Shortness of Breath (Dyspnea): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
  • Inspection (viewing).
    • Skin, mucous membranes, and sclerae (white part of the eye) [edema (water retention in tissues); cyanosis (bluish discoloration of skin and central mucous membranes, e.g., tongue) → acute emergency]
    • Neck veins:
      • Empty? (→ hypovolemic or hemorrhagic shock/volume deficiency or blood loss).
      • Congested? (→ cardiogenic shock/shock caused by pumping failure of the heart).
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture?
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels?
      • Scars? Hernias (fractures)?
  • Examination of the lungs
    • Auscultation of the lungs [the following is a description of the possible auscultation findings:
      • Bds. inspiratory (“on inhalation“) moist RG’s/coarse bubbly rales → pulmonary edema/water retention in the lungs (if: no fever, possibly leg edema/water retention in the legs, possibly heart failure/heart failure known).
      • Unilaterally attenuated or canceled breathing sound → pneumothorax (“collapse of the lungs”).
      • Unilaterally attenuated or canceled breath sound → pleural effusion.
      • Unilateral (or bilateral) inspiratory fine-bubble RG’s → pneumone (if: fever).
      • Bds. expiratory (“on exhalation”) humid RG’s/medium bubbly RǴs → bronchitis
      • Prolonged expirium (“breathing out”), expiratory wheezing, inspiratory free → bronchial asthma or chronic obstructive pulmonary disease (COPD).
      • Prolonged expirium, expiratory wheezing, inspiratory bds. RG’s → asthma cardiale (symptom complex of dyspnea and other asthma-like symptoms occurring in the setting of advanced left heart failure; when: no bronchial asthma, COPD, or heart failure is known)
      • Expiratory stridor → COPD
      • Inspiratory stridor → aspiration (e.g. Inhalation of foreign bodies), epiglottitis (inflammation of epiglottis), glottic edema (acute swelling (edema) of laryngeal mucosa), laryngotracheobronchitis (pseudocroup; Inflammation of the larynx (larynx), trachea (windpipe) and bronchi), laryngeal (laryngeal), tracheal stenosis (narrowing of the trachea), vocal cord dysfunction/dysfunction of the vocal cords in which they suddenly become tight and may even close for a short time (inspiratory/inhalation).
      • If auscultatory o. B. → measure RR]
    • Bronchophony (check the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of the lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent: e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
    • Percussion (tapping) of the lungs [eg. E.g. in emphysema (“pulmonary hyperinflation”); box tone (hypersonor) → pneumothorax; muffled → pleural effusion]
    • Vocal fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated: e.g. atelectasis, pleural rind; strongly attenuated or absent: in case of pleural effusion, pneumothorax, pulmonary emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
  • Auscultation (listening) of the heart [pulse irregular?, atrial fibrillation? ; III.Heart sound: LV dysfunction/heart failure (heart failure), myocardial infarction (heart attack); heart murmur: valvular vitium (heart defect), ]septal defects (incomplete closure of the heart wall)]
  • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)

Square brackets [ ] indicate possible pathological (pathological) physical findings.