Physical Examination

As respiratory diseases from agricultural exposures may present with nonspecific signs and symptoms, a complete physical exam is prudent rather than focusing only on findings suggested by the exposure history. Vital signs, presence of respiratory distress, if present, and the presence of clubbing or cyanosis should be recorded. Exam of the skin, eyes, and mucous membranes of the nasopharynx may reveal signs of inflammation or irritation. Oropha-ryngeal and nasal areas may reveal presence of ulcers or polyps. Lung exam should evaluate for presence of wheezing, rhonchi, or both (suggestive of airways disease) and for presence of rales or crackles (suggestive of presence of parenchymal lung disease). When crackles are heard, a cardiovascular system exam is important for evaluation for left ventricular heart failure. The presence of isolated right ventricular heart failure is suggestive of possible cor pul-monale, secondary to chronic severe lung disease with hypoxemia (119).

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