Thoracic Clinical Exam Findings

Question 1

Thorax includes

Answer 1

Lung, esophagus, heart

Bound by 1st rib and diaphragm

Question 2

Normal inspiration

Answer 2

Diaphragm contract doqn into abdominal cqavity
Thorax expands and IT presdure decreases

Abdominal contents compressed and ab wall extends outward

Question 3

Paradoxical breathing

Tachypnea
Bradypnea
Apnea
HYperpnea
Cheyne-stokes

Answer 3

Flail chest (rib dage sings in)

Paralyzed or weak diaphragm

Over 20 PBM
Under 10 BPM
Absence of resp
Increase in depth of respiration

Altering hyperpnea and shallow respiration followed by periods of apnea (Heart failure)

Question 4

Trachea deviation

Pneumothorax
Pleural effusion
Lung atelectasis

Answer 4

Away
Away
Toward

Question 5

Barrel chest
Pectus carinatum
Pectus excavatum

Answer 5

COPD or emphyema
AP diameter increase
AP diametes decreased

These deformities can cause dyspnea

Question 6

Retraction

Answer 6

Most apparent in lower interspaces and children

Severe resp distress (some kind of obstruction)

Question 7

Nasal flaring
Clubbing
Cyanosis
Splinter hemorrhage

Answer 7

Acute distress in children

Chronic resp failure, malig…shoud not see it in COPD

Hypoxia

Endocarditis

Question 8

COPD pt classic vignette

Answer 8

Daily sputum production

Tx for bronchitis often

Smoker

Short of breath

Question 9

Chest expansion…what should you see?

Answer 9

Lateral distance bt thumbs should increase symmetrically

Question 10

MSK chest pain is

Answer 10

Reproducible by compression or lateral twisting

Question 11

Tactile femitus

Answer 11

Palpable vibration while pt speaks (99)

Use palmar or ulnar surface

Normal is consistent throguhout and side to side with no increase or decrease

Question 12

INcrease and decreased fremitus

Answer 12

Increased in pneumonia or with increased density

Decreased or absnet when sound traveling through lungs is impeded…effusion, pnuemothorax, atelectasis, bronchial obstruction

Question 13

Pulm fibrosis findings classic

Answer 13

Clubbing

Decreased lung expansion, crackles

Question 14

Hyperresonance
Dullness
Flatness

Answer 14

loud, low-pitched booming sound with a long duration
Occurs with more air
Pneumothorax, emphyema, large bullae

Medium soft instensity with a thud-like sound
Pleural effusions, pneumonia, atelectasis

Soft, high pitched
Pleural effusion

Dullness and flatness are basically the same

Question 15

Diaphragmatic excursion

Answer 15

Dullness between full inspiration and expiration and assess distance

Should be about 5-6 cm

Decreased means diaphragm paralysis or bilateral emphysema

Question 16

Vesicular

Quality, timing, location, abnormal location

Answer 16

Soft and low pitched

Inspiration>exp

Periphery

Trachea or sternum

Question 17

Bronchovesicular

Q, tim, loc, abnorm, loc

Answer 17

Moderate, mod pitch

Eqaul

First and second IC spaces at border over major bronchi

Peripheral lung

Question 18

Bronchial or tracheal

Q, tim, loc, abnormal loc

Answer 18

Loud and high pitfched

Exp>insp

Over trachea

Lung

Question 19

Adventitious breath sounds

Continuous and discontinuous

Answer 19

Stridor, wheezes or rhonchi

Crackles and rales

Question 20

Abnormal voice

Egophony
Bronchophony
Whispered pectoriloquy

Answer 20

E more like A

Spoken words clearer than normal

Whispered louder and clearer

Lung consolidation or lung mass

Question 21

Dry crackles

Wet crackles

Answer 21

Discon, insp…opening of small airways…implies fibrosis or HF

Dis, inspi…fluid oscillating in small airways…lung edema, HF, or pneumonia

Question 22

Rhonchi
strido
Wheeze

Answer 22

Cont, insp, and exp…secretions in large airways…bronchiis or increased secretions

Continuous, insp, heard over neck…narrowing of extra-thoracic airway…vocal cord dz, ex edema, occlusion

Continuous, exp»»insp…narrowing of intra-thoracic airways…astham, COPD, edema (unilateral - occlusion or cancer)

Question 23

JVP

Answer 23

Normal less than 3 cm above sternal angle

Over 4 cm or 9 cm about RA

Increased in HF, tamponade, obstructed veins

Question 24

PMI

Answer 24

Should be 4th or 5th IC space at midclavicular line on the left

Displaced - enlarged heart or underlying lung dz with lung shift

Question 25

If a square, start at top left corner nad move right…ausculatation of valves

Answer 25

Aortic valve, pulmonary valve, mitral valve, tricuspid valve

Question 26

S1 and S2

Answer 26

S1 - mitral and tricuspid valve closure..start of systole

S2 - aortic and pulmonary valve closure (systole ends and disatole begins)

Question 27

S3 and S4

Answer 27

S3 - right after S2…when blood from LA enters already overfilled LV during early diastole

S4 - right befroe S1..when blood enters stiff LV during atrial contraction (late diastole)

Question 28

Diastolic heart murmurs and systolic heart murmurs

Answer 28

Diastolic - valvular heart dz

Systolic - may indicate valvular heart dz but also may be normal

Question 29

PE findings related to airway

Answer 29

Wheezes, rhonchi, hyperexpansion, resonant to hhyperresonant on percussion, sputum production

Question 30

COPD or bronchitis

Asthma

PE findings

Answer 30

Both - wheezes, rhonchi, hyperexpansion, resonant to hyperressonant, sputum production

SMoking

Hx of childhood ilness, allergy or irritant exposure, intermittent episodes

Question 31

PE findings

Pneumonia
Pleural effusion/atelectasis
Pneumothorax

Answer 31

Crackles, fever, increased fremitus, dullness to percussion, egophony

Decreased fremitus, dullness to percussion, tracheal deviation

Hyperresonant, tracheal deviation, decreased breath soudns

Question 32

HF PE findings

Answer 32

Crackles, edema, decreased refill, increased JVP, S3/S4 gallop, displaced PMI

Resonant percussion, maybe wheezes, normal fremitus

Question 33

Cancer PE findings

Answer 33

Unilateral wheeze, atelectasis, or effusion

Hx of hemoptysis, prior cancer, recurrent pneumonia, weight loss