Pulmonary Physical Exam Flashcards
(42 cards)
What are the four essential parts of the pulmonary physical exam?
- Inspection
- Palpation
- Percussion
- Auscultation
What are the five vital signs included during inspection?
- Heart rate (60-90bpm)
- Blood pressure (140/90 or less)
- Temperature (37.0 Celsius)
- Respiration Rate (12-20 per minute)
- Oxygen saturation (>93% in Denver)
Name some things to look for during inspection.
Respiratory pattern Cyanosis Nail clubbing Peripheral edema Body habitus- obesity, skeletal abnormalities Inspect chest wall for symmetry
What is tactile fremitus?
Fremitus refers to the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks “99”
What does decreased fremitus indicate?
- Excess air in the lung (emphysema, pneumothrorax)
- Fluid in the pleural space (Pleural effusion)
- Atelectasis due to an obstructed bronchus
What does increased fremitus indicate?
Occurs with consolidation in the lung (replacement of air with water, blood, pus, or other fluid) as occurs in pneumonia or pulmonary edema
What two clinical situations would push the trachea to one side?
Large pleural effusion
Tension pneumothorax
What two clinical situations would pull the trachea to one side?
Volume loss due to focal scarring/fibrosis
atelectasis
When does percussion produce a dull sound?
A dull sound occurs when fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath you percussing fingers.
Name three clinical scenarios in which a dull sound would be produced?
Large pleural effusions
Lobar pneumonia
Areas of atelectasis
When does percussion produced a resonant sound?
Occurs with anything that increases air in the lung
Name three clinical situations in which a resonant sound would be produced.
Pneumothorax
Emphysema
Large air-filled bullae in the lung
What is diaphragmatic excursion?
Percussion of where the diaphragms are on full expiration (resonance to dull) then on full inspiration.
What can diaphragmatic excursion used to diagnose?
Can detect unilateral diaphragmatic paralysis or other problems with the diaphragm
Describe what a vesicular sound sounds like.
Soft and low pitched
When are vesicular sounds pathological?
They are NEVER pathological
When do you hear vesicular lung sounds?
Throughout inspiration
and only one third though expiration
What lung sound is heard over the bronchi and produces a moderate pitch and intensity during inspiration and expiration?
Bronchovesicular lung sound- Normal when heard over appropriate area
What high pitched lung sound is normally heard over the trachea?
Bronchial- Normal lung sound when heard over appropriate area
When are bronchovesicular and bronchial breath sounds abnormal?
When heard over the peripheral lung tissue
What does bronchovesicular and bronchial breath sounds heard at the periphery indicate?
Suggestive of replacement of air-filled lung with solid tissue or fluid.
What do bronchial breath sounds indicate about the bronchus supplying the affected area?
That the bronchus is patent
How would post-operative atelectasis sound on auscultation?
Presents as bronchovesicular and bronchial breath sounds over the lower lobes.
How would pneumonia sound on auscultation?
Bronchial breath sounds with dullness, egophony, and crackles.
