Abnormal lung exam

Question 1

What is WOB?

Answer 1

“Work of breathing”

- Visual observation of if ptn. is straining

Question 2

3 Categories of extra sounds?

Answer 2

1. Wheezes
2. Crackles
3. Other: rhonchi, stridor

Question 3

Another name for crackles?

Answer 3

Rails

Question 4

What do wet / dry crackles mean?

Answer 4

Wet: CHF
Dry: Pulmonary fibrosis

Question 5

What causes wheezing?

Answer 5

-Air moving through narrow space

Question 6

What is stridor?

Answer 6

• Long musical tone from vocal cord area
• Worse on inspiration
• Wheezing is worse on expiration

Question 7

When is wheezing usually worse?

Answer 7

• Expiration

- Stridor worse on inspiration

Question 8

What is whispered pectoriloquy?

Answer 8

Have ptn whisper and see if you can still hear sounds clearly / loudly

Question 9

What can be heard in interstitial disease?

Answer 9

Crackles

Question 10

CC: Fever, productive cough, dyspnea. What do you expect to hear over left upper chest? Diagnosis?

Answer 10

• Acute lobular pneumonia
• Increased bronchial breath sounds over area of consolidation
• Maybe some crackles as well

Question 11

What is following indicative of on cxr:
● consolidation - alveoli full of pus and WBCs
● air bronchograms - airways are still clear
● silhouette sign - can’t see silhouette of heart

Answer 11

Acute lobular pneumonia

Question 12

What would cxr look like in acute lobular pneumonia?

Answer 12

● consolidation - alveoli full of pus and WBCs
● air bronchograms - airways are still clear
● silhouette sign - can’t see silhouette of heart

Question 13

What does air bronchogram mean?

Answer 13

• Airways are still clear but alveoli are consolidated on cxr
• White with black tubes on xray = consolidation

Question 14

CC: worsening DOE over years, 35 ppd smoking history. Expected diagnosis?

Answer 14

Emphysema

Question 15

How does percussion sound in emphysema?

Answer 15

• Hyperressonant

- Lungs are enlarged and filled with air

Question 16

What is following CXR indicative of?
● hyperinflation
● flat diaphragms
● increased retrosternal airspace

Answer 16

Emphysema

Question 17

How does CXR appear in emphysema?

Answer 17

● hyperinflation
● flat diaphragms
● increased retrosternal airspace

Question 18

What are the following findings indicative of?
■ thin/cachectic, tachypneic, +/- hypoxemic, +/- exercise desaturation
■ large lungs
■ limited chest wall excursion, prolonged expiration
■ wheezing

Answer 18

Emphysema

Question 19

Is clubbing seen in emphysema?

Answer 19

No

Question 20

How do breathe sounds appear in emphysema?

Answer 20

• Decreased to absent with prolonged expiration

- Wheezing and ronchi

Question 21

What is the following on cxr indicative of?
● small volumes
● reticulo-nodular

Answer 21

Interstitial lung disease

Question 22

What does reticulonodular mean?

Answer 22

• Lines and dots on cxr

- Pathpneumonic for interstitial lung disease

Question 23

What can lead to clubbing?

Answer 23

Pulmonary fibrosis

Question 24

What is heart in interstitial lung disease?

Answer 24

• Dry Crackles that can sound like velcro

Question 25

What is lack of lung markings on cxr indicative of?

Answer 25

Pneumothorax

Question 26

How does pneumothorax appear on cxr?

Answer 26

• Lack of lung markings

- Trachea pushed away from pneumothorax

Question 27

What is hyperresonance to percussion and absence of breath sounds indicative of?

Answer 27

Pneumothorax

Question 28

Pneumothorax on Physical exam?

Answer 28

• Hyperresonance

- Absence of breath sounds

Question 29

What is the following cxr indicative of?
● blunting of the angle
● meniscus sign
● complete white-out

Answer 29

Pleural effusion

Question 30

How does pleural effusion look on CXR?

Answer 30

● blunting of the angle
● meniscus sign
● complete white-out

Question 31

When is wheezing heard?

Answer 31

• Bronchospasm from asthma / copd

- Intrathoracic narrowing of airways during expiration

Question 32

What are crackles indicative of?

Answer 32

Secretions in alveoli, bronchi or cavity