OSCE 4: Respiratory Exam Flashcards
What is the correct order of a respiratory exam?
Inspection
Palpation
Percussion
Auscultation
What is tripoding?
Patients with obstructive lung diseases will tend to sit leaning forward with shoulders elevated
In what illnesses can clubbing be seen in?
Congenital heart disease Interstitial lung disease Bronchiectasis Pulmonary fibrosis Lung abscess Inflammatory Bowel Disease (IBD) Malignancies (lung cancer) Cystic fibrosis
What is tactile fremitus?
Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks
Where is tactile fremitus more prominent?
Interscapular area
- more prominent on the right than the left
- disappears below the diaphragm
In what disease states is there decreased or absent tactile fremitus?
COPD Pleural effusions Fibrosis Pneumothorax Thick chest wall Infiltrating tumor
In what disease states is there increased tactile fremitus?
Pneumonia
-due to consolidated tissue
What type of percussion is expected in a healthy lung?
Resonant
If fluid or solid tissue replace air-containing lungs, what type of percussion would be expected?
Dull
What can cause dullness in lungs?
Lobar pneumonia
Pleural accumulations (effusion, hemothorax, pus, fibrous tissue)
COPD/emphysema
Asthma
What is a normal diaphragmatic excursion?
3-5.5 cm
Describe vesicular breath sounds.
Soft and low pitched
-heard through inspiration and about 1/3 of expiration
Where are vesicular breath sounds heards?
Most of lungs (parenchyma)
Describe bronchovesicular breath sounds.
Intermediate in intensity and pitch
-heard equally in inspiration and expiration
Where are bronchovesicular breath sounds heards?
Heard best in 1st and 2nd interspaces anteriorly and between the scapulae posteriorly
Describe bronchial breath sounds.
Loud and high pitched
-expiratory sounds heard longer than inspiratory
Where are bronchial breath sounds heards?
Heard best over manubrium (larger proximal airways)
Describe tracheal breath sounds.
Very loud and high pitched
-Heard equally in inspiration and expiration
What are crackles/rales?
Discontinuous, intermittent, brief
- fine: soft, high-pitched, brief
- coarse: louder, lower in pitch
- usually inspiratory
What conditions are crackles heard?
Pneumonia Fibrosis Early heart failure COPD Asthma Bronchiectasis
What are wheezes?
- Continuous; musical quality and prolonged
- Relatively high pitched, musical, hissing or shrill quality
Where are wheezes heard?
Narrow Airways: Asthma COPD Bronchitis Heart failure
What are rhonchi?
Relatively low-pitched, snoring quality
What is stridor?
High pitched wheeze predominantly inspiratory in nature
-louder in neck than over chest wall
What does stridor indicate?
Partial obstruction of larynx or trachea
-medical emergency: immediate attention needed
What is pleural friction rib?
Inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly
delayed by increased friction
-sounds like “creaking”, usually during expiration
What is bronchophony?
What is whispered pectoriloquy?
What is egophony?
spoken words get louder
whispered words get clearer
ee sounds like A
What does positive vocal resonance test indicate?
brochophony - consolidations
whispered pectoriloquy - lobar pneumonia
How do you auscultate?
Ask patient to breathe with mouth open
Ladder like pattern (2 anterior, 4 posterior, 1 right lateral)
