Pulmonary Physical Exam Flashcards Preview

CVPR: Pulmonary > Pulmonary Physical Exam > Flashcards

Flashcards in Pulmonary Physical Exam Deck (18)
1

Major components of pulmonary physical exam

  • inspection
  • palpation
  • percussion
  • ausculation

2

Possible findings  for inspection portion of pulmonary PE

  • vital signs: heart rate (60- 90 bpm), blood pressure (140/90 or less), temperature (37.0 celsius), respiratory rate (12-20 per minute), oxygen saturation (> 93% in Denver)
  • abnormal findings: Accessory muscle use, tripodding, paradoxical abnominal movement, pursed lip breathing. 
    • Are they cyanotic (peripheral = acrocyanotic)?
    • Clubbing?
    • Skeletal shape?

3

Possible findings on palaption portion of physical exam


  • Tactile fremitus 


    • Decreased

      • pneumothorax



      • pleural effusion 





      • obstructed bronchus (atelectasis - compression of part of lung) 





    • Increased: lung consolidation: water, pus, blood - anything that fills alveoli with fluid

  • position of trachea 

    • atelectasis, fibrosis, resection  pulls trachea toward lesion



    • pleural effusion, tension pneumothorax pushes trachea away from lesion 

4

Possible findings on percussion portion of physical exam


  • Dull: effusion, consolidation, atelectasis 




  • Resonant: Pneumothorax, bullae, emphysema 






  • Diaphragmatic excursion- detect paralysis
     

5

Normal breath sounds

  • Vesicular: soft and low pitched, heard through inspiration and stop ⅓ into expiration, heard through normal chest
     

  • Bronchovesicular: moderate pitch and itnensity, heard during inspiration, gap, expiration, over bronchi

  • Bronchial: high pitched, over trachea

  • Bronchovesicular and Bronchial heard over periphery are abnormal - pneumonia and atelectasis

6

Abnormal breath sounds

  • Rales
  • Rhonchi
  • Wheezes
  • Egophany
  • Stridor (inspiratory & expiratory)
  • Friction Rub

7

Rales characteristics/causes

  • ~ "velcro sound" or popping sounds
  • pulmonary edema
  • pneumonia
  • ILD

8

Rhonchi characteristics/causes

  • snoring-like sound
  • caused by air flowing through airways partially obstructed by mucous

9

Wheezes characteristics/causes

  • high-pitched and musical sound
  • caused by airflow through narrowed airway
    • asthma
    • bronchiolitis
    • COPD

10

Egophany characteristics/causes

  • "E" sound ==> "A" sound
  • usually caused by fluid-filled area as in pneumoni

11

Stridor characteristics/causes

  • musical sounds heard w/o stethescope - inspiratory or expiratory ==> upper airway pathology
  • Inspiratory = laryngospasm, laryngeal edema, subglottic stenosis, vocal cord dysfunction
  • Expritory: central airway obstruction w/in thorax

     




  • Stridor = urgent evaluation!



     

 

 

12

Friction rub characteristics/causes

  • harsh sound during inspiration, like rubbing an inflated balloon
  • infection, malignancy, pulmonary infarct, lupus pleuritis. 

13

Pneumonia PE findings

  • decreased breath sounds
  • rales
  • consolidation w/increased fremitus, egophany, bronchophony ("99""), dullness to percussion
  • fever
  • tachypnea

14

Pleural effusion PE

  • dullness to percussion
  • decreased/absent tactile fremitus
  • decreased breath sounds
  • no voice transmission

15

Atelectasis PE findings

  • Low PaO2
  • cyanosis
  • tachypnea
  • tachycardia

16

Pneumothorax PE findings

  • decreased or absent breath sounds on affected side
  • decreased chest wall motion
  • hyperresonance to percussion
  • decreased fremitus
  • tachycardia common
  • hypotension, cyanosis and tachycardia ==> tension pneumothorax

17

Asthma PE findings

  • wheezes (generally expiratory)
  • normal fremitus
  • normal percussion

18

COPD PE findings

  • Rhonchi in lungs
  • hyperresonace to percussion
  • decreased tactile fremitus