Physical Exam Write Ups

Question 1

Normal pulm exam

Answer 1

Clear to auscultation bilaterally with no adventitious sounds, symmetric fremitus throughout lung fields, symmetrically resonant to percussion

Question 2

chronic bronchitis

Answer 2

Symmetrically resonant to percussion, rhonchi/crackles/wheezes bilaterally, symmetric fremitus throughout the lung fields

Question 3

emphysema

Answer 3

Symmetrically hyperresonant to percussion, decreased breath sounds, no adventitious sounds, decreased fremitus throughout lung fields

Question 4

pulmonary edema

Answer 4

Symmetrically resonant to percussion, course end inspiratory crackles with occasional wheeze, symmetric fremitus throughout lung fields

Question 5

Consolidation (pneumonia, hemorrhage)

Answer 5

Dull to percussion ________, decreased (or bronchial) breath sounds ______, late inspiratory crackles _______, increased fremitus/ bronchophony/ egophony/whispered pectoriloquy over the _________

Question 6

Atelectasis (lobar obstruction from mass, mucus, foreign object)

Answer 6

Lung: Dull to percussion ________, decreased (or absent) breath sounds ______, no adventitious sounds
Neck: trachea shifted toward _____ (involved side)

Question 7

pleural effusion

Answer 7

Dull to percussion ______, decreased (or absent) breath sounds ______, pleural rub, decreased fremitus ________

Question 8

Pneumothorax

Answer 8

Lung: Hyperresonant to percussion ________, decreased (or absent) breath sounds ____, no adventitious sounds, decreased fremitus ________
Neck: Trachea shifted toward _______ (NOT involved side)

Question 9

Asthma

Answer 9

Symmetrically resonant (or hyperresonant) to percussion, breath sounds obscured by wheezes, crackles, rhonchi, decreased fremitus throughout lung fields

Question 10

Bronchiolitis

Answer 10

Symmetrically resonant to percussion, breath sounds obscured by wheezes, rhonchi, and course crackles, symmetric fremitus throughout lung fields

Question 11

Upper airway obstruction (croup, laryngeal edema, laryngomalacia)

Answer 11

Symmetrically resonant to percussion, vesicular (or decreased) breath sounds, inspiratory stridor, symmetric fremitus throughout lung fields

Question 12

Normal cardiac

Answer 12

Regular rate and rhythm, regular S1 and physiologically split S2, PMI in 5th intercostal space in midclavicular line, no murmurs/rubs/gallops

Question 13

mitral regurgitation

Answer 13

High pitched harsh, grade __/6 holosystolic murmur heard best at apex and radiating to left axilla

S3 appreciated at apex, PMI diffuse and laterally displaced

Question 14

aortic stenosis

Answer 14

Harsh, grade 4/6 systolic crescendo-decrescendo murmur heard best at the right 2nd-3rd interspace with pt sitting up and leaning forward, radiates to carotids bilaterally,

S3 appreciated at apex, decreased S2, weak and delayed carotid pulses, sustained PMI

Question 15

aortic regurg

Answer 15

Soft high pitched, decrescendo blowing diastolic murmur heard best at the left 2nd-4th interspace, radiating to apex and right sternal border, appreciated with pt sitting up leaning forward

widened pulse pressure, bounding peripheral pulses, diffuse and infero-laterally displaced PMI, S3 appreciated at apex

Question 16

mitral stenosis

Answer 16

Opening snap and decrescendo rumbling diastolic murmur best heard at apex with pt in left lateral decubitus position, accentuated with hand grip