Podcast
Questions and Answers
Which diagnostic study could aid in identifying gastroesophageal reflux disease as a cause of chronic dyspnea?
Which diagnostic study could aid in identifying gastroesophageal reflux disease as a cause of chronic dyspnea?
- Pulmonary function testing (PFT)
- Jugular venous distention (JVD) assessment
- Esophageal pH monitoring (correct)
- Electrocardiography (ECG)
Atrophy is a likely examination finding in a patient with respiratory muscle weakness due to phrenic nerve palsy.
Atrophy is a likely examination finding in a patient with respiratory muscle weakness due to phrenic nerve palsy.
True (A)
What respiratory examination finding might be present in a patient experiencing anxiety-related dyspnea?
What respiratory examination finding might be present in a patient experiencing anxiety-related dyspnea?
Sighing
In bronchophony, normal voice transmission should be soft, __________, and indistinct.
In bronchophony, normal voice transmission should be soft, __________, and indistinct.
Match the voice sound technique with its expected finding in a healthy individual:
Match the voice sound technique with its expected finding in a healthy individual:
During bronchophony, a patient repeats "ninety-nine." What does a clear transmission of the phrase suggest?
During bronchophony, a patient repeats "ninety-nine." What does a clear transmission of the phrase suggest?
In egophony, a healthy individual will exhibit a change from an 'eeeee' sound to an 'aaaaa' sound when auscultating over the lungs.
In egophony, a healthy individual will exhibit a change from an 'eeeee' sound to an 'aaaaa' sound when auscultating over the lungs.
What change in sound is expected during egophony when auscultating over an area of lung consolidation?
What change in sound is expected during egophony when auscultating over an area of lung consolidation?
In whispered pectoriloquy, the whispered sound is normally faint, muffled, and almost __________.
In whispered pectoriloquy, the whispered sound is normally faint, muffled, and almost __________.
Match each voice sound finding with its corresponding clinical significance:
Match each voice sound finding with its corresponding clinical significance:
During whispered pectoriloquy, what does the clear and distinct transmission of a whispered phrase suggest?
During whispered pectoriloquy, what does the clear and distinct transmission of a whispered phrase suggest?
Decreased respiratory rate and pulse are typical inspection findings in atelectasis.
Decreased respiratory rate and pulse are typical inspection findings in atelectasis.
What percussion sound is typically heard over an area affected by atelectasis?
What percussion sound is typically heard over an area affected by atelectasis?
In atelectasis, tactile fremitus is typically __________ or absent over the affected area.
In atelectasis, tactile fremitus is typically __________ or absent over the affected area.
Match the condition with its expected auscultation finding:
Match the condition with its expected auscultation finding:
In a patient with atelectasis due to airway obstruction, what adventitious sounds are typically heard?
In a patient with atelectasis due to airway obstruction, what adventitious sounds are typically heard?
In normal lung assessment, the anteroposterior (AP) diameter is greater than the transverse diameter.
In normal lung assessment, the anteroposterior (AP) diameter is greater than the transverse diameter.
What is the expected percussion note over normal lung tissue?
What is the expected percussion note over normal lung tissue?
Normal respiratory rate typically falls within the range of __________ to 20 breaths per minute.
Normal respiratory rate typically falls within the range of __________ to 20 breaths per minute.
Match the lung condition with its characteristic inspection finding:
Match the lung condition with its characteristic inspection finding:
What does symmetric chest expansion during palpation typically indicate?
What does symmetric chest expansion during palpation typically indicate?
Tactile fremitus increases as you move towards the periphery of the lungs in a healthy individual.
Tactile fremitus increases as you move towards the periphery of the lungs in a healthy individual.
What finding on palpation would suggest the presence of masses or inflammation in the lungs?
What finding on palpation would suggest the presence of masses or inflammation in the lungs?
Breath sounds heard parasternally and between the scapulae are termed __________.
Breath sounds heard parasternally and between the scapulae are termed __________.
Match each term with their definition:
Match each term with their definition:
In atelectasis, tracheal shift occurs toward the affected side during:
In atelectasis, tracheal shift occurs toward the affected side during:
The word 'Wheezes' is an example of voice sounds.
The word 'Wheezes' is an example of voice sounds.
During an assessment of voice sounds, what instruction would you give to the patient to assess egophony?
During an assessment of voice sounds, what instruction would you give to the patient to assess egophony?
Airway obstruction is one potential cause of _________.
Airway obstruction is one potential cause of _________.
Match the following conditions with their respiratory findings:
Match the following conditions with their respiratory findings:
Which finding on auscultation indicates an increased lung density?
Which finding on auscultation indicates an increased lung density?
Adventitious sounds are typically present in normal lung function.
Adventitious sounds are typically present in normal lung function.
What does it mean if a patient has cyanosis during physical examination?
What does it mean if a patient has cyanosis during physical examination?
During percussion of the chest, a __________ note suggests the presence of consolidation.
During percussion of the chest, a __________ note suggests the presence of consolidation.
Match each respiratory assessment technique to what it evaluates.
Match each respiratory assessment technique to what it evaluates.
Which of the following is NOT an expected finding in a patient experiencing anxiety-related dyspnea?
