Pulmonary Physical Exam

Question 1

Major components of pulmonary physical exam

Answer 1

• inspection
• palpation
• percussion
• ausculation

Question 2

Possible findings for inspection portion of pulmonary PE

Answer 2

• 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?

Question 3

Possible findings on palaption portion of physical exam

Answer 3

• 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

Question 4

Possible findings on percussion portion of physical exam

Answer 4

• Dull: effusion, consolidation, atelectasis
• Resonant: Pneumothorax, bullae, emphysema
• Diaphragmatic excursion- detect paralysis

Question 5

Normal breath sounds

Answer 5

• 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

Question 6

Abnormal breath sounds

Answer 6

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

Question 7

Rales characteristics/causes

Answer 7

• ~ “velcro sound” or popping sounds
• pulmonary edema
• pneumonia
• ILD

Question 8

Rhonchi characteristics/causes

Answer 8

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

Question 9

Wheezes characteristics/causes

Answer 9

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

Question 10

Egophany characteristics/causes

Answer 10

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

Question 11

Stridor characteristics/causes

Answer 11

• 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!

Question 12

Friction rub characteristics/causes

Answer 12

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

Question 13

Pneumonia PE findings

Answer 13

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

Question 14

Pleural effusion PE

Answer 14

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

Question 15

Atelectasis PE findings

Answer 15

• Low P_aO2
• cyanosis
• tachypnea
• tachycardia

Question 16

Pneumothorax PE findings

Answer 16

• 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

Question 17

Asthma PE findings

Answer 17

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

Question 18

COPD PE findings

Answer 18

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