Lung & Chest

Question 1

Order of basic chest examination

Answer 1

1. Inspection and observation
2. Palpation
3. Percussion
4. Auscultation

Question 2

More about inspection and observation

Answer 2

Chest: 
Shape
Deformity 
Assymmetry 
Masses 

Lungs & Breathing:

• Respiratory rate
• Use of accessory muscles
• Patient position- upright, leaning forward in tripod position (extreme distress)
• Movement of abdominal wall during breathing (paradoxical breathing)
• Any audible noises (wheezes, gurgling)
• Colour of lips, nail beds

Question 3

Types of chest deformities

Answer 3

Pectus excavatum: congenital posterior displacement of lower part of sternum

Pectus carinatum: pigeon chest

Barrel chest: increased A-P diameter and diaphragm flattening assoc w/ emphysema and lung hyperinflation

Kyphosis

Scoliosis

Question 4

Palpation of Lungs- this involves?

Answer 4

1. detection of normal lung excursion
2. Tactile fremitus
3. investigation of tender areas in trauma

Question 5

What is tactile fremitus?

Answer 5

Fremitus = Vibration through the body
We use the bony edge of the hands (as they are sensitive to the vibrations)
Ask the patient to repeat 99 in or 1-1-1 or 33 in hungarian

Question 6

What changes tactile fremitus? What effect does it have? give an example of a disease in either case

Answer 6

1. Consolidation eg Pneumonia
   consolidation causes fremitus to be more pronounced
2. Pleural effusion eg hydrothorax in CHF
   causes fremitus to be decreased in the overlying area

Question 7

What is consolidation?

Answer 7

When the air-filled parenchyma become engorged with fluid or tissue

Question 8

Basic concept of Percussion

Answer 8

Striking a surface over an air-filled space will produce a resonant sound
Striking over a tissue or fluid filled cavity produces a dull sound

Question 9

Changes in percussed lung sounds?

Name two

Answer 9

Dullness: Lung with pleural effusion (fluid displaces the lung) or pneumonia (lung filled with pus) sound is deadened

Hyper resonant: Chronic (emphysema) or acute (PTX) air trapping in lung/ pleural space produces hyper resonant sound

Question 10

Where can you best hear (auscultate) the lower lobes?

Answer 10

The bottom 3/4 of posterior chest

Question 11

Where can you best hear the right middle lobe?

Answer 11

Right axilla

Question 12

Where can you best hear the lingula

Answer 12

Left axilla

Question 13

Where can you best hear the upper lobes

Answer 13

Anterior chest & top 1/4 post chest

Question 14

What abnormal sounds do we hear in the lungs?

Answer 14

Wheezes
Rales (crackles)
Rhonchi
Consolidation
Bronchial (not over trachea)

Question 15

Wheezes are:
type of sound
when you hear it
why you hear it

Associated with?

Answer 15

-whistling-type noises
-produced during expiration
-Due to narrowing of airway
-when air is forced through airways narrowed by bronchoconstriction, secretions, and/or associated mucosal edema.
can be heard with emphysema and asthma

Question 16

Rales

Answer 16

a.k.a. crackles
scratchy, high pitched, discontinuous popping sounds
Heard in both phases of respiration

Occurs with processes that cause fluid to accumulate within the alveolar and interstitial spaces.
e.g pulmonary edema (diffuse crackles), chronic bronchitis, pneumonia (localised) CHF, atelectasis

Can also occur with pulmonary fibrosis (very distinct, diffuse, dry-sounding crackles, sounds like velcro)

Question 17

Consolidation

Answer 17

Dense consolidation produces tubular or bronchial breath sounds in the periphery
Also will have ‘eee’ to ‘aaa’ changes which is called egophony.

Pneumonia can cause this

Question 18

Rhonchi

Answer 18

Low pitched wheezes, continuous sound
Secretions that form/collect in larger airways can produce a snoring, gurgling-type noise.
Occur in the bronchi
Due to bronchitis or other mucous creating process

Question 19

Common causes of pneumonia?

Answer 19

Typical: Strep pneumoniae 
Hemophilus influenzae 
Klebsiella 
E Coli
Pseudomonas Aeruginosa
Atypical: Legionella

Question 20

Atelectasis- what is it?

Answer 20

A complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. Can be complication after surgery. Or due to decreased surfactant in premature birth