Pulmonary physical exam Flashcards
What is tactile fremitus
palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks
Causes of decreased fremitus
• excess air in the lungs (emphysema, pneumothorax) •fluid in the pleural space (pleural effusion)• atelectasis due to an obstructed bronchus.
Causes of increased fremitus
consolidation in the lung (replacement of air with water, blood, pus, or other fluid) as occurs in pneumonia or pulmonary edema.
Causes of tracheal deviation
Deviation can be due to it being pushed away from one side (large pleural effusion, tension pneumothorax) or pulled toward one side (volume loss due to focal scarring/fibrosis, or atelectasis).
Causes of dullness to percussion
occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers
• large pleural effusions • lobar pneumonia • areas of atelectasis
causes of resonance to percussion
occurs with anything that increases air in the lung - pneumothorax - emphysema - large air-filled bullae in the lung
Describe vesicular breath sounds
soft and low pitched. They are heard through inspiration, continue through expiration and stop about one third through expiration. These are heard throughout the normal chest. Vesicular breath sounds are always normal
Describe bronchovesicular breath sounds
moderate in pitch and intensity. Heard during inspiration and expiration with a brief silent gap between inspiration and expiration. Can be heard over the major bronchi
describe bronchial breath sounds
high pitched and ordinarily heard over the trachea.
When/where are bronchovesicular and bronchial breath sounds abnormal
when heard over the peripheral lung tissue (i.e. anywhere other than over the main bronchi). This would suggest replacement of air filled lung with solid tissue or fluid.
Describe crackles
aka rales. discontinuous and heard more frequently during inspiration. Caused by disruptive airflow through the small airways. Associated with pulmonary edema, pneumonia and interstitial lung disease
Describe rhonchi
rumbling (or snoring) sounds that are more continuous. They are caused by passage of air through an airway partially obstructed by mucous or secretions.
Describe wheezes
continuous high-pitched, musical sound heard during inspiration or expiration. Caused by high airflow through a narrowed airway. Diffuse wheezes suggest widespread airway narrowing such as asthma or bronchiolitis whereas localized wheezing suggests a focal obstruction that needs to be evaluated.
Egophony
a change in timbre but not pitch or volume. Have the patient say “Eeee” as you ascultate (E to A change). It occurs over areas or compressed or fluid filled areas of the lung (i.e. pneumonia
Stridor
musical sounds typically audible without a stethoscope and can be either inspiratory or expiratory. It is loudest when ascultating the trachea. Stridor represents pathology in the upper airway (trachea, larynx, subglottis). Inspiratory stridor typically occurs due to laryngeal pathology such as laryngospasm or laryngeal edema, subglottic stenosis, or vocal cord dysfunction. Expiratory stridor typically represents central airway obstruction within the thorax, such as a tumor obstructing the trachea
