Respiratory System 2 - Percussion and Auscultation of the Lungs

Question 1

Percusses the anterior and posterior lung fields and comments on findings. Describes the percussion notes found in lobar pneumonia, pleural effusion, pneumothorax, asthma and chronic obstructive pulmonary disease (COPD)

Answer 1

“First, I’ll be percussing your lung fields (percuss in intercostal spaces). Can you please lean forward and hug yourself? This allows for retraction of the scapula and for better access to the lobes of the lung.”
“For the purpose of this examination, I’ll be percussing from the posterior aspect.”
DON’T TALK WHILE PERCUSSING.
Have the patient cross arms in front of chest.
“Upon percussion, I’m noting that resonant sounds were heard bilaterally and in all lung fields which is normal. If the sound was hyper resonant, that could be indicative of COPD, asthma, or pneumothorax (air in the lungs). If the sound was dull, that could be indicative of lobar pneumonia, pleural effusion; fluid or solid tissue within the lungs.”

Question 2

Percuss the level of the diaphragm posteriorly.

Answer 2

“Next, I’ll be percussing at the level of the diaphragm posteriorly.” Patient should have their arms crossed over chest. Should be done breathing normally and holding breath.
“The diaphragmatic excursion is [say number between 3 – 5.5cm] which is within normal limits of 3 – 5.5cm.”

Question 3

Auscultates the anterior and posterior lungs fields and comments on findings. Describes normal breath sounds and adventitious sounds.

Answer 3

“Next, I’ll be listening to the same areas of your chest (anterior and posterior lung fields) using the diaphragm of my stethoscope. Can you breathe in and out each time I place the stethoscope on your skin?” (inhale and exhale) Have patient cross arms across their chest. Auscultate in the same pattern as for percussion.
“Upon auscultation, I’m noting that there was normal, equal, and bilateral air entry in all lung fields.”
Normal breathing sound:
● Vesicular or soft and low pitched (expiration length 1/3 inspiration); this is the normal one
● Bronchovesicular (expiration length same as inspiration w/pause)
● Bronchial (expiration length longer than inspiration).
o If bronchovesicular or bronchial sounds are heard suspect fluid or solid mass in the lung

Question 4

Checks for transmitted voice sounds (vocal fremitus, bronchophony, egophony, and whispered pectoriloquy) and comments on findings. Describes what one would find in lobar pneumonia, pleural effusion, pneumothorax, asthma and COPD

Answer 4

“Lastly, I’ll be checking for transmitted voice sounds. I’ll need you to repeat some words each time I place the stethoscope on your skin.”
“Starting with bronchophony, can you please say “99” aloud? In this case the sounds were muffled and unclear. If it was loud and clear, that would be positive for bronchophony.”
“Next, I’ll be checking for egophony. Can you say “ee” aloud? Here, the sounds heard were “ee” which is normal. If I heard “ay” sound, that would be abnormal and indicative of pneumonia, or pleural effusion.”
“Next, I’ll be checking for whispered pectoriloquy. Can you whisper “99”? Here, the sounds heard were faint (or absent) which is normal. If I heard sounds quickly, that would be abnormal. “
“Now in terms of bronchophony, egophony, and whispered pectoriloquy, decreased vocal resonance could be indicative of COPD, asthma, pneumothorax, and pleural effusion. Increased vocal resonance could be indicative of lobar pneumonia.”