Lung Physical Exam Techniques

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Questions and Answers

What sound is heard during percussion of a normal lung?

  • Dull
  • Flat
  • Hyper resonant
  • Resonant (correct)

What condition is likely indicated by dull sounds during percussion?

  • Normal lung function
  • Pneumothorax
  • Consolidation due to pneumonia (correct)
  • Emphysema

Which method uses a stethoscope to examine lung sounds?

  • Inspection
  • Percussion
  • Palpation
  • Auscultation (correct)

What type of lung sounds are predominantly heard in pathological processes?

<p>Decreased (A)</p> Signup and view all the answers

What causes hyper resonant sounds during percussion?

<p>Extra air inside the rib cage (C)</p> Signup and view all the answers

Which of the following is NOT a technique used in the lung physical exam?

<p>Palpation (A)</p> Signup and view all the answers

What sound would be expected when tapping on the thorax of a patient with emphysema?

<p>Hyper resonant (D)</p> Signup and view all the answers

What type of breath sounds are considered normal?

<p>Vesicular (A)</p> Signup and view all the answers

What does pectoriloquy indicate when abnormal sounds are heard through the chest?

<p>Fluid in the lungs (C)</p> Signup and view all the answers

Which type of pectoriloquy is characterized by the patient saying '99' in a soft whispered voice?

<p>Whisper pectoriloquy (A)</p> Signup and view all the answers

What is the abnormality detected during egophony?

<p>Eee sounds like Aaa (D)</p> Signup and view all the answers

Which condition is primarily associated with increased fremitus?

<p>Pneumonia (A)</p> Signup and view all the answers

What finding is associated with decreased fremitus?

<p>Pleural effusion (A)</p> Signup and view all the answers

What physical exam finding indicates the presence of nail clubbing?

<p>A rounded bulge of the nail bed (D)</p> Signup and view all the answers

Which of the following conditions is NOT commonly associated with nail clubbing?

<p>Atelectasis (B)</p> Signup and view all the answers

What is the primary method used to detect fremitus during a physical examination?

<p>Feeling vibrations through the patient's back (A)</p> Signup and view all the answers

What causes the abnormal lung sounds associated with pectoriloquy findings?

<p>Fluid in the lungs (C)</p> Signup and view all the answers

In the context of lung examination, what does 'bronchophony' refer to?

<p>Increased clarity of voice sounds (A)</p> Signup and view all the answers

What does the presence of decreased breath sounds over the right upper lobe indicate?

<p>Pathologic process in the right upper lobe (A)</p> Signup and view all the answers

What are rales commonly referred to as?

<p>Crackles (D)</p> Signup and view all the answers

In which condition are rales most typically heard?

<p>Pneumonia (C)</p> Signup and view all the answers

What is the main cause of wheezes during an asthma attack?

<p>Narrowing of the bronchi (A)</p> Signup and view all the answers

What characterizes rhonchi in terms of their sound?

<p>Deep and coarse (D)</p> Signup and view all the answers

Where are bronchial breath sounds typically heard?

<p>In areas of lung consolidation (A)</p> Signup and view all the answers

What differentiates stridor from other wheezes?

<p>It is predominantly a high-pitched sound (D)</p> Signup and view all the answers

Which condition can cause localized wheezing in one lobe of the lung?

<p>Tumor (A)</p> Signup and view all the answers

Which of the following conditions is associated with cardiac asthma?

<p>Congestive heart failure (A)</p> Signup and view all the answers

What is typically heard with pectoriloquy during auscultation?

<p>Clear sounds through the chest (C)</p> Signup and view all the answers

What kind of lung sounds are associated with pulmonary edema?

<p>Rales usually in the lower lobes (D)</p> Signup and view all the answers

In which lung condition might you hear an inspiratory wheeze that primarily occurs in children?

<p>Croup (C)</p> Signup and view all the answers

Which of the following conditions can result in bronchial breath sounds?

<p>Lung consolidation (B)</p> Signup and view all the answers

What characterizes a wheeze during an asthma attack?

<p>Occurs due to airflow through narrowed bronchi (A)</p> Signup and view all the answers

The first method to examine the lung is through ______.

<p>percussion</p> Signup and view all the answers

Abnormal findings to percussion can include dull or ______ sounds.

<p>hyper resonant</p> Signup and view all the answers

Normal breath sounds during auscultation are described as ______.

<p>vesicular</p> Signup and view all the answers

Dull sounds to percussion suggest ______ or consolidation in the lungs.

<p>pleural effusion</p> Signup and view all the answers

Hyper resonant sounds are often a sign of air being ______.

<p>trapped</p> Signup and view all the answers

Auscultation is done by placing a ______ against the patient's back.

<p>stethoscope</p> Signup and view all the answers

During a normal percussion exam, sounds are described as ______.

