pulmonary fibrosis}}
{{Idiopathic pulmonary fibrosis}}
{{CMG}}
{{CMG}}; {{AE}} {{AEL}}  


==Overview==
==Overview==
Patients with idiopathic pulmonary fibrosis usually appear [[Fatigue|fatigued]] and [[short of breath]]. Physical examination of patients with idiopathic pulmonary fibrosis usually remarkable for [[Respiratory patterns|bronchial breathing]], increased vocal resonance, and fine [[crepitations]].


==Physical Examination==
==Physical Examination==
 
===Appearance of the Patient===
Patients with idiopathic pulmonary fibrosis usually appear [[Fatigue|fatigued]] and [[short of breath]].<ref name="pmid21471066">{{cite journal |vauthors=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 |title=An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management |journal=Am. J. Respir. Crit. Care Med. |volume=183 |issue=6 |pages=788–824 |year=2011 |pmid=21471066 |pmc=5450933 |doi=10.1164/rccm.2009-040GL |url=}}</ref><ref name="pmid18757459">{{cite journal |vauthors=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 |title=Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society |journal=Thorax |volume=63 Suppl 5 |issue= |pages=v1–58 |year=2008 |pmid=18757459 |doi=10.1136/thx.2008.101691 |url=}}</ref><ref name="pmid16109978">{{cite journal |vauthors=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 |title=Clinical and pathologic features of familial interstitial pneumonia |journal=Am. J. Respir. Crit. Care Med. |volume=172 |issue=9 |pages=1146–52 |year=2005 |pmid=16109978 |pmc=2718398 |doi=10.1164/rccm.200408-1104OC |url=}}</ref>
===Vital Signs===
*Low grade [[fever]] may be noted
*[[Tachypnea]]
*[[Pulsus paradoxus]]
**Pulse wave volume decreases with [[inspiration]]
===Skin===
*[[Tar (tobacco residue)|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===
*[[Jugular venous distension]]
**Suggests [[pulmonary hypertension]]
*[[Lymphadenopathy]]
===Lungs===
*Increased chest expansion
**[[Barrel chest]] suggests [[Chronic obstructive pulmonary disease|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===
*Right ventricular heave may be noted in [[cor pulmonale]]
===Extremities===
*[[Clubbing]]
*Peripheral or central [[cyanosis]]
*Pitting/non-pitting [[edema]] of the upper or lower extremities
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Medicine]]
[[Category:Up-To-Date]]
[[Category:Primary Care]

Latest revision as of 18:42, 9 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Patients with idiopathic pulmonary fibrosis usually appear fatigued and short of breath. Physical examination of patients with idiopathic pulmonary fibrosis usually remarkable for bronchial breathing, increased vocal resonance, and fine crepitations.

Physical Examination

Appearance of the Patient

Patients with idiopathic pulmonary fibrosis usually appear fatigued and short of breath.[1][2][3]

Vital Signs

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

Heart

Extremities

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.

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