Clinical Examination and Applied Medicine, Volume I

Pulmonology Series

Mushtaq Haroon

• Publisher: Momentum Press
• Year: 2019
• ISBN:
  9781947083028
• Topic: Medicine
• Subtopic: Pulmonary & Thoracic Medicine

This is the second in the series of books dealing simultaneously with examination technique, detail pathophysiological principles, differential diagnosis and clinical interpretation, along with applied medicine about the common respiratory diseases.

Medical students or postgraduates will learn history taking, clinical examination and find relevant applied medical knowledge needed for bedside assessment of the patient. This book will guide towards a correct diagnosis by history and examination, as well as provide relevant differential diagnosis, localize the disease, and identify the cause. It will fill this gap and inspire the reader to gain confidence not only in the performance of the examination but also to answer most bedside queries and problems and will serve as an indispensable resource for preparation of undergraduate and postgraduate viva and short and long case examination.

Part II

General Examination

A general look at the patient may be extremely useful in defining the cause, associated complications, or assist in the differential diagnosis. In the following section, relevant physical signs are discussed in general, and especially in relation to pulmonology.

Anemia

It is a decrease in hemoglobin with or without a corresponding decrease in the total red blood cell count below a normal range given for the age, sex, and race. Normal hemoglobin in adult males is 14 to 18 gm%, while in females, it is 12.5 to 16.5 gm%.

Figure 1 Gross anemia (pale complexion is best seen under the lower eyelid)

Examination: The conjunctiva under the lower eyelids, tongue, hands, nails, and general complexion of the patient indicates the amount of pallor (Figure 1), which is usually proportional to the extent of anemia. Pale complexion without anemia is seen with severe vasoconstriction seen in advanced heart failure.

History: A good history can only be taken while keeping the etiological causes in mind. One can ask direct questions pertaining to each cause. In relation to pulmonology, a detailed history of dietary habits, episodes of any blood loss (especially hemoptysis), drug intake (especially immunosuppressants and anti-cancer drugs), diseases associated with hemoptysis, especially tuberculosis (see section on hemoptysis), and AIDS.

Etiology: Anemia may be classified according to etiological and pathological causes. Morphological classification is based on the size and chromatin content of red cells. Hypochromic and microcytic anemia is classically seen in iron deficiency (blood loss) and thalassemia (rarely with sideroblastic anemia and chronic disorders). Macrocytic anemia is seen with megaloblastic marrow in B12 and folic acid deficiency. Hemolysis may be seen in congenital hemolytic anemias, autoimmune hemolytic anemia, and infections like mycoplasma pneumonia, bacterial endocarditis, malaria, clostridia, hemophilus, salmonella, and meningococcus. A normochromic and normocytic anemia is associated with chronic disorders, infections, malignancy, CRF, endocrine disorders, and connective tissue disorders.

Clinical Features

These are best divided into...