Abnormal lung exam Flashcards
What is WOB?
“Work of breathing”
- Visual observation of if ptn. is straining
3 Categories of extra sounds?
- Wheezes
- Crackles
- Other: rhonchi, stridor
Another name for crackles?
Rails
What do wet / dry crackles mean?
Wet: CHF
Dry: Pulmonary fibrosis
What causes wheezing?
-Air moving through narrow space
What is stridor?
- Long musical tone from vocal cord area
- Worse on inspiration
- Wheezing is worse on expiration
When is wheezing usually worse?
- Expiration
- Stridor worse on inspiration
What is whispered pectoriloquy?
Have ptn whisper and see if you can still hear sounds clearly / loudly
What can be heard in interstitial disease?
Crackles
CC: Fever, productive cough, dyspnea. What do you expect to hear over left upper chest? Diagnosis?
- Acute lobular pneumonia
- Increased bronchial breath sounds over area of consolidation
- Maybe some crackles as well
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
Acute lobular pneumonia
What would cxr look like in acute lobular pneumonia?
● consolidation - alveoli full of pus and WBCs
● air bronchograms - airways are still clear
● silhouette sign - can’t see silhouette of heart
What does air bronchogram mean?
- Airways are still clear but alveoli are consolidated on cxr
- White with black tubes on xray = consolidation
CC: worsening DOE over years, 35 ppd smoking history. Expected diagnosis?
Emphysema
How does percussion sound in emphysema?
- Hyperressonant
- Lungs are enlarged and filled with air
What is following CXR indicative of?
● hyperinflation
● flat diaphragms
● increased retrosternal airspace
Emphysema
How does CXR appear in emphysema?
● hyperinflation
● flat diaphragms
● increased retrosternal airspace
What are the following findings indicative of?
■ thin/cachectic, tachypneic, +/- hypoxemic, +/- exercise desaturation
■ large lungs
■ limited chest wall excursion, prolonged expiration
■ wheezing
Emphysema
Is clubbing seen in emphysema?
No
How do breathe sounds appear in emphysema?
- Decreased to absent with prolonged expiration
- Wheezing and ronchi
What is the following on cxr indicative of?
● small volumes
● reticulo-nodular
Interstitial lung disease
What does reticulonodular mean?
- Lines and dots on cxr
- Pathpneumonic for interstitial lung disease
What can lead to clubbing?
Pulmonary fibrosis
What is heart in interstitial lung disease?
- Dry Crackles that can sound like velcro
