Normlal and abnormal findings Thorax

Question 1

Cough - Duration & Timing

Answer 1

Normal:
No persistent cough or occasional short-lived cough due to irritants.
Abnormal:

Duration: Acute (<3 weeks), Chronic (>2 months).
Timing:
- Continuous: respiratory infection.
- Nighttime: sinusitis/postnasal drip.
- Morning (smoker’s bronchitis)

Question 2

Cough - abnormal Sputum Characteristics

Answer 2

Yellow/Green: Bacterial infections.
Rust-colored: TB, pneumococcal pneumonia.
Pink Frothy: Pulmonary edema.
Foul Odor: Severe infections.

Question 3

Cough - abnormal Sounds & Triggers

Answer 3

Sounds
- Hacking: Mycoplasma pneumonia.
- Barking: Croup. (infection)
- Dry: Heart failure.
- Congested: Bronchitis, pneumonia.
Triggers: Activity, lying down, anxiety, or cold exposure.

Question 4

Shortness of Breath (SOB)

Answer 4

SOB at rest or mild exertion.
Orthopnea: Difficulty breathing lying down. (HF)
Paroxysmal nocturnal dyspnea: Waking with SOB. (could be heart failure related)
Cyanosis: Bluish lips/nails. (hypoxia)
Wheezing sound. (airway obstruction)

Question 5

Chest Pain with Breathing

Answer 5

Burning, stabbing, or localized pain.
Associated with fever, coughing, or deep breathing.
Unequal chest rise or fall.
Pain following trauma or respiratory infection, or heart disease

Question 6

Respiratory Infections - History

Answer 6

Frequent or severe respiratory infections (e.g., pneumonia, bronchitis).
Family history of TB, allergies, or asthma.

Question 7

Smoking History

Answer 7

Current smoker with high pack-years.
Difficulty quitting; strong triggers.
Exposure to secondhand smoke

Question 8

Environmental Exposure

Answer 8

Risk Factors:
Exposure to pollutants (coal, pesticides, silica).
Symptoms from work-related irritants (e.g., “farmer’s lung”).
Protective Measures:
Use of masks, periodic health checks.
Poor ventilation or radon exposure: higher risk of lung cancer.
Risk of pneumoconiosis, asthma, or COPD.

Question 9

Impact on Activities of Daily Living (ADLs) (normal vs abnormal)

Answer 9

Normal:
No significant limitations.
Abnormal:
Fatigue or difficulty performing tasks like walking or climbing stairs.
Weight changes or reduced capacity due to chronic conditions (e.g., COPD).

Question 10

Thoracic Cage(normal vs abnormal)

Answer 10

Normal: Elliptical shape, straight spine, ribs sloping ~45° to spine.
Abnormal: Barrel chest (horizontal ribs), skeletal deformities (scoliosis, kyphosis).

Question 11

Muscle Tone(normal vs abnormal)

Answer 11

Normal: Neck/trapezius consistent with age/occupation.
Abnormal: Hypertrophy (COPD).

Question 12

Posture(normal vs abnormal)

Answer 12

Normal: Relaxed, upright.
Abnormal: Tripod position (COPD)

Question 13

Skin(normal vs abnormal)

Answer 13

Normal: No cyanosis/pallor.
Abnormal: Cyanosis (hypoxia), pallor, lesions
can reflect poor perfusion

• Pallor (white): Loss of red-pink tones from oxygenated hemoglobin; seen in high-stress states (anxiety, fear), cold, smoking, or edema. In dark-skinned individuals, may appear as ashen-gray.
• Cyanosis (blue): Indicates a lack of oxygen; appears in areas like lips, nail beds, or under the tongue.

