Diagnostic Skills Respiratory

Question 1

Chronic Bronchitis:

Answer 1

Adventitious Sounds:

• None or
• Scattered coarse crackles in early inspiration
• Wheezes
• Rhonchi

Question 2

Left-Sided Heart Failure (Early):

Answer 2

Adventitious Sounds:

• Late inspiratory crackles
• Possibly wheezes

Question 3

Consolidation:

Answer 3

Percussion: Dull
Breath sounds: bronchial over involved area
Adventitious Sounds: Late inspiratory crackles
Tactile Fremitus and Transmitted Voice Sounds: Increased fremitus, bronchophony, egophony (increased resonance of voice sounds), and whispered pectoriloquy (increased loudness of whisper)

Question 4

Atelectasis:

Answer 4

Percussion: Dull
Trachea: May be shifted toward involved side
Breath sounds: Usually absent but right upper lobe atelectasis may cause adjacent tracheal sound to be transmitted
Tactile Fremitus/Transmitted Sounds: Usually absent but w/ right upper lobe atelectasis it may be increased!

Question 5

Pleural Effusion:

Answer 5

Percussion: Dull
Trachea: Shifted to opposite side with large effusion
Breath sounds: Decreased to absent, but bronchial breath sounds may be heard near top
Adventitious Sounds: Pleural rub
Tactile Fremitus/Transmitted Voice Sounds: Decreased to absent but may be increased toward the top of a large effusion

Question 6

PTX:

Answer 6

Percussion: Hyperresonant
Trachea: shifted to opposite side if much air
Breath sounds: decreased to absent
Adventitious Sounds: None except possible pleural rub
Tactile Fremitus and Transmitted Voice Sounds: Decreased to absent

Question 7

COPD:

Answer 7

Percussion: Diffusely Hyperresonant
Breath sounds: Decreased to absent
Adventitious Sounds: None or crackles, wheezes and rhonchi associated with chronic bronchitis
Tactile fremitus/transmited voice sounds: decreased

Question 8

Asthma:

Answer 8

Percussion: Resonant to diffusely hyperresonant
Breath sounds: Often obscured by wheezes
Adventitious Sounds: Wheezes, possibly crackles
Tactile Fremitus/Transmitted Voice Sounds: Decreased