Jackson, age 65, comes to the doctors office complaining of a sharp pain in the right side of his chest. he says his chest hurts when he breathes deeply or coughs. this is a problem, he says, because he has been coughing a lot, has difficulty drawing breath, and feels a tightness in the center of his chest. 1. what condition(s) might the doctor suspect? name at least one condition and define it. 2. what method(s) of diagnosis would the doctor use? name one method. 3. what specific signs would the doctor look for to pinpoint the cause? name at least 2 signs that the doctor would look for that goes along with the condition you listed in question no. 1.

The answer 1: The pleurisy

Pleurisy corresponds to the presence of liquid between the two sheets of the pleura, the membrane lining the thoracic cavity and having for goal the protection of the lungs. We speak of purulent pleurisy when the fluid contained in this pleural cavity consists of pus.

Answer 2: Pulmonary auscultation

In healthy subjects, pulmonary auscultation can be used to hear normal breathing sounds called vesicular murmur. It results from the movement of air in the tracheobronchial tree and alveoli. He is gentle, breathing in inspiration; it is more intense but shorter in expiration. There may be variations in vesicular murmur intensity as a function of chest wall thickness (eg decreased vesicular murmur in obese subjects).

In the pathological state, several abnormalities can be found at auscultation:

Inversion of the respiratory rhythm with prolongation of expiratory time (emphysema and asthma)

Changes in the vesicular murmur:

Added noises like rales, and pleural friction.

Answer 3:

The auscultation of the lungs will find suspicious signs, showing the presence of fluid in the pleura: sounds heard on normal auscultation are reduced or inexistent, and it is only in one lung generally. The confirmation is simple enough to perform via a chest x-ray showing the presence of fluid in the pleura.

Besides that, the doctor will look at the location of the pain, and he will look for breathlessness too.

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