Thoracic exam and findings Flashcards
What is the order of examination techniques?
Observe/Inspect, percuss, palpate, auscultate.
When inspecting the chest what do you look for?
Shape and symmetry Chest wall movement Superficial venous patterns Prominence of ribs Anteroposterior vs. transverse diameter Barrel chest Sternal protrusion Spinal deviation
What periphial clues may suggest cardiovascular issues?
Fingers: clubbing Breath: odor Skin, nails, and lips: cyanosis or pallor Lips: pursing Nostrils: flaring
When inspecting respiration, what do you look for?
Rate
Quality
Pattern
When observing chest respirations, what do you need to be looking for?
-Symmetry
-Retractions are when the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest costal margins.
Suggests an obstruction to inspiration at any point in the respiratory tract
-Paradoxic breathing: on inspiration, the lower thorax is
drawn in, and on expiration, the opposite occurs.
When palpating the thoracic muscles and skeleton, be looking for the following:
Pulsations Tenderness Bulges/depressions Masses Unusual movement/positions Elasticity of rib cage Immovability of sternum Rigidity of thoracic spine
When palpating for thoracic expansion, what would signal an abnormality?
Loss of symmetry in the movement of the thumbs suggests a problem on one or both sides.
What is tactile fermitius?
Palpable vibration of the chest wall that results from speech or other verbalizations
When percussing over the lungs, what does Hyperresonance signify?
hyperinflation
When percussing over the lungs, what does dullness signify?
diminished air exchange
When percussing over the lungs, what is the normal sound that should be heard?
resonance
What four areas can auscultation sounds be listed under?
Intensity
Pitch
Quality
Duration
When auscultating for breath sounds what does vesicular sound like?
Low-pitched, low-intensity sounds heard over healthy lung tissue
When auscultation for breath sounds what does bronchovesicular sound like?
Heard over the major bronchi and are typically moderate in pitch and intensity
What do bronchial breath sounds sound like?
Highest in pitch and intensity
Ordinarily heard only over the trachea
Where are vesicular sounds heard, typically?
Over peripheral lung tissue.
Where are bronchovesicular sounds heard?
2nd and 3rd intercostal space on anterior chest; possibly in between the scapula on the posterior chest.
What are the four Adventitious breath sounds?
Crackles (rales), rhonchi (sonorous wheezes), Wheezes (sibilant wheeze), and friction rub
Describe a crackle(rale) and what are the two types?
Abnormal respiratory sound heard more often during inspiration and characterized by discrete discontinuous sounds
Fine: high pitched, and relatively short in duration
Coarse: low pitched, and relatively longer in duration
Describe rhonchi and what causes it?
Deeper, more rumbling, more pronounced during expiration, more likely to be prolonged and continuous, and less discrete than crackles
Caused by the passage of air through an airway obstructed by thick secretions, muscular spasm, new growth, or external pressure
Describe a wheeze and what causes it.
Continuous, high-pitched, musical sound (almost a whistle) heard during inspiration or expiration
Caused by a relatively high-velocity air flow through a narrowed or obstructed airway
May be caused by the bronchospasm of asthma (reactive airway disease) or acute or chronic bronchitis
Describe a friction rub and what causes it.
Occurs outside the respiratory tree
Dry, crackly, grating, low-pitched sound and is heard in both expiration and inspiration
Caused by inflamed, roughened surfaces rubbing together
Describe bronchophony, Pectoriloquy, and Egophony.
Bronchophony
Greater clarity and increased loudness of spoken sounds
Pectoriloquy
Extreme bronchophony where even a whisper can be heard clearly through the stethoscope
Egophony
Intensity of the spoken voice is increased and there is a nasal quality.
e’s become stuffy broad a’s
