Thorax/Lungs/Abdomen

Question 1

Barrel Chest

Answer 1

Increased AP diameter of the chest

ex. Chronic Obstructive Pulmonary Disease

Question 2

Pectus Excavatum

Answer 2

Chest deformity characterized by depression of the lower portion of the sternum (“funnel” chest)

(ex. congenital; Rickets; Marfan’s; Cobbler’s Chest)

Question 3

Pectus Carinatum

Answer 3

Chest deformity characterized by the anterior displacement of the sternum (“pigeon” chest)

(ex. congenital; Rickets; Marfan’s)

Question 4

Tactile Fremitus

Answer 4

Palpable vibrations transmitted through the bronchopulmonary tree. Best appreciated by placing the palmar aspect of the metacarpal-phalangeal joints against the thorax.

(ex. increased when there is consolidation as with pneumonia; decreased with a bronchial plug or with pleural effusion.)

Question 5

Percussion Notes

Answer 5

Resonant- (ex. over the normal chest)
Hyperresonant- (ex. in COPD)
Dull- (ex. over the liver)
Flat- (ex. over the thigh muscle)

Question 6

Breath Sounds (Vesicular)

Answer 6

Inspiration is longer that expiration (true over most of the thorax)

Question 7

Breath Sounds (Bronchovesicular)

Answer 7

Inspiration equals expiration in length (between scapulae)

Question 8

Breath Sounds (Bronchial or Tracheal)

Answer 8

Expiration is longer that inspiration (over suprasternal notch

Question 9

Crackles

Answer 9

Relatively brief, inspiratory (primarily) non-musical adventitial sounds heard on auscultation of the chest. Come from small airways and can relate to secretions or fibrosis.

Fine - soft, high pitched (ex. congestive heart failure - CHF)
Coarse - louder, lower in pitch (ex. pneumonia)

Question 10

Rhonchi

Answer 10

Low pitched adventitial sounds heard on auscultation of the chest. They are of longer duration than crackles, a snoring-like quality, come from secretions in large airways.

(ex. Bronchitis)

Question 11

Wheeze

Answer 11

High pitched, musical adventitial sounds heard on auscultation of the chest. They are of longer duration than crackles or rhonchi. Caused by air flow through narrowed airways.

(ex. Asthma (bronchospasm); foreign body in a bronchus)

Question 12

Stridor

Answer 12

An upper airway inspiratory sound caused from airway obstruction in the trachea or larynx. Louder and typically lower pitched than a wheeze. Commonly heard without the stethoscope.

(ex. Acute Laryngotracheobronchitis (Croup); foreign body in the trachea)

Question 13

Bronchophony

Answer 13

Louder than normal and more clearly heard transmitted voice sound.

(ex. “99” increased with consolidation as with pneumonia)

Question 14

Egophony

Answer 14

The spoken letter “E” is heard as “A.” Somewhat of a nasal quality.

(ex. Heard with consolidation as with pneumonia.)

Question 15

Whispered Pectoriloquy

Answer 15

Whispered sounds are heard louder and more clearly.

ex. “99” heard with consolidation as with pneumonia

Question 16

Friction Rub

Answer 16

Pleural and Cardiac
Like pieces of leather rubbed together or a creaking sound. Heard during inspiration and expiration.

(ex. pleuritis; pericarditis)

Question 17

Murmurs

Answer 17

Relatively prolonged extra heart sounds caused by a disruption in blow flow through and out of the heart. Some are “innocent” - non-pathologic; others are pathologic. Can be caused by a septal defect, valvular disease, etc.

Described as systolic and/or diastolic
-also as early, mid, late, holo (pan)
Described as flow or ejection
Described by quality and pitch
Described by duration
Described by location and if radiation

Question 18

Murmurs (cont.)

Answer 18

Loudness is graded
Grade 1: Barely audible
Grade 2: Easily audible
Grade 3: Loud; no palpable thrill
Grade 4: Loud; palpable thrill
Grade 5: Loudest requiring a stethoscope on the chest
Grade 6: Can be heard with stethoscope off the chest

(ex. Grade 3/6 high pitched systolic ejection murmur heard best at)

Question 19

Thrill

Answer 19

Palpable vibration over the chest

ex. May accompany loud murmurs (4/6 or greater in intensity

Question 20

Click

Answer 20

Extra systolic sound of short duration

(ex. Mitral Valve Prolapse

Question 21

Bruit

Answer 21

Basically a murmur over a vessel

ex. Carotid bruit in partial carotid artery occlusion

Question 22

Convex

Answer 22

Gently rounded

Question 23

Flat

Answer 23

Not convex or concave

Question 24

Concave or Scaphoid

Answer 24

Concavity

Question 25

Striae

Answer 25

Streaks most often on abdomen. Collagen fibers disrupted.

(ex. Stretch marks from pregnancy - pink and become silvery with time)
(ex. Striae with Cushing’s Syndrome – purplish pink in color)

Question 26

Bulging Flanks

Answer 26

Prominence of flanks

ex. Ascites - free fluid in the abdomen

Question 27

Bowel Sounds

Answer 27

Borborygmi describes bowel sounds that are frequent and loud peristaltic sounds.

Question 28

Bruit

Answer 28

Murmur over a vessel. Systolic bruits may be heard normally over the aorta, in particular, and sometimes the renal arteries in thin individuals. Both systolic and diastolic bruit over a renal artery suggests renal artery stenosis.

(ex. Renal artery stenosis; abdominal aortic aneurysm)

Question 29

Shifting Dullness

Answer 29

An abnormal finding on percussion of the abdomen - a characteristic physical finding of ascites.

Question 30

Fluid Wave

Answer 30

An abnormal palpable finding on examination of the abdomen - a characteristic of ascites.

Question 31

Percussion

Answer 31

Dullness over liver

Tympanitic with gas in GI tract