Question 14

Symmetrical Expansion(normal vs abnormal)

Answer 14

Normal: Thumbs move symmetrically.
Normal: Symmetrical expansion.
Abnormal: Asymmetry (atelectasis, pneumothorax), pain (pleuritis), fractured rib

Question 15

Tactile Fremitus(normal vs abnormal)

Answer 15

Normal: Symmetrical vibrations when saying “ninety-nine.” Strongest between scapulae/sternum; decreases downward. Greater in thin chest walls or deep voices.
Abnormal: Increased (consolidation= pneumonia), Decreased: Obstructions (e.g., pneumothorax, pleural effusion).
Rhonchal Fremitus: Thick secretions.
Pleural Fremitus: Pleural inflammation

Question 16

Palpation(normal vs abnormal)

Answer 16

Normal: No tenderness, lumps, or crepitus (popping, clicking or crackling sound in a joint).
Abnormal:
Tenderness: Trauma/inflammation.
Crepitus: Subcutaneous emphysema.

Question 17

Percussion(normal vs abnormal)

Answer 17

Normal: Resonance over healthy lungs.
Abnormal:
Hyper-resonance: Excess air (e.g., emphysema).
Dullness: Increased density (e.g., tumor, pneumonia).

Question 18

Auscultation(normal vs abnormal)

Answer 18

Normal: Clear, vesicular sounds in peripheral lungs.
General Auscultation (Anterior, Posterior, Lateral):
Rationale: Normal sounds include bronchial (trachea), bronchovesicular (major airways), and vesicular (peripheral lung fields).

Abnormal:
- Crackles (pneumonia, fluid overload), wheezes suggest airway narrowing (asthma, COPD), or absent sounds (e.g., atelectasis, obstruction)

Question 19

Voice Sounds(normal vs abnormal)

Answer 19

Bronchophony: Normal: Muffled “ninety-nine”. Abnormal: Clear “ninety-nine” suggests lung consolidation.
Egophony: Normal: “Eeee” sound. Abnormal: “Eeee” changes to “Aaaa” with compression/consolidation.
Whispered Pectoriloquy: Normal: Faint “one-two-three.” Abnormal: Clear, loud whisper over consolidation.

Question 20

Diaphragmatic Excursion(normal vs abnormal)

Answer 20

Normal: Should be 3-5 cm bilaterally, up to 7-8 cm in well-conditioned patients.
Abnormal:
Asymmetry or absence of excursion.

Question 21

Pulmonary Function Testing(normal vs abnormal)

Answer 21

Normal Forced Expiratory Time (FET): < 4 seconds.
Abnormal: FET > 6 seconds suggests obstructive lung disease.

Question 22

Thoracic Shape(normal vs abnormal)

Answer 22

Normal chest has an elliptical shape, with a 1:2 to 5:7 anteroposterior-to-transverse ratio. A barrel chest shows equal AP-to-transverse ratio with horizontal ribs, common in emphysema and aging.

Question 23

Pectus Excavatum(normal vs abnormal)

Answer 23

Sunken sternum, noticeable on inspiration. Can be congenital and asymptomatic but may require surgery in severe cases.

Question 24

Pectus Carinatum(normal vs abnormal)

Answer 24

Protrusion of the sternum, sometimes with vertical depressions along ribs. Generally, no treatment unless severe

Question 25

Scoliosis(normal vs abnormal)

Answer 25

Lateral curvature of the spine, causing asymmetry in shoulders, scapulae, and hips. Severe cases can impair lung volume

Question 26

Kyphosis(normal vs abnormal)

Answer 26

Excessive curvature of the thoracic spine, causing pain and limited movement. Common in older adults, especially postmenopausal women.

Question 27

Abnormal Lung sounds

Answer 27

Discontinuous Sounds Fine Crackles: Short, high-pitched, and non-clearing with coughing. Found in restrictive diseases (e.g., pneumonia). Coarse Crackles: Loud, low-pitched, bubbling sounds in early inspiration and sometimes in expiration. Associated with pulmonary edema and pneumonia. Atelectatic Crackles: Disappear after first few breaths, common in bedridden or recently aroused patients. Pleural Friction Rub: Coarse, grating sound during inspiration and expiration caused by pleural inflammation. Continuous Sounds High-Pitched Wheeze: Musical, squeaking sounds heard mainly in expiration, indicating airway obstruction (e.g., asthma, emphysema). Low-Pitched Wheeze: Snoring or moaning sound, can clear somewhat with coughing. Seen in bronchitis. Stridor: High-pitched, inspiratory crowing sound indicating upper airway obstruction (e.g., croup, foreign body).