Occupational lung disease physical examination

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

Overview[edit | edit source]

Patients with occupational lung disease usually appear fatigued and short of breath. Physical examination of patients with occupational lung disease is usually remarkable for bronchial breathing, increased vocal resonance, and fine crepitations.

Physical Examination[edit | edit source]

Appearance of the Patient[edit | edit source]

Patients with occupational lung disease usually appear fatigued and short of breath.^[1][2][3]

Vital Signs[edit | edit source]

• Low grade fever may be noted
• Tachypnea
• Pulsus paradoxus
  • Pulse wave volume decreases with inspiration

Skin[edit | edit source]

• 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[edit | edit source]

• Conjunctival pallor
• Inflamed nares

Neck[edit | edit source]

• Jugular venous distension
  • Suggests pulmonary hypertension
• Lymphadenopathy

Lungs[edit | edit source]

• Increased chest expansion
  • Barrel chest suggests 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[edit | edit source]

• Cardiovascular examination of patients with occupational lung disease is usually normal
• Right ventricular heave may be noted in cor pulmonale

Neuromuscular[edit | edit source]

Horner's syndrome may be noted, and may indicate malignancy

Extremities[edit | edit source]

• Clubbing
• Peripheral or central cyanosis
• Pitting/non-pitting edema of the upper or lower extremities

References[edit | edit source]