Thoracic Examination Flashcards
(21 cards)
Thoracic examination for respiratory disorder
Inspection of anterior, lateral and posterior thorax
Palpation of posterior thorax
- General palpation, Symmetrical expansion , Tactile fremitus
Percussion of posterior thorax
Auscultation of posterior thorax
Thoracic examination for cardiovascular disorder
• Inspection of anterior, lateral and posterior thorax
• Palpation
• General palpation of posterior thorax
• Palpation of apex beat in the anterior thorax
• Auscultation of four valve areas in the anterior thorax
• Mitral ,Tricuspid , Aortic and Pulmonic
Common presentations in respiratory and cardiac disorders
Cough
Shortness of breath
Chest pain
Palpitations
Fatigue
Cyanosis or pallor
Presence of bilateral oedema
Past history of respiratory infections
History of smoking
Environmental exposure
Past history of cardiac disorders
Family history
Cardiac risk factors and lifestyle
Inspection of thorax
Facial expression and demeanour
Level of consciousness
Quality of respiration
Effort of breathing
Respiratory rate
Shape of chest and orientation of ribs
Position person takes to breathe
Skin colour and condition
Palpation of thorax
Helps identify skin temperature, moisture, areas of tenderness, superficial lumps or masses, explore any visible skin lesions
Mainly performed on posterior chest wall
Using the pads of your fingers, in round circular motion begin from the apex
of the lungs and work downwards, palpating the entire posterior thorax
Thorax: Symmetric expansion
Unequal expansion can occur with marked atelectasis, lobar
pneumonia, pleural effusion, thoracic trauma or pneumothorax
Confirms equal expansion of thorax on both sides as patient breathes in.
• Place hands together at the level of
T9 or T10.
• Pinch up a small fold of skin between
your thumbs and ask the person to take a
deep breath.
• Both thumbs should move apart
symmetrically with inhalation. Note any
lag in expansion
Thorax: Tactile fremitus
Fremitus=palpable vibration normally most prominent between scapulae, decreases as you progress down. Should feel the same each side.
Decreased fremitus occurs with obstructed bronchus, pleural effusion or
thickening, pneumothorax, or emphysema.
Increased fremitus occurs with compression or consolidation of lung tissue (e.g., lobar pneumonia).
Posterior Thorax: Percussion
Help identify healthy lung tissue
Starting at the apices across the top of shoulders followed by percussing intercostal spaces side to side all the way down the lung region at 5 cm interval
Healthy lung tissue in adult elicit ‘Resonance’- the low-pitched, clear,
hollow sound. Percussion over scapulae and ribs produces flat sound. As
we progress towards the lower region, abdominal viscera/liver leads to
dull percussion notes
Posterior Thorax: Ausculation
Breathing sounds
Posterior chest wall auscultated by standing behind the person, starting from apices at C7 to bases (around T10) and laterally from axilla down to 7th or 8th rib
Auscultation: normal breathing sounds
Larger hollow tubular structures (eg trachea, primary bronchus) produce high pitched loud sounds called bronchial or tracheal sounds
Medium sized airways (eg most of the bronchi, some alveoli) produce mixed quality bronchovesicular sounds
Peripheral lung fields where air flows predominantly through bronchioles and
alveoli have very low pitched soft vesicular sound
Decreased/Absent breath sounds
Occurs with bronchial tree obstruction by secretions, mucus plug, or a foreign body,
Pleurisy or pleural thickening or pneumothorax or pleural effusion
Increased breath sounds
Sounds are louder than their normal pitch. They have a high-pitched, tubular quality, with a prolonged expiratory phase and a distinct pause between inspiration and expiration
Occur with consolidation (e.g., pneumonia) or compression (e.g., fluid in the intrapleural space
Breath sounds: Crackles (fine)
Discontinuous, high-pitched, short crackling, popping sounds heard during inspiration that are not cleared by coughing
Occur with restrictive diseases like pneumonia, heart failure, and interstitial fibrosis or obstructive diseases like chronic bronchitis, asthma, and emphysema
Breath sounds: Crackles (course)
Loud, low-pitched bubbling and gurgling sounds that start in early inspiration and may be present in expiration; may decrease somewhat by suctioning or coughing but reappear shortly
Occur with Pulmonary edema, pneumonia, pulmonary fibrosis, and the terminally ill who have a depressed cough reflex
Breath sounds: Wheeze (high pitched)
High-pitched, musical squeaking sounds that sound polyphonic (multiple notes as in a musical chord); predominate in expiration but may occur in both expiration and inspiration Diffuse airway obstruction from acute asthma or chronic emphysema
Breath sounds: Wheeze (low pitched)
Low-pitched; monophonic, single note, musical snoring, moaning sounds; they are heard throughout the cycle, although they are more prominent on expiration; may clear somewhat by coughing
Bronchitis, single bronchus obstruction
from airway tumor
Breath sounds: Stridor
High-pitched, monophonic, inspiratory, crowing sound; louder in neck than over chest wall
Croup and acute epiglottitis in children
and foreign inhalation
Anterior Thorax: Ausculation
Listening to heart sounds
Can be heard all over precordium
Individual valve auscultation done along direction of blood flow from that valve
Auscultation areas for each valve:
Aortic, Pulmonic, Tricuspid, Mitral (Apex beat)
Aortic valve - in the 2nd right intercostal space, next to sternum.
Pulmonic valve - in the 2nd left intercostal space, next to sternum. The splitting of S2 during forced inhalation can be heard in this area, by asking the person to take a deep breath and hold.
Tricuspid valve - along the left lower sternal border, 4th or 5th intercostal space.
Mitral valve - for an apex beat in the left 5th intercostal space, mid clavicular line. Listen to the S1 and S2. Correlate S1 with the carotid pulse in the neck.
Clinical significance: Murmur
A blowing, swooshing sound that occurs with turbulent blood flow in the heart or great vessels.
Usually caused by incompetent heart valves, valvular heart diseases,
increased viscosity of the blood or increased vascular resistance
Timing, intensity, pitch, pattern and quality usually most important
in determining cause of murmur
Innocent murmurs are non-pathological, generally soft, clearly audible
but faint, mid-systolic, short and with a vibratory or musical quality
Clinical presentation: Heart Failure
Dilated pupils
Skin pale, grey, or cyanotic
Dyspnoea, Orthopnea, crackles, wheeze
Cough with frothy pink or white sputum
Decreased blood pressure
Nausea and vomiting
Ascites
Dependant, pitting oedema in sacrum, legs
Anxiety
Falling O2 saturation
Confusion
Jugular vein distension
Infarct
Fatigue
Heart rate S3 gallop, tachycardia
Decreased urine output
Weak pulse
Cool, moist skin
