RESPIRATORY EXAM Flashcards
What should normal percussion sound be on the back?
Resonant
Give two differential diagnosis for dull and hyperresonant percussion of lungs
- Dull: Plural effusion, consolidation
- Hyperresonant → trapped air: pneumothorax, emphysema
What is the name for normal breathing sounds heard on auscultation? Most pathological processes cause what to happen to lung sounds?
Vesicular
⇒ most pathological processes result in decreased breath sounds over affected area
What do crackles indicate on auscultation? What are they caused by? What are the two types of crackles, examples of causes of each
Indicate Inflammation or infection of small bronchioles and alveoli. Caused by a small airways popping open after collapse as air flows through.
Fine and course crackles
- Fine: Classically pulmonary fibrosis, pulmonary oedema
- Course: pneumonia, bronchitis
Crackles that do you not change or disappear after coughing indicates which diagnosis?
Pulmonary oedema or pulmonary fibrosis
What is pulmonary fibrosis?
Lungs become scarred over time
Symptoms SOB, dry cough, tired, weight loss, nail clubbing
Complications: pulmonary hypertension, respiratory failure, pneumothorax, lung cancer
Causes pollution, medications, connective tissue diseases, infections (including SARS), interstitial lung diseases
Idiopathic pulmonary fibrosis (IPF) is most common
What causes a wheeze? What is the classic cause?
Airflow through narrowed bronchi
Asthma
Wheeze in one lobe of lung (localised wheeze), such as right upper lobe should flag which diagnosis?
Tumour causing bronchial obstruction
Course breathing sounds caused by secretions in large airways are called what? Coughing will do what typically? What are rhonchi classically caused by?
Rhonchi
Since secretions are in large airways coughing typically reduces rhonchi
classic cause: COPD
Inspiratory wheeze louder over neck is most likely what? What is it called by? What are some classic causes?
Stridor = always consider in an INSIRATORY wheeze!
Indicates partial obstruction of larynx or trachea
- Laryngotracheitis (croup)
- Epiglottitis
- Retropharyngeal abscess
- Diphtheria
Explain what pectoriloquy is and why it is caused
Sounds heard clearer through stethoscope than normal
► happens in consolidation and effusion → Sound waves can only travel through a solid, liquid or gas medium. They travel fastest and furthest in solids, then liquids and slowest in gas
What is fremitus? What causes increased and decreased fremitus?
- Increased: pneumonia
- Decreased: plural effusion, pneumothorax, atelectasis
Which lung condition can cause nail clubbing in children?
Cystic fibrosis
Crackles, increased tactile fremitus and dullness to percussion over an area of lung indicates which cause?
Consolidation: likely lobar pneumonia
Decreased breath sounds in right lung and dullness to percussion in someone on mechanical ventilation with the following chest x-ray is most likely to be what condition? What is this caused by? Explain the x-ray findings. How can this be differentiated from other causes of reduced breath sounds and dullness to percussion
Right lung atelectasis: collapse of lung tissue involving entire right lung
Patients on mechanical ventilation often develop it because plugs obstruct bronchi resulting in collapse of lung tissue distal to obstruction
KEY CONCEPT: Collapsed tissue takes up less space in thoracic cavity ⇒ mediastinal shift towards side of collapse on imaging. This contrasts with pneumothorax and massive effusion which push mediastinum away. In addition a white out of entire lung on mechanical ventilation is classic presentation for mucus plugging
When a mass partially obstructs an airway what can be heard over obstruction? Areas distal to the obstruction are common sites for which 2 conditions?
Wheeze
Pneumonia or atelectasis