<p>resonant</p> Signup and view all the answers

The sounds heard during percussion are affected by whether the space around the lungs is filled with ______ or air.

<p>fluid</p> Signup and view all the answers

Pectoriloquy indicates that sounds can be heard over the chest through the ______.

<p>stethoscope</p> Signup and view all the answers

In bronchophony, voice sounds are louder and clearer when listening to the patient's chest with a ______.

<p>stethoscope</p> Signup and view all the answers

Whisper pectoriloquy involves asking the patient to say ______ in a very soft whispered voice.

<p>99</p> Signup and view all the answers

Egophony is when the patient says ______ and it sounds like an Aaaaay if there is an abnormality in the lungs.

<p>Eeeeee</p> Signup and view all the answers

Increased fremitus occurs when there is ______ in the lung tissue.

<p>thickening</p> Signup and view all the answers

Decreased fremitus is often caused by conditions such as ______, pneumothorax, and atelectasis.

<p>pleural effusion</p> Signup and view all the answers

Nail clubbing is associated with various pulmonary diseases, including ______ and cystic fibrosis.

<p>bronchiectasis</p> Signup and view all the answers

Patients with clubbing show a nail bed that bulges out instead of having a gentle downward ______.

<p>slope</p> Signup and view all the answers

The presence of abnormal pectoriloquy findings often indicates that there is ______ in the lungs.

<p>fluid</p> Signup and view all the answers

In pneumonia, the inflamed lung tissue leads to ______ fremitus compared to normal lung tissue.

<p>increased</p> Signup and view all the answers

Decreased breath sounds over the right upper lobe indicate some type of ______ process in that area.

<p>pathologic</p> Signup and view all the answers

Abnormal lung sounds are referred to as ______ lung sounds.

<p>adventitious</p> Signup and view all the answers

Rales are also known as ______ due to the sound they produce.

<p>crackles</p> Signup and view all the answers

One common cause of rales is ______ edema, which causes fluid accumulation in the lungs.

<p>pulmonary</p> Signup and view all the answers

Wheezes typically occur when air flows through narrowed ______.

<p>bronchi</p> Signup and view all the answers

A classic cause of wheezing is ______, often seen during exacerbations.

<p>asthma</p> Signup and view all the answers

Rhonchi sound coarse due to the presence of ______ in the large airways.

<p>secretions</p> Signup and view all the answers

Bronchial breath sounds are often associated with ______ that has consolidation.

<p>pneumonia</p> Signup and view all the answers

Stridor indicates partial obstruction of the ______ or trachea.

<p>larynx</p> Signup and view all the answers

A classic cause of stridor in children is ______, usually a viral infection.

<p>croup</p> Signup and view all the answers

Epiglottitis can cause stridor and is a serious condition often related to ______ infection.

<p>Hib</p> Signup and view all the answers

When patients speak, you should not be able to hear them clearly during ______.

<p>pectoriloquy</p> Signup and view all the answers

In addition to rales, patients with pneumonia may also exhibit ______ breath sounds.

<p>bronchial</p> Signup and view all the answers

Wheezes can be either ______ or expiratory and indicate airway obstruction.

<p>inspiratory</p> Signup and view all the answers

Localized wheezing may indicate an ______ to airflow, such as from a tumor.

<p>obstruction</p> Signup and view all the answers

Flashcards

Lung Percussion

Tapping on the chest wall to assess lung sounds.

Resonant Lung Sound

Hollow sound, like tapping on an empty barrel, heard during normal lung percussion.

Dull Lung Sound

Sound heard when tapping on a fluid-filled lung, similar to tapping on a full barrel.

Hyper-Resonant Lung Sound

Louder than normal sound, like tapping on an excessively inflated barrel, indicating trapped air.

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Lung Auscultation

Listening to lung sounds with a stethoscope.

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Vesicular Breath Sounds

Normal breath sounds heard during auscultation.

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Decreased Lung Sounds

Pathologic condition, often abnormal, lung sounds that are quieter than expected.

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Pleural Effusion

Fluid in the pleural space (area between lungs and chest wall)

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Pectoriloquy

Able to hear sounds over the chest through stethoscope, usually muted. Loud and clear sounds are abnormal.

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Bronchophony

Voice sounds are louder and clearer when listening to the chest with a stethoscope. An abnormal finding.

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Whisper Pectoriloquy

Patient whispers '99, 99, 99'. Sounds should be muffled; clear sounds are abnormal.

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Egophony

Patient says "eeeee", sound changes to "aaaa" - abnormal.

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Pneumonia Consolidation

Lung tissue becomes thickened, causing abnormal sounds.

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Fremitus

Vibrations felt when patient says '99'. Varying with lung tissue density

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Increased Fremitus

Stronger vibrations felt, usually due to thickened lung tissue (as in pneumonia).

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Decreased Fremitus

Weaker vibrations, due to blocked vibrations (pleural effusion, pneumothorax).

