PE skills: Respiratory

Question 1

What is chronic bronchitis?

Answer 1

Bronchi are chronically INFLAMED.

PRODUCTIVE COUGH

AIRWAY OBSTRUCTION may develop

Question 2

What adventitious sounds are heard in a pt w/ chronic bronchitis?

Answer 2

None

Crackles in early inspirations

Wheezes or ronchi

Question 3

What is left sided heart failure?

Answer 3

Increased pressure in the pulmonary veins causes congestion and interstitial edema around the alveoli.

Bronchial mucosa can become eddematous

Question 4

What adventitious sounds are associated with left sided heart failure?

Answer 4

LATE INSPIRATORY CRACKLES in the dependent portions of the lungs

possibly wheezes

Question 5

In what three conditions are the lungs resonant when you percuss them?

Answer 5

Normal
Chronic bronchitis
Left sided EARLY heart failure

Question 6

What is consolidation?

Answer 6

Alveoli are filled with fluid or blood cells, as in pneumonia, pulmonary edema, or pulmonary hemorrhage.

Question 7

What breath sounds would you hear with consolidation?

Answer 7

BRONCHIAL over the involved area

Question 8

If you listen to a pt with pneumonia, what adventitious sounds would you hear?

Answer 8

Late inspiratory CRACKLES

Question 9

In a pt w/ pneumonia (consolidation) would tactile fremitus be increased, decreased or the same?

Answer 9

Increased

with:
Broncophony (99> sound stays loud at periphery)
egophony (E–> A transition)
whispered pectoriloquy (increased resonance)

Question 10

What is atelectasis (lobar obstruction)?

Answer 10

When a plug ina mainstem bronchus (as from mucus or a foreign object) obsturcts air flow, affected lunt tissue collapses into an airless state?

Question 11

What is seen on exam in a pt w/ atelectasis?

Answer 11

DULL over airless area
Trachea SHIFTS towards the INVOLVED side.
ABSENT breath sounds.
ABSENT tactile fremitus.

Question 12

What is a pleural effusion?

Answer 12

Fluid accumulates in the pleural space, separates the air-filled lung from the chest wall, blocking the transmission of sound.

Question 13

What is seen on exam in a pt w/ pleural effusion?

Answer 13

DULL over the fluid.
Large effusion SHIFTS trachea towards OPPOSITE side.
DECREASED TO ABSENT breath sounds.
Pleural rub.
Tactile fremitus may be INCREASED at the TOP of a pleural effusion but usually DECREASED to ABSENT.

Question 14

What conditions are dull upon percussion?

Answer 14

Consolidation
Atelectasis
Pleural effusion

Question 15

What is a pneumothorax?

Answer 15

When air leaks into the pleural space, usually unilaterally, the lung recoils from the chest wall.

Pleural air BLOCKS transmission of sound.

Question 16

What conditions are hyperesonant upon percussion?

Answer 16

Pneumothorax
COPD
Asthma

Question 17

What is seen on exam in a pt w/ a pneumothorax?

Answer 17

Trachea SHIFTED toward OPPOSITE side if there is a lot of air.

DECREASED to ABSENT breath sounds, adventitious sounds and tactile fremitus over pleural air.

Question 18

What is COPD?

Answer 18

Slowly progressive disorder in which the DISTAL AIR SPACES ENLARGE and the lungs become superinflated.

Question 19

What is seen on exam in a pt w/ COPD?

Answer 19

HYPERRESONANT
Decreased/absent breath sounds

Crackles, wheezes, and rhonchi of associated bronchitis

Question 20

What is asthma?

Answer 20

Widespread NARROWING of the trachebronchial tree diminishes air flow to a fluctuating degree. During attacks, air flow decreases further and the lungs hyperinflate.

Question 21

What is seen/heard on exam in a pt w/ asthma?

Answer 21

Wheezes