Pulmonary Exam and Ultrasound Flashcards
What is the normal adult respiratory rate?
10-14 breaths
What is the normal neonate respiratory rate?
30 to 60 breaths
What is the normal young child respiratory rate?
20 to 40
What is the normal older child respiratory rate?
15-25
Define tracheal tugging. What is it a sign of?
sucking in of skin and tissue just above the suprasternal notch.
Indicates respiratory distress
What is the cause of tracheal tugging towards the diseased side of the body?
volume loss of the lung
What is the cause of tracheal tugging away from the diseased lung?
Increase in lung pressure or volume, potential emergency if tension pneumothorax
What disease processes can caused decreased fremitus?
disease processes that decrease the transmission of sound from the lung to the chest wall (“increased air” in the lungs - emphysema, asthma; air or fluid in the pleural space – pneumothorax, pleural effusion).
What disease processes cause increased fremitus?
present with increased fluid in the lung tissue, facilitating sound transmission (consolidation of the lung as with pneumonia or pulmonary hemorrhage).
Where is resonance normally heard during percussion?
over the lung fields
What is normal lung percussion described as?
resonant
What is suggested by hyperresonance?
less dense lung tissue or more air
What is suggested by percussive dullness?
more dense tissue
How must a patient breathe during auscultation?
through their mouth, to minimize nasal passage noise
How are normal breath sounds described? what does this mean?
vesicular
(where the inspiratory sound lasts longer than the expiratory component) and are heard over most of the lung fields
What are bronchovesicular breath sounds?
normal
In bronchovesicular breath sounds, the inspiratory and expiratory components are equal. These can be heard in the normal lung in the 1st and 2nd interspaces anteriorly and between the scapulae.
What are bronchial breath sounds?
normal
Bronchial breath sounds are louder and more high-pitched and are only hard over the manubrium, if at all, in the normal lung.
What are tracheal breath sounds like?
Tracheal breath sounds are very loud and high-pitched and can be heard over the trachea in the neck.
What bronchial breath sound findings are indicative of pulmonary consolidation?
If bronchial or bronchovesicular breath sounds are heard in an area of lung where vesicular breath sounds should be,
Define adventitious breath sounds
Adventitious breath sounds refer to extra sounds heard in addition to the normal lung sounds. They suggest the presence of a disease process.
What do crackles sound like?
brief, intermittent, discontinuous sounds that can be on a continuum from fine and dry to coarse and wet-sounding.
What causes crackles?
The sounds are believed to be caused by small airways popping open during inspiration and sometimes may be related to secretions in closed small airways
What do persistent mid to late inspiratory crackles suggest?
abnormal lung parenchyma or abnormal small airways
“continuous sounds with a musical quality” describes what adventitious breath sound?
rhonchi
What causes rhonchi?
Rhonchi are caused by narrowing of larger airways from secretions in the airways (as in COPD, bronchitis, bronchiolitis). These noises often change breath-to-breath, or clear after coughing.
What does wheezing suggest? What part of the breath are they heard on?
Wheezing suggests a narrowing of the intra-thoracic airways (as in asthma, COPD, bronchiolitis). Wheezing should contain an expiratory component, though can be biphasic (inspiratory and expiratory).
What causes stridor? What part of the breath are they heard on?
Stridor is caused by narrowing of the extra-thoracic upper airway (croup, laryngeal edema, mass) and should contain an inspiratory component, though can be biphasic (inspiratory and expiratory).
Define bronchophony
Increased transmission of spoken words heard in the presence of consolidation of the lungs. Words will be transmitted louder than normal if bronchophony is present.
Define whispered pectorlioquy
Intensification of whispered words (“one-two-three”) heard in the presence of consolidation of the lung.
Define egophony
The spoken word heard through the lungs takes on a nasal or bleating sound. When consolidation is present, the “ee” sound will be heard as a long “a”.
What findings would I expect to hear in consolidated lung tissue? What special tests would support this?
findings on auscultation in the focal area of consolidation may include: decreased breath sounds, bronchial breath sounds, and/or persistent late inspiratory crackles in the affected area of the lung. You may not hear these all at once depending on the degree of consolidation.
Findings of bronchophony, egophony and whispered pectoriloquy in the area of consolidation would support this diagnosis.
What findings would I expect on percussion and auscultation in a patient with asthma?
Asthma – resonant or hyperresonant to percussion throughout both lungs, diffuse wheezes; with severe bronchoconstriction there may be markedly decreased breath sounds bilaterally such that very little wheezing is heard, or wheezing may just be at end expiration.
What findings would I expect on percussion and auscultation of a pneumothorax?
Pneumothorax – hyperresonant to percussion on the affected side only, absent breath sounds over the area of pneumothorax
Describe differences between crackles and rhonchi and in what disease process they are heard
Crackles are brief, intermittent, nonmusical adventitious (extra) breath sounds caused by abnormalities of the lung parenchyma or small airways, such as with interstitial lung disease, pulmonary fibrosis, pulmonary edema, pneumonia and bronchiolitis. Rhonchi are lower-pitched musical sounds created by mucous in the larger airways, which often change when the patient coughs, and are found in diseases such as bronchitis and bronchiolitis.
Describe the difference between wheezes and stridor. In what disease processes are these sounds heard?
Wheezes are higher-pitched musical sounds, often more continuous, though not heard throughout the entire respiratory cycle, and are caused by narrow airways of asthma, COPD, bronchitis and bronchiolitis. Wheezing is usually heard in expiration due to collapse of the airways with obstructive lung disease, but can be biphasic (in inspiration and expiration).
Stridor is a high-pitched musical sound caused by narrowing of the upper airway, as with airway edema from intubation or anaphylaxis, epiglottitis, croup, or a foreign body in the airway. Stridor should be heard in inspiration, but can also be biphasic (in inspiration and expiration).
Absent sliding of the pleural line indicates what state?
pneumothorax
What are A lines? are they normal or abnormal?
A lines are horizontal lines deep to the pleura which are artifacts caused by the ultrasound waves bouncing between the skin surface and the pleura (these are normal)
Describe the normal luing in an evaluation of a pleural effusion or hemothorax
In a normal lung the ultrasound waves are scattered and an artifact is created which makes the lung appear just like the liver or spleen
Describe the abnormal or positive findings in a lung ultrasound for pleural effusion or hemothorax
· In a lung with a pleural effusion or hemothorax, the ultrasound sound waves can travel through the fluid and a black triangle is seen cranial (on the left of the screen) to the liver or spleen
spine sign
How do you evaluate for interstitial fluid with ultrasound?
B lines
What 2 things do B lines indicate?
interstitial fluid (e.g. pulmonary edema) or thickening of the interstitial tissue (e.g. pulmonary fibrosis, diffuse lung infections)