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Nail Clubbing

Nail beds become rounded, not sloping, associated with lung diseases.

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Adventitious lung sounds

Extra or non-native lung sounds not normally present.

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Rales (Crackles)

Crackling sounds during inhalation due to small airways opening after collapse.

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Pulmonary edema rales

Rales in the lower lung fields due to fluid buildup.

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Pneumonia rales

Rales in the affected lung lobe due to inflammation.

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Wheezes

High-pitched whistling sounds during breathing from narrowed airways.

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Asthma wheezes

Wheezes caused by inflamed and narrowed airways in asthma.

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Cardiac asthma

Wheezing caused by heart failure.

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Rhonchi

Coarse, rattling sounds caused by secretions in large airways.

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COPD rhonchi

Rhonchi frequently linked with COPD exacerbations.

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Bronchial breath sounds

High-pitched, hollow sounds like air through a tube, often with long exhalation.

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Pneumonia bronchial sounds

Bronchial sounds present in pneumonia when part of the lung becomes solid (consolidated).

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Stridor

Sound during inspiration (breathing in) caused by narrowed upper airway.

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Stridor location

Stridor sounds loudest in the neck area, not in the lungs.

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Croup

Viral infection causing an inflamed upper airway.

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Percussion

Tapping on the chest wall to assess lung sounds. Different sounds indicate different lung conditions.

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Resonant Sound

Normal lung sound that is hollow, like tapping on an empty barrel. Shows mostly air in the lung.

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Dull Sound

Abnormal lung sound, like tapping on a full barrel. Indicates fluid in the lung.

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Hyper-Resonant Sound

Louder than normal lung sound. Indicates too much air in the lung.

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Auscultation

Listening to lung sounds using a stethoscope. Helps identify normal and abnormal lung conditions.

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Epiglottitis

Severe inflammation of the epiglottis (flap of tissue that covers the trachea) that can cause stridor, usually in children.

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Study Notes

Lung Physical Exam

  • Exam Techniques: Lung exams use percussion, auscultation, and special techniques like fremitus and pectoriloquy.

  • Percussion: Used to assess lung sounds by tapping on the chest wall.

    • Resonant sounds: Normal; sound like tapping on an empty barrel, indicating air-filled lungs.
    • Dull sounds: Abnormal; sound like tapping on a liquid-filled barrel. Indicates fluid in or around the lungs (pleural effusion, pneumonia consolidation).
    • Hyperresonant sounds: Abnormal; abnormally resonant, more resonant than normal. Indicates trapped air in the chest (pneumothorax, emphysema).
  • Auscultation: Listening to lung sounds with a stethoscope.

    • Normal Breath Sounds (Vesicular): The expected sound during breathing; not detailed but is the baseline for comparison to abnormal findings.
    • Decreased Breath Sounds: Abnormal; indicate a pathologic process in the affected lung area.
  • Abnormal Breath Sounds (Adventitious): Sounds not normally heard.

    • Rales (Crackles): Popping or crackling sounds, usually on inspiration. Caused by small airways popping open. Common locations include pulmonary edema, pneumonia, and interstitial fibrosis, with location often relating to fluid distribution due to gravity.
    • Wheezes: Whistling or musical sounds, usually on expiration. Caused by narrowed airways. Common causes include asthma, heart failure (cardiac asthma), chronic bronchitis, and rarely, tumors. Localized wheezing to one lobe suggests potential tumor.
    • Rhonchi: Coarse, rattling sounds, usually on both inspiration and expiration. Caused by secretions in larger airways; common in COPD exacerbations.
    • Bronchial Breath Sounds: High-pitched, hollow sounds, like air flowing through a tube. Longer expiratory phase; commonly found in pneumonia with consolidation.
    • Stridor: A high-pitched, inspiratory wheeze, loudest over the neck. Indicates a partial obstruction of the larynx or trachea; usually a sign of impending respiratory dysfunction. Causes include laryngotracheitis (croup), epiglottitis, retropharyngeal abscess, and diphtheria.
  • Pectoriloquy: Abnormal findings where voice sounds are audible through the stethoscope.

    • Bronchophony: Increased loudness and clarity of voice sounds.
    • Whispered Pectoriloquy: Increased clarity and loudness of whispered sounds.
    • Egophony: Change in voice sounds; "E" sounds like "A".
  • Fremitus: Palpable vibrations transmitted through the chest.

    • Increased Fremitus: Indicates thickening of lung tissue, frequently associated with pneumonia.
    • Decreased Fremitus: Indicates obstructions to the transmission of vibrations; common in pleural effusion, pneumothorax, and atelectasis.
  • Nail Clubbing: Abnormal rounding of the nail bed. Associated with several pulmonary diseases, including bronchiectasis, cystic fibrosis, lung tumors, pulmonary fibrosis, and cyanotic congenital heart disease.

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