A 60-year old male has a long 5tanding history of breathlessness lie has been a heavy smoker since the age of 20 years. Physical examination reveals an anxious male who is emaciated, puffing for breath but is not cyanosed. The chest is barrels shaped. An additional clinical finding would be –
Correct Answer: Muffled hea sounds
Description: From the history and clinical findings,the patient is having chronic obstructive pulmonary disease-emphysematous type.it is characterised by hyperinflation of lungs with low set diaphragm.Breath sounds are typically quiet.Right hea failure and cor pulmonale can occur in severe cases,evident as bilateral pitting pedal edema. Ref:Harrison's medicine-18th edition,page no:2156;Davidson's medicine-22nd edition,page no:674.
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