Which of the following is NOT an expected finding in a patient experiencing anxiety-related dyspnea?
Whispered pectoriloquy detects only large amounts of consolidation.
Whispered pectoriloquy detects only large amounts of consolidation.
What pathology does the presence of a 'bleating' sound when auscultating 'EEE' indicate?
What pathology does the presence of a 'bleating' sound when auscultating 'EEE' indicate?
When alveoli collapse to form a shrunken section of lung tissue, it is called ______.
When alveoli collapse to form a shrunken section of lung tissue, it is called ______.
Match each term with their clinical significance:
Match each term with their clinical significance:
Flashcards
Normal Bronchophony
Normal Bronchophony
Soft, muffled, and indistinct voice transmission when auscultating the chest wall. You can hear sound but not distinguish words.
Abnormal Bronchophony
Abnormal Bronchophony
Clear "ninety-nine" sound auscultated over the chest wall, indicating increased lung density.
Abnormal Egophony
Abnormal Egophony
Over an area of lung consolidation, the spoken "eeee" sound changes to a bleating long "aaaaa" sound.
Atelectasis (Collapse)
Atelectasis (Collapse)
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Causes of Atelectasis
Causes of Atelectasis
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Inspection Findings in Atelectasis
Inspection Findings in Atelectasis
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Palpation Findings in Atelectasis
Palpation Findings in Atelectasis
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Percussion Note in Atelectasis
Percussion Note in Atelectasis
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Auscultation Findings in Atelectasis
Auscultation Findings in Atelectasis
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Adventitious Sounds in Atelectasis
Adventitious Sounds in Atelectasis
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Study Notes
- Diagnostic clues to chronic dyspnea and associated systems cover gastrointestinal, neuromuscular, and psychological systems.
Gastrointestinal
- Aspiration related to gastroesophageal reflux disease may present with postprandial night cough and intermittent crackles or wheezes.
- Diagnostic studies for gastrointestinal issues include chest radiography, esophagography, and esophageal pH measurement.
Neuromuscular
- Respiratory muscle weakness from phrenic nerve palsy or neuromuscular disorders can manifest as atrophy.
- Maximal inspiratory and expiratory pressures can be measured to diagnose neuromuscular issues.
Psychological
- Anxiety, depression, or a history of trauma or abuse may manifest as sighing.
- Psychological causes of dyspnea may result in no abnormal findings.
Voice Sounds
- Voice sounds include bronchophony, egophony, and whispered pectoriloquy.
Bronchophony
- Bronchophony technique: instruct the patient to say "ninety-nine" while auscultating over the chest wall with a stethoscope, especially when pathology is suspected.
- Normal bronchophony: Normal voice transmission should sound soft, muffled, and indistinct. It should be possible to hear sounds through the stethoscope, but not distinguish the words clearly.
- Abnormal bronchophony: With pathology, lung density increases enhancing the transmission of voice sounds creating a clear "ninety-nine" sound. The sound is more than normal and sounds close to the ear.
Egophony
- Egophony technique: Auscultate the chest while a person phonates a long "ee-ee-ee-ee" sound.
- Normal egophony: With normal lungs, the "eeeeeeee" sound should be heard through the stethoscope.
- Abnormal egophony: Over an area of consolidation or compression, the spoken "eeee" sound changes to a bleating long "aaaaa" sound.
Whispered Pectoriloquy
- Whispered Pectoriloquy technique: ask the person to whisper a phrase such as "one-two-three" as you auscultate.
- Normal Whispered Pectoriloquy: The normal response is faint, muffled, and almost inaudible.
- Abnormal Whispered Pectoriloquy: With only small amounts of consolidation, the whispered voice is transmitted very clearly and distinctly, although still somewhat faint; it sounds as if the person is whispering right into your stethoscope "one-two-three".
Assessment of Common Respiratory Conditions
- Normal lung is compared to atelectasis.
Normal Lung (for Comparison)
- Inspection: AP < transverse diameter, relaxed posture, normal musculature; rate 10 to 20 breaths/min, regular, no cyanosis or pallor, vital signs WNL.
- Palpation: Symmetric chest expansion. Tactile fremitus present and equal bilaterally, diminishing toward periphery. No lumps, masses, or tenderness.
- Percussion: Resonant.
- Auscultation: Vesicular over peripheral fields. Bronchovesicular parasternally (anterior) and between scapulae (posterior). Infant and young child – bronchovesicular throughout.
- Adventitious Sounds: None.
Atelectasis (Collapse)
- Condition: Collapsed shrunken section of alveoli or an entire lung as a result of (1) airway obstruction; (2) compression on the lung; or (3) lack of surfactant.
- Inspection: Cough. Lag on expansion on affected side. Increased respiratory rate and pulse. Possible cyanosis.
- Palpation: Chest expansion decreased on affected side. Tactile fremitus decreased or absent over area. With large collapse, tracheal shift toward affected side.
- Percussion: Dull over area.
- Auscultation: Breath sounds decreased vesicular or absent over area. Voice sounds variable, usually decreased or absent over affected area.
- Adventitious Sounds: None if bronchus is obstructed. Occasional fine crackles if bronchus is patent.
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