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Thorax and Lungs #2

Chest/Lungs Physical and Exam

Auscultation involves the following: breath sounds, adventitious sounds and voice transmission
Where are vesicular breath sounds heard? over most of both lungs
Where are bronchovesicular breath sounds heard? 1st and 2nd interspaces anteriorly and between the scapulae
Where are bronchial breath sounds heard? over the manubrium (larger proximal airways)
Where are the tracheal breath sounds heard? over the trachea in the neck
When breath sounds are decreased what do they suggest? obstructive lung disease, muscular weakness
When breath sounds are poor in nature, what do they suggest pleural effusion, pneumothorax or COPD
Adventitious breath sounds are sounds that are superimposed on the usual breath sounds
If you hear crackles (rhales), especially those that doesn't clear after coughing, listen for the following characteristics: loudness, pitch, duration (fine/coarse), number, timing, location, persistence (breath to breath), change after cough or change in patient position
What does fine late inpiratory crackles that persist from breath to breath suggest? Abnormal lung tissue
What does clearing of adventitious lung sounds after coughing or position change suggest? Inspissated (thickened or congealed) secretions, seen in bronchitis or atelectasis
Crackle may be from abnormalities in the lungs such as... pneumonia, fibrosis, early heart failure
Crackles may be from abnomalites in the airways such as bronchitis or bronchiectasis
Wheezing suggests narrow airways as in... asthma, COPD or bronchitis
Rhonchi suggests... secretions in the large airways
Assess for transmitted voice sounds are if you hear abnormally located bronchovesicular or bronchial breath sounds.
When the patient says "99", normally the sounds through the chest wall are muffled and indistinct. Increased transmission suggests... that air-filled lungs has become airless
What are louder voice sounds are called? bronchophony
When the patient say "ee", you will normally hear a muffled long e sound. If the "ee" sounds like "a", an E-to-A change or egophony are seen in what? lobar consolidation from pneumonia
In patients with fever, cough, the presence of bronchial breath sounds and egophoney more than triples the likelihood of what disease? pneumonia
Louder, clearer whispered sounds when patients are tolded to whisper "99 or 1-2-3 are called... whispered pectoriloquy
Patients with severe COPD may prefer to sit leaning forward with lips pursed durign exhalation and arms supported on their knees or a table
During inspection of the anterior chest wall you must observe the shape of the patients chest and the movement of the chest wall
Retraction of the lower interspaces during inspiration and supraclavicular restraction ... are chest wall movements that occur in severe asthma, COPD and upper airway obstruction
Palpation of the anterior chest wall is used to... identify tender areas, assess abnormalities, assess chest expansion and tactile fremitus
Tactile fremitus is increased in pneumonia as fluid conducts the sound better causing a stronger vibration
Tactile fremitus is decreased in pleural effusion as the fluid blunts the sound and in pneumothorax as the sounds does not travel well in the air in the pleural space
What is the clinical assessment of the pulmonary function? The 6 min walk test (100ft hallway). It provides a global evaluation of the cardiovascular and pulmonary systems, neuromuscular units and muscle metabolism
What does the Forced Expiratory Time assess? the expiratory phase of breathing which is typically slowed on obstructive pulmonary disease. (FEV/FEV1)
Pain and tenderness over one or more ribs may suggest a... rib fracture which may be tested by doing an AP compression of the chest (sternum and thoracic spine). This will help differentiate from a soft tissue injury.
Created by: cljohnson2000
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