Symptoms and Signs of Lung Disease

Normal respiratory inspection findings

Unlabored breathing, mouth closed, normal speech, diaphragm as primary muscle, trachea midline

Abnormal respiratory inspection findings

Labored breathing, mouth open, accessory muscle use (SCM hypertrophy, intercostal retractions, abdominal contractions), tripod position, barrel chest, tracheal deviation

Normal vesicular breath sounds

Soft, low‑pitched, inspiratory phase longer than expiratory, heard over lung lobes

Normal bronchial breath sounds

Loud, high‑pitched, equal inspiratory/expiratory phases, normally only over trachea

Bronchial sounds heard over lung fields indicate

Consolidation (pneumonia)

Wheezes definition

Continuous, high‑pitched musical sounds from airway wall fluttering

Common causes of wheezes

Asthma (classic), pulmonary edema, vocal cord dysfunction, foreign body

Rhonchi definition

Low‑pitched continuous sounds from fluid film rupture or airway secretions

Common causes of rhonchi

Pneumonia, chronic bronchitis, poor pulmonary toilet

Crackles definition

Discontinuous popping sounds from collapsed airways opening

Early inspiratory crackles causes

Pulmonary edema, heart failure

Late inspiratory crackles causes

Pulmonary fibrosis(fibrotic alveoli take longer to pop open)

Stridor definition

Loud, predominantly inspiratory sound from turbulent flow in extrathoracic airway

Common causes of stridor

Vocal cord dysfunction, tracheal stenosis, foreign body

Percussion: hyperresonant

Pneumothorax

Fremitus increased

Consolidation lung»lobar pneumonia (sound travels better through solid lung)

Fremitus decreased

Pleural effusion or pneumothorax (sound blocked by fluid/air)

Findings in lobar pneumonia

Increased fremitus, dull percussion, decreased breath sounds, bronchial breath sounds

Findings in complete pneumothorax

Lag on affected side, absent fremitus, hyperresonant/tympanic percussion, absent breath sounds

Findings in large pleural effusion

Lag, decreased fremitus, dull/flat percussion, absent breath sounds, tracheal shift away

Findings in atelectasis (lobar obstruction)

Lag, decreased fremitus, dull percussion, absent breath sounds, tracheal shift toward affected side

Findings in end‑stage fibrosis

Normal inspection, symmetric fremitus, resonant percussion, late‑inspiratory crackles, shallow rapid breathing

Findings in bronchial asthma(acute attack)

Hyperinflation, use of accessory muscles; impaired expansion + decreased fremitus; hyperresonnance, low diaphragm; prolonged expiration» inspiratory + expiratory wheezes

Orthopnea definition

Dyspnea when lying flat

Platypnea definition

Dyspnea relieved when lying flat

Major respiratory causes of acute + chronic dyspnea

Acute: Pneumothorax, pulmonary embolism, pneumonia, asthma

Chronic: COPD, ILD, Lung Cancer, pulmonary arteriovenous malformations

Common acute causes of cough

URI, irritant inhalation, foreign body aspiration

Common chronic causes of cough

GERD, asthma, chronic bronchitis, ACE inhibitors, upper airway cough syndrome, lung cancer

Definition of hemoptysis

Coughing up blood from lower respiratory tract

Most common cause of hemoptysis

Acute bronchitis

High‑risk hemoptysis considerations

Tuberculosis, lung cancer

Initial testing for hemoptysis

Chest X‑ray, vitals, sputum AFB if TB risk, CT or bronchoscopy if cancer risk

Digital clubbing definition

Bulbous enlargement of distal fingers with angle >180°. NOT CAUSED BY COPD

Diseases associated with digital clubbing

Lung cancer, pulmonary fibrosis, bronchiectasis, cystic fibrosis, cyanotic congenital heart disease

Diseases NOT associated with clubbing

COPD

Central cyanosis causes

Low FiO2, impaired ventilation/diffusion, congenital heart shunts, hemoglobinopathies

Peripheral cyanosis causes

Low cardiac output, arterial/venous occlusion, cold exposure