Phsyical assessment of Pulmonary system lecture Flashcards
which of the 4 cornerstones are used in the pulmonary exam?
Inspection
palpation
percussion
auscultation
Where can we get the closest to the lung tissue?
the intercostal space
What is a good starting point for determining clinical anatomy?
suprasternal notch
What is located 5cm below the suprasternal notch?
the sternal angle (angle of Louis)
What intercostal space is located at the same level and the sternal angle?
2nd
What is marker for the beginning of the posterior chest wall?
the C-7 spinous process.
Which lobes can you auscultate anteriorly?
RUL, RML, LUL
Where can you auscultate the Lower Lobes anteriorly?
LLL and RLL are located at the costophrenic angle
What lobes can you osculate posteriorly?
LLL and RLL (uppers as well)
systemic signs of pulmonary dz.
cyanosis
clubbing
barrel chest
tripod position
signs of respiratory distress
Rate and effort
accessory muscle use
Unusual respiratory noises
What do you inspect anteriorly?
trachea midline
obvious deformities
asymmetry
trauma
pectus carinatum
pigeon chest (convex)
Pectus excavatum
funnel chest (concave)
Pectus excavatum
funnel chest (concave)
inspection of posterior chest
deformities
asymmetry
abnormal retractions
Palpation of chest
Any abnormalities seen on inspection.
Symmetric chest expansion
causes of asymmetric chest expansion
pna
bronchial obstruction
pleural effusion
pain (splinting
Decreased tactile fremitus indicates
bronchial obstruction pleural effusion Pleural fibrosis COPD PTX tumor unusual thick chest wall
Increased tactile fremitus indicates:
pneumonia
percussion note for pleural effusion
dull/flat depending on size
Percussion note for consolidation (edema/pna)
dull over area of decreased aeration
percussion note for atelectasis
dull over atelectasis
percussion note for normal lung tissue
resonant
percussion note for ptx
hyperresonant or tympanic if large
percussion note for COPD
hyperresonant diffusely
percussion note for Asthma
hyperresonant
what 3 things are you listening for on ausculation?
Lung sounds
Presence of adventitious sounds
when abnormal-sound of whispered word
What must you ALWAYS ask pt to do when auscultating?
breathe through mouth.
Vesicular sounds
soft and low
throughout inspiration but fade after 1/3 expiration.
throughout lungs
Bronchovesicular sounds:
Louder than vesicular sounds
Heart equally insp. and exp. usually separated by interval
Heart best at 1 and 2 ICS anterior, and between scap posterior
Bronchial sounds:
very loud high pitched sounds
Exp sounds longer
heart best over manibrium
3 types of adventitious sounds
Rhonchi
Wheezes
Crackles (Rales)
Rhonci
low pitched - snoring/geese honking-secretions in large airways
Wheezes
High pitched, shrill, inspiratory/expiratory, assoc. w/ asthma, COPD, bronchitis
Stridor-long inspiratory wheeze
Crackles
fine-high pitched brief duration (suddenly pop open during late inspiration!!
Coarse-Low pitched louder longer duration-alveoli bubbles through secretions early inspiration!!
NOTE WHAT PHASE OF BREATHING YOU HEAR THE CRACKLES!
Pleural friction rub
inflamed pleural spaces
