Pulmonary Physical Exam Flashcards
What is Kussmaul breathing and when do you see this?
Rapid and deep breaths.
Seen in response to metabolic acidosis (trying to blow off CO2)
What is Cheyne-Stokes breathing and when is this seen?
Increasing and decreasing respiratory rate due to insensitivity in the respiratory centers of the brain to CO2.
Typically seen in heart failure patients.
In pulmonary physical exams, name 4 signs of distress/labored breathing.
- Use of accessory muscles
- Tripoding
- Paradoxical abdominal movement
- Pursed lip breathing
What is acrocyanosis?
Peripheral cyanosis
What are 2 types of cyanosis?
- Central
- Peripheral (acrocyanosis)
What is clubbing? What can this be a sign of?
Distorted angle of nail bed. It is a sign of hypoxemia, lung cancer, pulmonary fibrosis, cystic fibrosis, etc.
What are some skeletal shapes to watch out for during pulmonary physical exams? (name 5)
- scoliosis
- kyphosis
- straight spine
- pectus excavatum (chest dent inwards)
- pectus carinatum (chest protruding outwards)
What is tactile fremitus? What increases (name 1) and decreases (name 3) tactile fremitus?
This is placing your hands on the posterior chest and having the patient say “99”. You’re feeling for the vibrations through the chest wall.
Things that increase tactile fremitus:
- lung consolidation (water, blood, pus, etc). This is because the fluid will transmit the sound from the patients voice better than air which increases the vibration you palpate.
Things that decrease tactile fremitus are things that interfere with the connection between lung and the chest wall
- pneumothorax
- pleural effusion
- obstructed bronchus – atelectasis
It is important to check the position of the trachea during the pulmonary physical exam. What can change the position of the trachea?
The trachea can be pushed away from a side that has a large pleural effusion or tension pneumothorax. Or, the trachea can be pulled towards a side that has atelectasis, fibrosis, or resection.
What can percussion during a pulmonary physical exam tell you about a patient?
Percussion that results in a dull sound can be from an effusion, consolidation (pneumonia, pulmonary edema, etc), or atelectasis.
Percussion that results in a resonant sound can be from a pneumothorax, bullae, or emphysema.
What is diaphragmatic excursion and how is it helpful?
This is when you percuss on a patient’s back during full inspiration and full expiration to approximate the position of the diaphragm. This can help you detect unilateral diaphragmatic paralysis or other problems with the diaphragm.
Name and describe the pitch, duration, and location of 3 normal breath sounds
- vesicular - soft and low pitched; heard through inspiration and continues through expiration stopping about 1/3 the way through expiration. This is heard throughout the chest and is always normal.
- bronchovesicular - moderate in pitch and intensity; heard during inspiration, brief silent gap, then again during expiration. This is heard over the major bronchi
- bronchial - high pitched and ordinarily heard over the trachea
Note: bronchovesicular and bronchial breath sounds heard over the periphery of the lungs is abnormal (can be atelectasis or pneumonia)
What do crackles/rales sound like? When are they heard? What are they associated with?
A “velcro” sound that is discontinuous and typically during inspiration. Rales/crackles are associated with pulmonary edema, pneumonia, or interstitial lung disease/fibrosis
What does wheezing sound like? When is it heard? What is it associated with?
Wheezing is a high-pitched, musical sound heard most commonly during expiration but sometimes during inspiration. It is sometimes audible without a stethoscope and is caused by high airflow through a narrowed airway. Diffuse wheezing is associated with asthma, bronchitis, COPD exacerbation, and local wheezing sounds suggest a focal obstruction and need to be evaluated further (e.g. aspirated peanut)
What are ronchi?
Rumbling sounds that are continuous, caused by passage of air through an airway that is partially obstructed by mucous or secretions.
What is egophany? How do you test for this?
Egophany is the change in timbre but not pitch or volume. Have the patient say “E” as you auscultate and if it sounds more like an “A” sound, that change is known as egophany. Egophany is present in areas of the lung that are over compressed or fluid filled (e.g. pneumonia).
