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Examination of the respiratory system
Published in Tracy Lapworth, Deborah Cook, Clinical Assessment, 2022
Palpate for tactile fremitus: this is a vibration felt on the surface of the chest as the patient speaks. Compare side to side at three or four levels. Place the ulnar edge of your palms on the chest and ask the patient to keep saying ‘99’ loudly while you auscultate. Vibrations that are more intense on one side may indicate abnormalities such as consolidation
Respiratory Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Physical findings may be non-specific. In pulmonary TB, there may be crackles. Dullness and reduced vocal fremitus could indicate pleural effusions or thickening. For extrapulmonary TB, findings relate to the site of disease.
Respiratory
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Vocal resonance and tactile vocal fremitus are two methods of assessing the same thing, namely the way in which sound is transmitted through the lung parenchyma. Fremitus is a palpable vibration that is felt whilst the patient speaks. The vibration is felt by placing the ulnar border of both hands simultaneously on either side of the patient’s chest wall.
Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)
Published in Expert Review of Clinical Pharmacology, 2021
Bernardo L. Rapoport, Tim Cooksley, Douglas B. Johnson, Ronald Anderson, Vickie R. Shannon
Common clinical features of CAP include fever, productive cough, dyspnea, tachypnea, and pleuritic chest pain. Leukocytosis, bronchial breath sounds, tactile fremitus, dullness to percussion, and egophony on lung examination are supportive findings; however, they are only present in approximately one-third of patients. Leukocytosis (typically between 15,000 and 30,000 per mm3) with a leftward shift is a common finding, particularly in pneumonia of bacterial origin. Leukopenia may also be seen and portends a poor prognosis. Mucopurulent sputum is a prominent feature of bacterial pneumonia, while symptoms of coryza, symptoms and myalgias more often signal pneumonia of viral origin [139]. Lung nodules or mass-like lesions with associated adenopathy, and abnormalities of the skin, central nervous system, or bone are important clues to fungal pneumonia. However, no clear constellation of signs and symptoms is reliably predictive of any specific type of pneumonia [39]. Furthermore, impaired immune responses in the cancer setting may diminish the clinical and radiographic hallmarks of pneumonia. Thus, fever, leukocytosis, and productive cough and the characteristic radiographic findings of lobar infiltrates may be minimal or absent. Competing diagnoses that mimic pneumonia, including diffuse alveolar hemorrhage, radiation pneumonitis, drug toxicity, hydrostatic pulmonary edema, and cancer progression, are frequent challenges for the neutropenic cancer patient and should be excluded with appropriate testing.
Disseminated BCG sepsis following intravesical therapy for Bladder Carcinoma: A case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Oreoluwa Oladiran, Ifeanyi Nwosu, Adeolu Oladunjoye, Olubunmi Oladunjoye
A 78-year-old man with high-grade T1 urothelial carcinoma status post-transurethral resection of bladder tumor who had been on once-weekly intravesical BCG instillation for 2 months presented to the emergency room (ER) with fever, rigors and altered mental status.111111 He also reported shortness of breath but denied cough or chest pain. He had no urinary or gastrointestinal symptoms. He had his most recent BCG instillation done the day before the index presentation. Vital signs revealed a temperature of 102.8 F, pulse rate of 92/min, respiratory rate of 40/min and blood pressure 78/45 mmHg with oxygen saturation of 93% on ambient air. On physical examination, he appeared toxic, dehydrated and in respiratory distress. Chest examination revealed asymmetric chest expansion with dullness to percussion, decreased tactile fremitus on the left side with reduced air entry on auscultation. The cardiovascular examination was however unremarkable.
Allergic bronchopulmonary aspergillosis without asthma or cystic fibrosis
Published in Paediatrics and International Child Health, 2020
Parminder Kaur, Pankaj Kumar, Shivani Randev, Vishal Guglani
On admission, vital parameters were normal. The anthropometric parameters were appropriate for age (height-for-age was −1.14 Z-score, weight-for-age −0.51 Z-score and BMI −1.28 Z-score, as per WHO growth charts) [4]. The results of a general physical examination were normal, apart from the respiratory rate which was 24/minute with the trachea deviated to the right. On percussion, there was dullness in the right infrascapular area, and tactile vocal fremitus and vocal resonance were increased on that side. Air entry was decreased on the right side and there was bronchial breathing. There were no adventitious sounds.