Cough physical examination
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Overview
once an in dept history is collected from the patient,a detailed physical examination should be done when evaluating coughing patients.
Physical Examination
The sequence of examination of patients with cough follows the traditional inspection,palpation,percussion and auscultation.
Inpsection
This is usually the first step to any physical examination.
- Is the patient struggling to breathe ie dyspnea?
- Does the patient look anxious or calm?
- What is the color of the patients skin? eg a dusky blue color indicates cyanosis.
- What is the patients appearance: A cachexic appearance could suggest an underlying chronic disease.
The clinicians sense of smell should also be utilized,a strong smell of stale cigarette smoke in the patients cloth could suggest chronic smoking also a fowl smelling diaper in kids could suggest fatty stool associated with cystic fibrosis and pancreatic insufficiency. Inspection should also check the fingers for finger clubbing and the chest wall for chest wall abnormalities such as barrel chest.
Palpation
Palpation in a coughing patient often includes feeling for the centrality of the trachea,a displaced trachea to the left or right could suggest a pneumothorax.Palpating for tactile fremitus by asking the patient to repeat the word ninety-nine(phrase often used) helps the examiner to identify areas of increased parenchymal density withing the lungs.Increased tactile fremitus is noted in conditions such as lobar pneumonia and decreased fremitus can be associated with pneumothorax or pleural effusion.
Percussion
This is usually done by the examiner tapping his dominant hand middle finger on that of his non-dominant hand middle finger while resting on the chest wall.The percussion note audible can be dull over areas of consolidation of hyperresonant with air trapping.
Auscultation
The stethoscope is used to achieve auscultation.With auscultation different patterns of air movement through the lungs and the airways can be heard dependind the the location auscultated.The normal breath sounds are:
The adventitious sounds are associated with diffrent underlyinin illnesses.
- Stridor:This is best heard on inspiration.Its is associated with airways narrowing.Stridor can be heard in croup.