Physical Exam

Question 1

Trachea Deviation

Answer 1

• Deviates toward volume loss (atelectasis or resection)

- Deviates away from space occupying disease (tumor, pneumothorax, large effusion)

Question 2

Cheyne-Stokes Breathing

Answer 2

• alternating crescendo-decrescendo (fluctuation in PCO2)
• Seen in CHF b/c takes more time for circulation to get to brain –> delay in signaling PaCO2 to respiratory center
• Also seen in neuro disorders like stroke or infection

Question 3

Kussmaul’s Respirations

Answer 3

• deep, regular breaths resulting in steady, low PCO2; rate can be fast, slow or normal
• Seen in metabolic acidosis (compensate by deep breaths that minimize dead space for efficient CO2 elimination)

Question 4

What increases and decreases fremitus?

Answer 4

• Vibration thru chest wall
• Inc if consolidation (transmitted better thru solid or liquid)
• Dec if lung is physically further from chest wall (ex - moved due to effusion)
• **R lobe fremitus&raquo_space; L lobe fremitus b/c L lobe is separated from trachea by the aorta (opp would be true if someone had R-sided aorta)

Question 5

Vesicular v. Bronchial v. Bronchovesicular Breath Sounds

Answer 5

• Vesicular - (Insp > Exp)
  
  • Normal alveoli
  • Heard of anterior and posterior chest
• Bronchial (Exp > Insp)
  
  • Always abnormal
  • Heard over trachea
  • Reflect consolidation (solid connection b/n large airway and stethoscope)
• Bronchovesicular (Insp = Exp)
  
  • Always abnormal
  • Intermediate; suggests small degree of consolidation

Question 6

3 Adventitious Sounds

Answer 6

• Rales - velcro like crackles from parenchymal disease (HF, pneumonia, fibrosis)
• Rhonchi - low pitched cont sound from airway obstruction (asthma or COPD)
• Wheezing - high pitched musical sound from turbulent flow due to airway obstruction or bronchial obstruction

Question 7

3 Examples of Voice Changes and What They’re Associated With

Answer 7

CONSOLIDATION

• Bronchophony - consolidated lung transmits “99” better than normal lung (less muffled)
• Whispered Pectoriloquy - whispered words audible at lung periphery
• Egophony - change in timbre so “e” sounds like “a” at lung periphery (sounds like goat)

Question 8

What generally happens when there is a mucus plug or tumor blocking airway?

Answer 8

• Dec transmission of breath sounds and vibrations b/c no air in this area
• If there is no air entry into a region then there will be no adventitious sounds (no wheezes, rales, rhonchi)