Module 4: Thorax/Abdomen Terminology

Question 1

Barrel Chest

Answer 1

Increased AP (anterior-posterior) diameter of the chest
e.g. chronic obstructive pulmonary disease (COPD)

Question 2

Pectus Excavatum

Answer 2

Chest deformity characterized by depression of the lower portion of the sternum (“funnel” chest)
e.g. congenital, Rickets, Marfan’s, Cobbler’s Chest

Question 3

Pectus Carinatum

Answer 3

Chest deformity characterized by anterior displacement of the sternum (“pigeon” chest)
e.g. congenital, Rickets, Marfan’s

Question 4

Tactile Fremitus

Answer 4

Palpable vibrations transmitted through the bronchopulmonary tree. Best appreciated by placing palmar aspect of the metacarpalphalangeal joints against the thorax
e.g. increased when there is consolidation as with pneumonia; decreased with a bronchial plug or with pleural effusion

Question 5

Percussion Notes

Answer 5

Resonant - over the normal chest
Hyperresonant - e.g. in COPD
Dull - e.g. over the liver
Flat - e.g. over the thigh muscle

Question 6

Breath Sound: Vesicular

Answer 6

Inspiration is longer than expiration (true over most of the thorax)

Question 7

Breath Sound: Bronchovesicular

Answer 7

Inspiration equals expiration in length (between scapulae)

Question 8

Breath Sound: Bronchial or Tracheal

Answer 8

Expiration is longer than inspiration (over suprasternal notch)

Question 9

Crackles

Answer 9

Relatively brief, inspiratory (primarily) non-musical adventitial sounds heard on auscultation of chest. Come from small airways and can relate to secretions or fibrosis
Fine - soft, high pitched, e.g. CHF
Coarse - louder, lower in pitch, e.g. pneumonia

Question 10

Rhonchi

Answer 10

Low pitched adventitial sounds heard on auscultation of the chest. Longer duration than crackles, snoring-like quality, come from secretions in large airways
e.g. Bronchitis

Question 11

Wheeze

Answer 11

High-pitched, musical adventitial sounds heard on auscultation of the chest. Longer duration than crackles/rhonchi. Caused by air flow through narrow airways
e.g. Asthma (bronchospasm); foreign body obstruction in bronchus

Question 12

Stridor

Answer 12

Upper airway inspiratory sound caused from airway obstruction in the trachea or larynx
Louder and typically lower pitched than a wheeze
Commonly heard without stethoscope
e.g. Acute Laryngotracheobronchitis (Croup); foreign body in trachea

Question 13

Bronchophony

Answer 13

Louder than normal and more clearly heard transmitted voice sound
e.g. “99” increased with consolidation as with pneumonia

Question 14

Egophony

Answer 14

The spoken letter “e” heard as “a”
Somewhat of a nasal quality
e.g. Heard with consolidation as with pneumonia
(“voice of a goat” - nasal or bleating quality)

Question 15

Whispered Pectoriloquy

Answer 15

Whispered sounds are heard louder and more clearly

e.g. “99” heard with consolidation as with pneumonia

Question 16

Friction Rub

Answer 16

Pleural and cardiac
Like pieces of leather rubbed together or a creaking sound; heard during inspiration and expiration
e.g. pleuritis, pericarditis
(almost bumpy)

Question 17

Murmurs

Answer 17

Relatively prolonged extra heart sounds caused by disruption in blood flow through and out of heart. Some are “innocent” - non-pathologic - others are pathologic. Can be caused by a septal defect, valvular disease, etc.
Described as systolic and/or diastolic (also as early, mid, late, holo (pan))
Described as flow or ejection, by quality and pitch, by duration, and by location and if radiation
Loudness is graded
1: barely audible
2: easily audible
3: loud, no palpable thrill
4: loud, palpable thrill
5: loudest requiring a stethoscope on the chest
6: can be heard with stethoscope off the chest
e.g. Grade 3/6 high pitched systolic ejection murmur heard best at….

Question 18

Thrill

Answer 18

Palpable vibration over the chest

e.g. May accompany loud murmurs (4+/6)

Question 19

Click

Answer 19

Extra systolic sound of short duration

e.g. Mitral valve prolapse

Question 20

Bruit

Answer 20

Basically a murmur over a vessel; systolic bruits may be heard normally over aorta, in particular, and sometimes the renal arteries in thin individuals
Both systolic and diastolic bruit over a renal artery suggests renal artery stenosis
e.g. Renal artery stenosis, abdominal aortic aneurysm
e.g. Carotid bruit in partial carotid artery occlusion

Question 21

Convex

Answer 21

Gently rounded (abdomen)

Question 22

Flat

Answer 22

not convex or concave (abdomen)

Question 23

Concave or Scaphoid

Answer 23

concavity of abdomen

Question 24

Striae

Answer 24

Streaks most often on abdomen; collagen fibers disrupted

e. g. stretch marks from pregnancy - pink and become silvery with time
e. g. Striae with Cushing’s Syndrome - purplish pink in color

Question 25

Bulging Flanks

Answer 25

Prominence of flanks | e.g. Ascites - free fluid in abdomen

Question 26

Bowel Sounds

Answer 26

Borborygmi describes bowel sounds that are frequent and loud peristaltic sounds

Question 27

Shifting Dullness

Answer 27

Abnormal finding on percussion of the abdomen - a characteristic physical finding of ascites

Question 28

Fluid Wave

Answer 28

Abnormal palpable finding on examination of the abdomen - characteristic of ascites

Question 29

Percussion

Answer 29

Dullness over liver | Tympanitic with gas in GI tract