Lung & Chest Flashcards
Order of basic chest examination
- Inspection and observation
- Palpation
- Percussion
- Auscultation
More about inspection and observation
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
Types of chest deformities
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
Palpation of Lungs- this involves?
- detection of normal lung excursion
- Tactile fremitus
- investigation of tender areas in trauma
What is tactile fremitus?
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
What changes tactile fremitus? What effect does it have? give an example of a disease in either case
- Consolidation eg Pneumonia
consolidation causes fremitus to be more pronounced - Pleural effusion eg hydrothorax in CHF
causes fremitus to be decreased in the overlying area
What is consolidation?
When the air-filled parenchyma become engorged with fluid or tissue
Basic concept of Percussion
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
Changes in percussed lung sounds?
Name two
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
Where can you best hear (auscultate) the lower lobes?
The bottom 3/4 of posterior chest
Where can you best hear the right middle lobe?
Right axilla
Where can you best hear the lingula
Left axilla
Where can you best hear the upper lobes
Anterior chest & top 1/4 post chest
What abnormal sounds do we hear in the lungs?
Wheezes Rales (crackles) Rhonchi Consolidation Bronchial (not over trachea)
Wheezes are:
type of sound
when you hear it
why you hear it
Associated with?
-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
Rales
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)
Consolidation
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
Rhonchi
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
Common causes of pneumonia?
Typical: Strep pneumoniae Hemophilus influenzae Klebsiella E Coli Pseudomonas Aeruginosa Atypical: Legionella
Atelectasis- what is it?
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
