08 Pulmonary Exam - Boards and Beyond

Percussion

  • similar to tap on empty barrel, mostly air, hollow
  • dull: full of liquid

Auscultation

  • e.g. decreased breath sound in RUL = pathologic in RUL

  • adventitious: extra or not native

Rales

  • usually on inspiratory to pop open wet alveoli
  • pulmonary edema: gravity pulls water to bottom
  • fibrosis: sticky fibrous tissues

Wheezes

  • usually expiratory when pushing air through narrow bronchi
  • very rare: obstruction to airflow (see localized wheeze in 1 lobe, think tumor)

Rhonchi

  • sounds like water flowing

Bronchial

Stridor

  • most wheezes expiratory, pt try to exhale
  • inspiratory: very unusual
  • loudest at neck: very unusual
  • diptheria: membrane that blocks

  • parainfluenza seal: Seal bark cough seen in Croup (caused by parainfluenza virus)
  • wind blowing in: Inspiratory stridor seen in Croup
  • church with steeple: Patients with Croup will often have a "steeple sign" on Chest X-ray, narrowing of subglottic region

  • child screaming and drooling: Epiglottitis, inflammed epiglottis, inspiratory stridor, drooling
  • chocolate covered cherries, kid with icecream and cherry: Cherry red epiglottis

  • Candy with plastic wrap: Pseudomembrane on throat and tonsils
  • Bull: Bull neck

Pectoriloquy

  • usually shouldn't hear sound through chest.

Fremitus

  • thickened lung tissue, increased fremitus (pneumonia, thickened inflammed tissue)
  • decreased: block transmission of vibration

Nail Clubbing