Adventitious Lung Sounds

Question 1

Crackles

Answer 1

Discontinuous

aka Rales

• bronchitis
• pneumonia
• fibrosis
• CHF
• fine, high-pitched crackling and popping noises
  
  • heard during the end of inspiration
    *

Question 2

Wheeze

Answer 2

Continuous, especially on the exhale

• Asthma, COPD, and Airway Obstruction
• high-pitched musical sound
  
  • heard most commonly during expiration
    
    • occurs in small airways

Question 3

Rhonchi

Answer 3

continuous

snore

suggest secretions in the large airways

• coarse, loud, low snoring or moaning tone
  
  • heard mostly during expiration, but can also be heard during inspiration

Question 4

Pulmonary Edema/CHF and Atelectasis

Answer 4

• Pulmonary Edema/CHF
  
  • fluid in alveoli creates crackles that do not clear with cough
  • crackles start at the base and move up the lung fileds as the edema gets worse
  • can also hear gurgling, grunting, wheezing expecially in moderate to severe pulmonary edema
• Atelectasis:
  
  • crackles that resolve with cough

Question 5

Physical Findings of Pleural Effusion

Answer 5

Muffled lung sounds

Dull to percussion

decreased fremitus

Question 6

Physical Findings of Lobar Pneumonia

Answer 6

increased breath sounds

crackles (adventitial)

increased vocal and tactile resonance (fremitus)

usually local/focal

Question 7

Physical Findings of Viral Pneumonia

Answer 7

crackles

increased fremitus

bronchial breath sounds

more often diffuse

Question 8

Physical Findings of Moderate Asthma

Answer 8

Hyperinflation

Wheezing

Increased Work of Breathing

Cough

SOB

Question 9

Physical Findings of Pulmonary Edema

Answer 9

Definition: fluid retention in the alveoli causing swelling of the lungs

• s/sxs: SOB, pink frothy secretions, tachypnea,
  
  • peripheral edema, hypoxemia, auscultation (rails/crackles)
• Causes:
  
  • ARDS
  • Pneuomothorax (re-expansion pulmonary edema)
  • CHF
  • kidney failure

Question 10

CXR pneuomnic (in depth)

Answer 10

• ABCDEFGHI
• A: assessment of quality/airway
  
  • PIER:
    
    • position: is this a supine AP file? PA? Lateral?
    • inspiration: count the posterior ribs, should see 10-11 ribs with good inspiratory effect
    • exposure: well-exposed films have good lung detail and an outline of the spinal column
    • rotation: the space b/w the medial clavicle and the margin of the adjacent vertebrae should be roughly equal to each other
• B: Bones and soft tissues
  
  • scan the bones for symmetry, fractures, osteoporosis, and lesions. Evaluate the soft tissues for foreign bodies, swelling, and subcutaneous air
• C: Cardiac
  
  • evaluate heart size; <50% of the chest diameter on PA films
• D: Diaphgram
  
  • shape (flattened, curved, unilateral?)
  • look below diaphragm for free gas and gastric bubble
• E: Effusions/Extrathoracic soft tissue
  
  • pleural effusions may be large
• F: fields, fissures and foreign bodies
  
  • check lungs for infiltrates (interstitial vs. alveolar) masses, consolidation,
  • check major and minor fissure for thickening, fluid or change in position
  • check position of foreign bodies
• G: Great Vessels/ Gastric Bubble
  
  • check aortic size and shape and outlines of pulmonary vessels
    
    • aortic knob should be clearly visible
  • gastric bubble should be seen clearly and not displaced
• H: Hila and Mediastinum
  
  • evaluate hila for lymphadenopathy, calcifications, and masses
  • check for widening of mediastinum and tracheal deviation
• I: impression
  
  • synthesize all the findings and double check

Question 11

CXR pneumonic overview

Answer 11

ABCDEFGHI

• A: assessment/airway
  
  • PIER
    
    • P: position
    • I: inspiration
    • E: exposure
    • R: rotation
• B: bones and soft tissues
• C: cardiac
• D: diaphragm
• E: effusuions/extrathoracic soft tissue
• F: fields, fissures, and foreign bodies
• G: Great vessels/ gastric bubble
• H: hila and mediastinum
• I: impression

Question 12

what percentage of current cancers in the US are due to CT?

Answer 12

0.4%

Question 13

CT scan exposure in millirems and equivalent # of low dose digital dental X-rays

Answer 13

1100 millirems

12,200 dental x-rays

Question 14

Chest x-ray exposure in millirems and equivalent # of low dose digital dental X-rays

Answer 14

10-40millirems

100-400 dental x-rays

Question 15

Plain PA Chest X-ray and approx equiv period of natural background radiation and addition lifetime risk of fatal and non-fatal cancer

Answer 15

3 days of natural background radiation

1: 1,000,000 additional risk

Question 16

CT chest (non-contrast) and approx equiv period of natural background radiation and addition lifetime risk of fatal and non-fatal cancer

Answer 16

400 plain chest radiograph equivalent

3. 6 years of natural background radiation
   1: 1200 addition risk of cancer