Term
| What are the essential elements of inspection of surface structures? |
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Definition
STIS
1) Surface structures
- Symmetry (Kyphosis, scoliosis) and shape of thorax (pectus excavatum or carinatum)
2) Tracheal position (towards side of volume loss)
- Towards atelectasis and away from tension pneumo
3) Intercostal spaces
- will bulge with inefficient emptying like obstructive disease.
4) Skin
- Scars, rashes (shingles), wounds |
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Term
| How can tracheal deviation help you in narrowing down your ddx? |
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Definition
It will deviate towards the side of volume loss
1) In atelectasis, where lung deflates, it will deviate towards the injury.
2) In tension pnuemothorax, where intrapulmonary volume actually increases (flap opens only during inspiration), trachea will deviate away |
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Term
| If a patient presents with a pattern of apnea alternating with crescendo increases in rate and amplitude of respirations, what should you immediately think of? |
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Definition
Cheyne-Stokes respirations are seen in CHF, Neurological disorders (stroke, infection) and High Amplitude exposure.
1) CHF- Increased circulatory time to brain resulting in delay of PaCO2 signaling changes to respiratory center, as well as increased chemoreceptor sensitivity. |
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Term
| A patient presents with deep regular breaths and you smell a fruity scent. What is going on? |
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Definition
This is Kussmaul respirations in Diabetic Ketoacidosis.
The patient is trying to compensate for the acidosis since dead space is minimized and CO2 elimination is most efficient. |
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Term
| Why would you especially concerned about a patient who presents with alternating apnea and deep regular breathes that terminate abruptly? |
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Definition
This is NOT Cheyne-Stokes (respirations with be crescendo-decrescendo), but BIOT's breathing.
Meningitis! |
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Term
| What is the "RPE" of respiratory inspection? |
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Definition
1) Respiration rate (14-18)
2) Respiration pattern (Cheyne-stokes or Kussmall?)
3) Effort (SCN use? suggests FEV1 <30% of normal) |
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Term
| Why should you be especially worried if the abdominal wall moves inward on inspiration? |
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Definition
This means diaphragm is failing and it is a sign of impending respiratory failure.
SCN is pulling diaphragm up |
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Term
| What are the 3 main respiratory signs that can be detected on Palpation? |
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Definition
1) Chest excursion
- asymmetric expansion may be seen in paralyzed diaphragm, localized pain, fibrosis or airspace disease.
2) Tactile Fremitus
- vibration felt through chest wall indicating lung consolidation
- decreased fremitus indicates airway obstruction (tumor), pleural effusion or pneumothorax
3) Crepitation
- Sub-Q air due to thoracic dieses implying bronchopleural fistula
- Seen in trauma patients, pneumothorax and airway obstruction |
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Term
| Under what conditions might you expect to detect increased/decreased tactile fremitus? |
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Definition
1) Increased in lung consolidation
2) Decreased
- Pneumothorax
- Pleural effusion (effusion moves airways farther from chest wall)
- Airway obstruction from tumor |
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Term
True or False:
In a normal patient, tactile fremitus will be more perceptible in the left upper lung lobe than in the right? |
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Definition
False!
The trachea should be directly entering the right lobe, making the sound more perceptible. |
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Term
| What 4 qualities of sound are you looking for on percussion? |
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Definition
1) Resonant (normal over lung)
2) Hyper-resonant (over emphysematous lung)
3) Tympanitic (gastric bubble)
4) Dull (pleural effusion or consolidated lung)
**Pneumothorax can be hyperresonant or amphoric (bottle/jar sound)** |
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Term
What breath sound is described by each of the following?
1) Inspiratory phase> expiratory phase: audible over anterior and posterior chest walls
2) Inspiratory phase= Expiratory phase
3) Expiration > Inspiration phase heard over trachea
4) Continuous, low-pitched sound heard on expiration |
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Definition
1) Normal Vesicular
2) Bronchovesicular suggesting slight consolidation
3) Bronchial (Tubular) sounds reflection conduction fo sound from large airways indicating consolidation (Pneumonia)
4) Rhonchi found in airway disease like asthma, COPD and secretions |
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Term
When might you hear each of the following breath sounds?
1) Rales/Crackles
2) Rhonchi
3) Wheezing
4) Rubs |
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Definition
1) Parenchymal disease such as HF, Pneumonia or fibrosis
2) Airway disease such as Asthma, COPD or secretions
3) Turbulent airflow in airway obstructive disease or bronchial obstruction from tumor/foreign body
4) Inflammation of either/both pleural surfaces seen in Pneumonia, PE, rheumatological disease and malignancy. |
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Term
| What are the 3 important voice changes that indicate lung consolidation (fluid-filled)? |
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Definition
1) Bronchophony
- Words sound clear and loud over consolidation
2) Whispered pectoriloquy
- Audible patient whispering through stethescope
3) Egophony
- "E" to "A" at periphery of lung |
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Term
A patient displays the following PE findings. What is your diagnosis?
Fremitus: Decreased
Percussion: Dull
Breath sounds: Decreased
Tracheal deviation: None
Pectoriloquy: Absent
Rhales: Absent
Wheezing: Absent |
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Definition
Small pleural effusion that is pushing lungs away from chest wall (decreased fremitus and breath sounds) and dull to percussion.
No tracheal deviation rules out Atelactasis and bronchial plug |
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Term
A patient displays the following PE findings. What is your diagnosis?
Fremitus: Decreased
Percussion: Dull
Breath sounds: Decreased
Tracheal deviation: Left
Pectoriloquy: Absent
Rhales: Absent
Wheezing: Absent |
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Definition
Atalectasis (local collapse) with tracheal deviation to sight of volume loss.
Collapse is decreasing fremitus and breath sounds. |
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Term
A patient displays the following PE findings. What is your diagnosis?
Fremitus: increased
Percussion: Dull
Breath sounds: Bronchial
Tracheal deviation: None
Pectoriloquy: yes
Rhales: yes
Wheezing: Absent |
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Definition
| Massive consolidation in increasing fremitus vibrations, breath sounds at trachea and vocal indications of consolidation (Pectoriloquy and Rhales) |
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Term
A patient displays the following PE findings. What is your diagnosis?
Fremitus: Normal
Percussion: Normal
Breath sounds: Normal
Tracheal deviation: None
Pectoriloquy: No
Rhales: Yes
Wheezing: No |
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Definition
Pulmonary fibrosis.
Isolated rales suggests parenchymal disease |
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