Pulmonary Physical Exam Flashcards
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.
How would obstructing lesion in the bronchus sound on auscultation?
Dullness and absent breath sounds including absent bronchial breath sounds
Name 5 abnormal breath sounds.
- Crackles
- Rhonchi
- Wheezes
- Egophony
- Stridor
When are crackles heard?
They are discontinuous and heard more frequently during inspiration
What causes crackles (rales)?
They are caused by disruptive airflow through the small airways although the specific cause is unclear
What are crackles (rales) commonly associated with?
Pulmonary edema
Pneumonia
Interstitial lung disease
Describe rhonchi.
Rumbling sounds that are more continuous. They are caused by passage of air through an airway partially obstructed by mucous or secretion.
Describe the sound a wheeze produces.
Continuous high-pitched, musical sound heard during inspiration or expiration
What causes a wheeze?
Caused by high airflow through a narrowed airway
What does diffuse wheezing indicated?
suggestive of widespread airway narrowing such as asthma or bronchiolitis
What does localized wheezing suggest?
Focal obstruction that needs to be evaluated
Describe the egophony test.
Place stethoscope and have patient say E if the E sound changes to an A sound something is wrong
What does a positive egophony test indicate?
This occurs over areas or compressed or fluid filled areas of the lung
What is stridor?
Musical sounds typically audible without a stethoscope and can be either inspiration or expiratory
Where is stridor heard the loudest?
Trachea
What does stridor indicate?
Pathology in the upper airway (trachea, larynx, subglottis)
What does inspiratory stridor indicate?
Typically occurs due to laryngeal pathology such as laryngospasm or laryngeal edema, subglottic stenosis, or vocal cord dysfunciton.
What does expiratory stridor indicate?
Typically represents central airway obstruction within the thorax, such as a tumor obstructing the trachea.
Is stridor a big deal?
Yeah it is an emergency
