Pulmonary Physical Exam

Question 1

What are the four essential parts of the pulmonary physical exam?

Answer 1

1. Inspection
2. Palpation
3. Percussion
4. Auscultation

Question 2

What are the five vital signs included during inspection?

Answer 2

1. Heart rate (60-90bpm)
2. Blood pressure (140/90 or less)
3. Temperature (37.0 Celsius)
4. Respiration Rate (12-20 per minute)
5. Oxygen saturation (>93% in Denver)

Question 3

Name some things to look for during inspection.

Answer 3

Respiratory pattern
Cyanosis 
Nail clubbing
Peripheral edema
Body habitus- obesity, skeletal abnormalities 
Inspect chest wall for symmetry

Question 4

What is tactile fremitus?

Answer 4

Fremitus refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks “99”

Question 5

What does decreased fremitus indicate?

Answer 5

• Excess air in the lung (emphysema, pneumothrorax)
• Fluid in the pleural space (Pleural effusion)
• Atelectasis due to an obstructed bronchus

Question 6

What does increased fremitus indicate?

Answer 6

Occurs with consolidation in the lung (replacement of air with water, blood, pus, or other fluid) as occurs in pneumonia or pulmonary edema

Question 7

What two clinical situations would push the trachea to one side?

Answer 7

Large pleural effusion

Tension pneumothorax

Question 8

What two clinical situations would pull the trachea to one side?

Answer 8

Volume loss due to focal scarring/fibrosis

atelectasis

Question 9

When does percussion produce a dull sound?

Answer 9

A dull sound occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath you percussing fingers.

Question 10

Name three clinical scenarios in which a dull sound would be produced?

Answer 10

Large pleural effusions
Lobar pneumonia
Areas of atelectasis

Question 11

When does percussion produced a resonant sound?

Answer 11

Occurs with anything that increases air in the lung

Question 12

Name three clinical situations in which a resonant sound would be produced.

Answer 12

Pneumothorax
Emphysema
Large air-filled bullae in the lung

Question 13

What is diaphragmatic excursion?

Answer 13

Percussion of where the diaphragms are on full expiration (resonance to dull) then on full inspiration.

Question 14

What can diaphragmatic excursion used to diagnose?

Answer 14

Can detect unilateral diaphragmatic paralysis or other problems with the diaphragm

Question 15

Describe what a vesicular sound sounds like.

Answer 15

Soft and low pitched

Question 16

When are vesicular sounds pathological?

Answer 16

They are NEVER pathological

Question 17

When do you hear vesicular lung sounds?

Answer 17

Throughout inspiration

and only one third though expiration

Question 18

What lung sound is heard over the bronchi and produces a moderate pitch and intensity during inspiration and expiration?

Answer 18

Bronchovesicular lung sound- Normal when heard over appropriate area

Question 19

What high pitched lung sound is normally heard over the trachea?

Answer 19

Bronchial- Normal lung sound when heard over appropriate area

Question 20

When are bronchovesicular and bronchial breath sounds abnormal?

Answer 20

When heard over the peripheral lung tissue

Question 21

What does bronchovesicular and bronchial breath sounds heard at the periphery indicate?

Answer 21

Suggestive of replacement of air-filled lung with solid tissue or fluid.

Question 22

What do bronchial breath sounds indicate about the bronchus supplying the affected area?

Answer 22

That the bronchus is patent

Question 23

How would post-operative atelectasis sound on auscultation?

Answer 23

Presents as bronchovesicular and bronchial breath sounds over the lower lobes.

Question 24

How would pneumonia sound on auscultation?

Answer 24

Bronchial breath sounds with dullness, egophony, and crackles.

Question 25

How would obstructing lesion in the bronchus sound on auscultation?

Answer 25

Dullness and absent breath sounds including absent bronchial breath sounds

Question 26

Name 5 abnormal breath sounds.

Answer 26

1. Crackles
2. Rhonchi
3. Wheezes
4. Egophony
5. Stridor

Question 27

When are crackles heard?

Answer 27

They are discontinuous and heard more frequently during inspiration

Question 28

What causes crackles (rales)?

Answer 28

They are caused by disruptive airflow through the small airways although the specific cause is unclear

Question 29

What are crackles (rales) commonly associated with?

Answer 29

Pulmonary edema
Pneumonia
Interstitial lung disease

Question 30

Describe rhonchi.

Answer 30

Rumbling sounds that are more continuous. They are caused by passage of air through an airway partially obstructed by mucous or secretion.

Question 31

Describe the sound a wheeze produces.

Answer 31

Continuous high-pitched, musical sound heard during inspiration or expiration

Question 32

What causes a wheeze?

Answer 32

Caused by high airflow through a narrowed airway

Question 33

What does diffuse wheezing indicated?

Answer 33

suggestive of widespread airway narrowing such as asthma or bronchiolitis

Question 34

What does localized wheezing suggest?

Answer 34

Focal obstruction that needs to be evaluated

Question 35

Describe the egophony test.

Answer 35

Place stethoscope and have patient say E if the E sound changes to an A sound something is wrong

Question 36

What does a positive egophony test indicate?

Answer 36

This occurs over areas or compressed or fluid filled areas of the lung

Question 37

What is stridor?

Answer 37

Musical sounds typically audible without a stethoscope and can be either inspiration or expiratory

Question 38

Where is stridor heard the loudest?

Answer 38

Trachea

Question 39

What does stridor indicate?

Answer 39

Pathology in the upper airway (trachea, larynx, subglottis)

Question 40

What does inspiratory stridor indicate?

Answer 40

Typically occurs due to laryngeal pathology such as laryngospasm or laryngeal edema, subglottic stenosis, or vocal cord dysfunciton.

Question 41

What does expiratory stridor indicate?

Answer 41

Typically represents central airway obstruction within the thorax, such as a tumor obstructing the trachea.

Question 42

Is stridor a big deal?

Answer 42

Yeah it is an emergency