Term
| What are the distinguishing characteristics of bronchial versus vesicular sounds? |
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Definition
- Bronchial: loud, high pitched, 1:3 inspiratory to exhalation ratio, sounds tubular. Heard over manubrium
- Vesciular: soft, low pitched, 3:1 inspiration exhalation ratio, sounds like gentle rustling. Heard in peripheral lung
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Term
| When listening to chest, spoken word sounds nasal and louder. When patient is asked to say "eeee" sounds like "aaaa". What is this phenomenon called? What does it indicate? |
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Definition
Egophony
Indicates lobar consolidation (e.g. pneumonia) |
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Term
| You ask the patient to whisper "ninety-nine" as you ascultate. It sounds loud and clear, even in the peripheral sections of the lung. What is this phenomenon called? What does it indicate? |
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Definition
| Whispered pectoriloquy; consolidation (e.g. pneumonia) |
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Term
| You ask the patient to say "ninety-nine" in a normal tone. What would be the normal response? What would be the response in a patient with consolidation due to pneumonia or lung cancer? |
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Definition
| Muffled and indistinct in normal; loud and clear in bronchophony |
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Term
| During the exam, you place the ulnar surface of your hand and ask the patient to speak, observing for vibrations. What are these vibrations called? What would cause them to dissipate? What could cause them to exacerbate? |
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Definition
- Fremitus
- Obstructed bronchus, COPD, separation of the pleural surfaces by fluid (pleural effusion), fibrosis (pleural thickening), air (pneumothorax) or infiltrating tumor
- Consolidation
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Term
| Upon ascultation, you hear short, discontinuous nonmusical sounds during inspiration. What are these called? What can cause them? |
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Definition
Rales
Bronchitis, respiratory infection, pulmonary edema, atelectasis (paralysis of diaphragm), fibrosis, CHF |
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Term
| After percussing the patient's back, you note a unilateral hyperresonance. What does this indicate? How would you change your diagnosis if you heard a uniform hyperresonance? |
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Definition
| Pneumothorax; emphysema/asthma (not reliable sign) |
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Term
| What can cause a dull sounding percussion? |
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Definition
- Fluid/solid tissue replaces air in alveoli (lobar pneumonia)
- Pleural accumulation of serous fluid (pleural effusion), blood (hemothorax), pus (empyema)
- Fibrous tissue
- Tumor
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Term
| A pediatric patient comes in looking distressed and cyanotic. On ascultation, you here a distinct wheeze, but ONLY during inhalation. What is this sound called? Where would expect to here it the loudest? What does it indicate? |
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Definition
- Stridor
- Neck (compared to chest wall)
- Indicates partial obstruction of the larynx or trachea, demanding immediate attention
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Term
| During ascutation, you hear a continuous low-pitched, snoring sound. What is this noise generally called? What is the general cause? |
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Definition
| Rhonchi; secretion in the large airways |
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Term
| How would you locate the right upper lobe from the front? Middle lobe? Lower lobe? |
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Definition
- 2-4cm above the clavicle to the 4th rib
- From 4th rib to the 6th rib along the mid-clavicular line (inframammary)
- Along anterior axillary line near 6th rib
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Term
| How far does the left upper lobe extend along mid axillary line? Left lower lobe? |
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Definition
- Axillary --> 5th rib
- 5th rib --> 8th rib
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Term
| What is the range of the lower lobes from the posterior surface? |
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Definition
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Term
| Where is the best place to examine RML? Apices? |
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Definition
- Anteriorly, between 4th and 6th rib
- Supraclavicular fossae
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Term
| From inspiration to expiration, the point of dullness shifts upwards. What is this phenomenon called? What can cause it to decrease bilaterally? Unilaterally? |
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Definition
- Diaphragmatic excursion (note: normal is 3-5 cm)
- COPD
- Phrenic deenervation
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Term
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Definition
| Wheezing; indicative of asthma, pulmonary edema, bronchitis CHF |
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Term
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Definition
| Vesicular breathing; normal |
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Term
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Definition
Crackles
- Early = chronic bronchitis, pulmonary edema
- Late = pneumonia, ARDS (?)
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Term
| Where is the most likely place to hear bronchovesicular noise? |
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Definition
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Term
| Young patient presents with tachypnea, tachycardia and dyspnea. He uses his accessary muscles to breath. He has decreased fremitus, and normal percussion. Auscultation shows prolonged expiration, wheezing and decreased lung sound. Thoughts? |
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Definition
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Term
| Elderly patient comes in with increased anteroposterior diameter, using acessory muscles. Decrease tactile fremitus, with increased resonances and decreased excursion of diaphragm. Decreased lung sounds. |
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Definition
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Term
| Patient presents with tachycardia and mild cyanosis. Palpation and percussion are both normal. You hear early crackles and ronchi on auscultation. What is the most likely diagnosis? |
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Definition
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Term
| Patient presetns with tachycardia, fever, and tachpnea, with splinting on left side. You note increased tactile fremitus on the left side, along with dull percussion. Auscultation shows late crackles with bronchial breath sounds. On chest excursion, there's a distinct asymmetry. What is the most likely diagnosis? |
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Definition
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Term
| Patient comes in with tachycardia, tachypnea, and signs of elevated right heart pressure. Palpation and percussion are normal, but auscultation shows early crackles and wheezes. What is the most likely diagnosis? |
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Definition
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Term
| Patient presents with absent fremitus and trachea shifted to his left side. This side is hyperresonant and is absent of breath sounds. What is the most likely diagnosis? |
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Definition
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Term
| Patients presents with decreased fremitus and trachea shifted to left side. The RIGHT side is dull to percussion and absent of breath sounds. What is the most likely diagnosis? |
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Definition
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Term
| Patient presents with decreased fremitus and trachea shifted to the right side. This side is also dull to percussion and absent of breath sounds. On chest excursion, there's a distinct asymmetry. What is the most likely diagnosis? |
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Definition
| Atelectasis (collapse of lung) |
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Term
| Patient presents with cyanosis and observable accessory breathing muscles. Auscultation initially sounds normal, but you can hear crackling and decreased lung sounds later. What is the most likely diagnosis? |
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Definition
| ARDS (acute respiratory distress syndrome) |
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Term
| Patient presents with assymetrical chest excursion, dullness to percussion, absent breath sounds and tactile fremitus. What is the most likely diagnosis? |
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Definition
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