Thorax Findings

Question 1

Smoking
Pack years=

Predisposes to
Exacerbates
Rf for

Answer 1

packs/day X yrs

Emphysema, CB, lung cancer
Asthma
Pneumococcal/Legionnaire’s dz

Question 2

Occupational exposures

Asbestos
Strongly consider in

Answer 2

Silica/coal dust, mining, sandblasting, small industry

Old insulation, shipping, auto mechanics

Adult onset asthma

Question 3

Pleurisy dx finding

Syndromes with pleurisy possible

Answer 3

Pleural rub (listen @ worst spot)

PNA, Pulm infarct (PE)
Viral Pleurisy
Immunology (SLE, RA)
Metabolic cx
Pericarditis, esophageal rupture, PTX

Question 4

Dyspnea causes

Exertion should

Patients will

Answer 4

Disconnect bw expected work of breathing and system output
Hypercarbia/hypoxemia

Worsen (may improve with psych SOB)

Accomodate to chronic, sense acute changes

Question 5

RD signs

Sensorium
Diaphoresis
Posture
Accessory muscle
Paradoximal motion

Answer 5

May be altered at end

High symp toe

Upright if able (dont put in supine unless intubation is available)

PAM- chest out and ab in with inspiration (diaphragmatic fatigue/denervation)

Question 6

Accessory muscle use

Inspiration

Expiration (obstructive dz)

Answer 6

Scalenes, SCM
Trapezius, intercostals (alae nasai)

Abdominal, ie RA

Question 7

Chest structure and motion

Normal breathing

Hoover’s sign

Answer 7

AP diameter= 1/2 width\

diaphragmatic, ab rises with chest during inspiration

Inferior chest pulled in with inspiration (severe hyperexpansion)

Question 8

Severe airflow obstruction

Answer 8

Percussion reveals minimal excursion

Palpation will reveal inward retraction of lower ribs with inspration (Hoovers)

Question 9

Tactile fremitus

Trasmission enhanced with

PNA vs PTX

Pleural effusion and atalectasis

Answer 9

Sound transmitted to chest wall (requires path for airflow)

Greater density

Enhanced. decreased

Reduced bc no bronchial communication

Question 10

Dull note

Hyperresonant

Percussion sounds

Answer 10

Inc density (pleural fluid, consolidation, atalectasis)

Dec density (PTX, hyperexpansion)

Question 11

Continuous (i and e)

Discontinuous (i)

Ausculatation sounds

Answer 11

wheeze (high) narrowed airways (asthma, bronchiectasis, HF)
Rhonchi (low) fluid in large airways (bronchitis/BPNA)

Fine (velcro) opening of alveolar structures (IF, ILD, Bronchiolitis, HF)
Coarse (louder, wetter) fluid in small airways (PNA, florid HF)

Question 12

Consolidation (transmitted sounds)

Bronchophony
Egophony
Whispered pectoriloquoy

Answer 12

B- enhanced, louder

E- e sounds like a

WP- louder, clearer sounds

Question 13

Tracheal shift to dull side

Tracheal shift away from dull side

No tracheal shift (any)

Answer 13

Atalectasis, ptx (Dull is normal)

Pleural effsion (large, acute)

Consolidation (PNA)
Dec breath sounds (atalectasis, pleural effusion)