Rational Clinical Exam
COPD
UHN/MSH Medical Consult Service
INSPECTION
FINDING
LR +
LR -
Maximum laryngeal height <= 4 cm
3.6
0.7
Hoover's sign
4.2
0.5
PALPATION
FINDING
LR +
LR -
Subxiphoid cardiac impulse
7.4
ns
PERCUSSION
FINDING
LR +
LR -
Absent cardiac dullness LLSB
11.8
ns
Hyperresonnance upper right anterior chest
5.1
ns
AUSCULTATION
FINDING
LR +
LR -
Early inspiratory crackles
14.6
ns
Any unforced wheeze
2.8
0.8
Breath sound score (see below)
 
 
     <=9
10.2
 
    10-12
3.6
 
    13-15
ns
 
    >=16
0.1
 
ANCILLARY TESTS
FINDING
LR +
LR -
Forced expiratory time (over trachea)
 
 
    < 3 sec
0.2
 
    3-9 sec
ns
 
    > 9 sec
4.1
 
COMBINED FINDINGS
FINDING
LR +
LR -
2 out of the following 3 present
    1) smoked 70 pack years or more
    2) self reported history of COPD
    3) diminished breath sounds
25.7
0.3
REFERENCES
McGee S. Evidence based physical diagnosis. 2nd ed pp 361-362. Saunders Elsevier 2007
BREATH SOUND SCORE
1. Listen in the following six locations
       bilateral upper anterior chest
       bilateral midaxillae
       bilateral posterior bases

2. Score each site for
inspiratory sounds
       0 - absent
       1 - barely audible
       2 - faint but definitely heard
       3 - normal
       4 - loud

3. Add up the points

COPD