I would like to end my examination by checking the temperature chart, doing a peak flow meter and looking into the sputum pot of the patient.
Mr X has a diagnosis of interstitial lung disease, currently not in respiratory failure.
On general examination, he is not tachypneic, with respiratory rate of 16 breaths a minute. He has finger clubbing with no signs of carbon dioxide retention. There is no jaundice or pallor and no central cyanosis. His tracheal is centrally located.
On chest examination, there is no scar or deformities noted. My findings are confined to the bilateral lower zone, with reduced chest expansion, dull percussions, reduced breath sounds with fine-end inspiratory creptitations not altered by coughing and normal voval resonance. The JVP is not raised, no displaced apex beat or loud P2 and there is no pedal oedema. There is no palpable cervical lymphadenopathy.
In summary, Mr X has findings in keeping with a diagnosis of interstitial lung disease and currently not in respiratory failure. In the context of chronic lung disease, there is no sign of cor pulmonale. The likely etiology would be idiopathy pulmonary fibrosis. I would like to offer a few differentials of lower zone fibrosis such as connective tissue disease induced - rheumatoid arthritis, SLE and dermatomyositis, drug induced fibrosis - amiodarone, methotrexate and nitrofurantoin and radiation induced fibrosis.