Pulmonary Physical Exam Flashcards
What are the four basic parts of the pulmonary physical exam?
- Inspection
- palpation
- percussion
- auscultation
What do you do on inspection?
Vitals including respiratory rate (normal range is 12-20) and O2 sat. (which should be above 93% in Denver).
You also want to look for respiratory patterns (for instance if they are breathing super deep (hyperpnea) this might be a good time to notice… NARF!).
Also, look for pursed lip breathing, cyclic breathing patterns such as Kussmaul breathing (Rapid and deep breathing) or Cheyne-Stokes (oscillates between higher and lower RR)
what is tripoding?
putting hands on legs or a table while breathing.
What pulmonary diseases should be in your differential diagnosis if a patient presents with nail clubbing?
- lung cancer
- pulmonary fibrosis
- Cystic Fibrosis
On palpation you should do a tactile fremitus. What sort of pulmonary diseases are you looking for?
decreased fremitus:
- excess air in lungs (emphysema, pneumothorax)
- fluid in the pleural space (pleural effusion)
- atelectasis due to an obstructed bronchus
increased fremitus:
- consolidation in the lung–replacing air with water or other fluid (pneumonia, pulmonary edema)
fluid will generally increase fremitus as it transmits vibrations better than air, exception is if it doesn’t replace air (fills pleural space)
What is deviated trachea generally due to?
either being pushed or pulled to one side by pathology in the lungs. For instance, tension pneumothorax and large pleural effusion will push the trachea while volume loss due to focal scarring or atelectasis will pull the trachea from midline.
T or F chest should sound dull not hallow.
F it should sound hallow not dull– remember its full of air.
What causes dullness of sound when percussing the chest?
fluid or solid tissue replaces air in the lung or fills in the pleural space such as:
- large pleural effusions
- lobar pneumonia
- areas of atelectasis
Basically consolidation–stuff filling the lungs
What causes a resonant sound when percussing the chest (think of this as the opposite of dullness)?
anything that increases air in the lungs:
- pneumothorax
- emphysema
- large air-filled bullae in the lung
- a snare drum placed in your lung
ok fine he didn’t talk about that last one
What are vesicular sounds? describe them.
normal lung sounds. They are heard through inspiration, continue through expiration and stop about one third through expiration.
What are bronchovesicular and bronchial breath sounds?
bronchovesicular- heard over the major bronchi. moderate in pitch and intensity. Heard during expiration and inspiration with a little gap between the two.
Bronchial- high pitched heard over the trachea
It is bad if these sounds are heard in the periphery of the lung because that indicates that these areas contain a lot of fluid or tissue which is conducting the sound to the periphery of the lung. These are normal sounds though in their respective locations.
What are crackles? What causes them?
They are also known as rales. the exact cause is unknown though it has something to do with disruptive airflow through the small airways.
Know This below:
It points to Pulmonary edema, pneumonia, and ILD
What causes Rhonchi?
rumbling sounds caused by passage of air partially obstructed by mucous or secretions.
Think of Ronchi as “snoring wheezes”
What does a wheeze suggest (both localized and diffuse)?
Diffuse- widespread airway narrowing- asthma or bronchiolitis
Localized- focal obstruction (like if you got a peanut stuck in there)
What is egophony?
change in timbre but not pitch or volume. This is similar to a change in note.
The patient says “Eeeee” and you hear “Aaaa” on auscultation.
occurs because areas of lung are compressed or filled with fluid like PNEUMONIA
