Thoracic Lung Exam Guide

Thoracic Exam Guide ==================== - **Inspect:** shape, configuration, facial expression, skin color, respiratory effort, accessory muscles - **Palpate**: - Palpate for symmetric expansion or lag expansion. - Palpate for tenderness, lumps, **turgor**, temperature,...

Thoracic Exam Guide ==================== - **Inspect:** shape, configuration, facial expression, skin color, respiratory effort, accessory muscles - **Palpate**: - Palpate for symmetric expansion or lag expansion. - Palpate for tenderness, lumps, **turgor**, temperature, moisture, **crepitus**. - Tactile fremitus or palpable vibration - ask patient to say 99 or blue moon to feel vibrations. - **Percuss**: Bilateral comparison from percussion to elicit sound - Dull over lungs (mass, consolidation part of pneumonia, atelectasis, fluid part of pleural effusion) - Resonance, (normal) - Hyperresonance (asthma, pneumothorax, emphysema) - **Ausculate: bilateral comparison when you listen. 8 points anterior, 6 points posterior.** - Breath sounds - Adventitious sounds - Voice sounds +-----------------+-----------------+-----------------+-----------------+ | | Technique | Normal Finding | Abnormal | | | | | Finding | +=================+=================+=================+=================+ | 1. Bronchophon | Ask the person | Voice sounds | Clear | | y | to say | are soft, | \"ninety-nine,\ | | | \"ninety-nine\" | muffled, and | " | | | while listening | unclear. | words are | | | with a | | louder and more | | | stethoscope. | | distinct. | +-----------------+-----------------+-----------------+-----------------+ | 2. Egophony | Ask the person | Hear \"eeee\" | \"Eeee\" | | | to say | clearly. | changes to | | | \"ee-ee-ee\" | | \"aaaa\" sound, | | | while listening | | indicating | | | with a | | consolidation. | | | stethoscope. | | | +-----------------+-----------------+-----------------+-----------------+ | 3. Whispered | Ask the person | Whispered | Whispered | | Pectoriloqu | to whisper | sounds are | \"one-two-three | | y | \"one-two-three | faint and | \" | | | \" | barely heard. | is heard | | | while listening | | clearly and | | | with a | | distinctly, | | | stethoscope. | | indicating | | | | | consolidation. | +-----------------+-----------------+-----------------+-----------------+ Concepts ======== - **Palpation of Vibration (Tactile Fremitus) **goes up when the lung or airways are more solid/consolidated (better conduction of vibration) and down when there is more air or fluid blocking transmission. - **Percussion** is dull over denser areas (fluid, solid tissue) and hyperresonant (very "hollow") when there is extra air (e.g. emphysema or pneumothorax). - **Auscultation**: Breath sounds are louder/"bronchial" over consolidated lung (sound travels well in solids), and diminished when air or fluid separates the lung from the chest wall. - **Adventitious Sounds** arise from turbulent airflow through fluid-filled or constricted airways (e.g. crackles in fluid, wheezes in narrowed airways, rubs in inflamed pleura). - **Specific Voice Sounds:** Bronchophony (louder \"ninety-nine\"), Egophony (\"ee\" heard as \"ay\"), and Whispered Pectoriloquy (clear whispered sounds like \"one, two, three\") are all louder and clearer over areas of lung consolidation. - **Increased density** (e.g., consolidation) →\ ↑ fremitus, dull percussion, bronchial breath sounds. - **Extra air** (pneumothorax or hyperinflation) →\ ↓ fremitus, hyperresonance, ↓ breath sounds. - **Fluid/effusion** → ↓ fremitus, dullness, ↓ breath sounds. - **Crackles, wheezes, rubs** arise from fluid in alveoli, narrowed airways, or inflamed pleura. +---------+---------+---------+---------+---------+---------+---------+ | Conditi | **Inspe | **Palpa | **Percu | **Auscu | | | | on | ction** | tion | ssion** | ltation | | | | | | of | | ** | | | | | | Vibrati | | | | | | | | on\ | | | | | | | | (Tactil | | | | | | | | e | | | | | | | | Fremitu | | | | | | | | s)** | | | | | +=========+=========+=========+=========+=========+=========+=========+ | | | | | Breath | Adventi | Voice | | | | | | Sounds | tious | Sounds | +---------+---------+---------+---------+---------+---------+---------+ | **Norma | AP \< | Symmetr | Resonan | Vesicul | None | Broncho | | l | transve | ic | t | ar | | phony: | | Lung\ | rse | chest | | over | | Muffled | | **Norma | diamete | expansi | | periphe | | (you c | | l | r, | on, | | ry, | | an't ma | | gas | relaxed | no | | broncho | | ke out | | exchang | , | tendern | | vesicul | | distinc | | e, | 10-20 | ess | | ar | | t words | | airway | breaths | | | central | | ) | | patency | /min | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (you | | | | | | | | hear " | | | | | | | | eee" as | | | | | | | | "eee," | | | | | | | | not "a | | | | | | | | aa") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pered w | | | | | | | | ords ar | | | | | | | | en't di | | | | | | | | stinctl | | | | | | | | y heard | | | | | | | | ) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Norma | | | | | | | | l air-f | | | | | | | | illed a | | | | | | | | lveoli | | | | | | | | do not | | | | | | | | enhance | | | | | | | | sound | | | | | | | | conduct | | | | | | | | ion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | +---------+---------+---------+---------+---------+---------+---------+ | **Atele | Cough, | ↓ | Dull | Diminis | Often | Broncho | | ctasis | cyanosi | (collap | (less | hed/abs | none; | phony: | | (Collap | s, | sed | air, | ent | maybe a | Muffled | | se)\ | lag on | area | relativ | breath | few | (words | | **Alveo | affecte | doesn't | ely | sounds | crackle | not cl | | lar | d | transmi | more | (no air | s | early h | | collaps | side | t | solid | movemen | if | eard) | | e | | vibrati | tissue) | t | partial | ------- | | → less | | ons | | in | reopeni | ------- | | air in | | well) | | collaps | ng | ------- | | affecte | | | | ed | | ------- | | d | | | | region) | | ------- | | segment | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (no | | | | | | | | "eee" → | | | | | | | | "aaa" | | | | | | | | change) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pered w | | | | | | | | ords no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Colla | | | | | | | | psed al | | | | | | | | veoli i | | | | | | | | mpede s | | | | | | | | ound tr | | | | | | | | ansmiss | | | | | | | | ion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | +---------+---------+---------+---------+---------+---------+---------+ | **Lobar | Fever, | ↑ | Dull | Bronchi | Crackle | Broncho | | Pneumon | increas | (solid/ | (tissue | al | s | phony: | | ia\ | ed | fluid‐f | is more | (tubula | (air | Clear ( | | **Conso | respira | illed | dense) | r) | bubblin | words b | | lidatio | tions | lung | | breath | g | ecome d | | n/infec | (\>24/m | conduct | | sounds | through | istinct | | tion | in), | s | | over | fluid) | ly hear | | fills | cyanosi | vibrati | | consoli | | d) | | alveoli | s | ons | | dation; | | ------- | | → | | better) | | egophon | | ------- | | denser | | | | y | | ------- | | lung | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Pres | | | | | | | | ent (yo | | | | | | | | u hear | | | | | | | | "aaa" i | | | | | | | | nstead | | | | | | | | of "eee | | | | | | | | ") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Dist | | | | | | | | inct (w | | | | | | | | hispere | | | | | | | | d words | | | | | | | | are cl | | | | | | | | early h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Conso | | | | | | | | lidated | | | | | | | | lung t | | | | | | | | issue c | | | | | | | | onducts | | | | | | | | sound | | | | | | | | more ef | | | | | | | | fective | | | | | | | | ly) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | --- | +---------+---------+---------+---------+---------+---------+---------+ | **Heart | Increas | Normal | Resonan | Normal | Charact | Broncho | | Failure | ed | or | t | vesicul | eristic | phony: | | ** | respira | slightl | or | ar, | fine | Often n | | | tions, | y | slightl | S3 | crackle | ormal o | | **Pulmo | SOB, | ↑ in | y | gallop | s | r mildl | | nary | edema, | areas | dull at | | ("rales | y decre | | Edema\ | pink | of | bases | | ") | ased (w | | \ | frothy | fluid | (fluid | | at | ords ma | | **Eleva | sputum | (mild | accumul | | bases | y remai | | ted | | consoli | ation) | | (fluid | n somew | | pulmona | | dation | | | in | hat ind | | ry | | effect) | | | alveola | istinct | | venous | | | | | r | ) | | pressur | | | | | spaces) | ------- | | e | | | | | | ------- | | → fluid | | | | | | ------- | | in | | | | | | ------- | | alveoli | | | | | | ------- | | (pulmon | | | | | | ------- | | ary | | | | | | ------- | | edema) | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt ("ee | | | | | | | | e" does | | | | | | | | not be | | | | | | | | come "a | | | | | | | | aa") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Usua | | | | | | | | lly fai | | | | | | | | nt or n | | | | | | | | ormal ( | | | | | | | | whisper | | | | | | | | s not d | | | | | | | | istinct | | | | | | | | ly hear | | | | | | | | d) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Diffu | | | | | | | | se "wet | | | | | | | | " lungs | | | | | | | | , but n | | | | | | | | ot typi | | | | | | | | cally s | | | | | | | | olid co | | | | | | | | nsolida | | | | | | | | tion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | +---------+---------+---------+---------+---------+---------+---------+ | **Pleur | Dyspnea | ↓ | Dull | Decreas | Possibl | Broncho | | al | , | (fluid/ | (fluid | ed | y | phony: | | Effusio | asymmet | pleural | is | or | a | Muffled | | n\ | ric | changes | relativ | absent | pleural | (words | | **Fluid | expansi | block | ely | breath | rub if | not di | | or | on | vibrati | dense) | sounds | inflame | stinctl | | thicken | | on) | | (lung | d; | y heard | | ing | | | | is | often | ) | | in | | | | "pushed | none | ------- | | pleural | | | | away") | | ------- | | space | | | | | | ------- | | separat | | | | | | ------- | | es | | | | | | ------- | | lung | | | | | | ------- | | from | | | | | | ------- | | chest | | | | | | - | | wall | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt or s | | | | | | | | lightly | | | | | | | | increa | | | | | | | | sed nea | | | | | | | | r fluid | | | | | | | | level | | | | | | | | (usuall | | | | | | | | y no cl | | | | | | | | ear "ee | | | | | | | | e" → "a | | | | | | | | aa") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pers no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Fluid | | | | | | | | or thi | | | | | | | | ckened | | | | | | | | pleura | | | | | | | | dampens | | | | | | | | conduc | | | | | | | | tion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | +---------+---------+---------+---------+---------+---------+---------+ | **Pneum | Unequal | ↓ | Hyperre | Absent | None | Broncho | | othorax | expansi | (vibrat | sonant | or | | phony: | | \ | on, | ions | (excess | markedl | | Muffled | | **Air | tachypn | blocked | air) | y | | or abs | | in | ea, | by | | decreas | | ent (wo | | pleural | cyanosi | pleural | | ed | | rds not | | space → | s | air) | | breath | | transm | | lung | | | | sounds | | itted) | | collaps | | | | | | ------- | | es | | | | | | ------- | | away | | | | | | ------- | | from | | | | | | ------- | | chest | | | | | | ------- | | wall | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (no | | | | | | | | "eee" → | | | | | | | | "aaa" | | | | | | | | change) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t or ab | | | | | | | | sent (n | | | | | | | | o disti | | | | | | | | nct whi | | | | | | | | spers h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Air i | | | | | | | | n the p | | | | | | | | leural | | | | | | | | space d | | | | | | | | isrupts | | | | | | | | sound | | | | | | | | transmi | | | | | | | | ssion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | +---------+---------+---------+---------+---------+---------+---------+ | **Asthm | SOB, | Often | Normal | Prolong | Bilater | Broncho | | a\ | wheezin | normal | to | ed | al | phony: | | **Bronc | g, | or | hyperre | expirat | wheezin | Muffled | | hoconst | use of | slightl | sonant | ory | g | (words | | riction | accesso | y | (air | phase, | (expira | not cl | | + | ry | ↓ | trappin | wheezin | tory) | early h | | hyperin | muscles | | g) | g | | eard) | | flation | | | | (turbul | | ------- | | → | | | | ent | | ------- | | narrowe | | | | flow | | ------- | | d | | | | through | | ------- | | airways | | | | narrowe | | ------- | | with | | | | d | | ------- | | trapped | | | | bronchi | | ----- | | air | | | | ) | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (you | | | | | | | | hear " | | | | | | | | eee" as | | | | | | | | "eee") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pered w | | | | | | | | ords no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Hyper | | | | | | | | inflate | | | | | | | | d lungs | | | | | | | | reduce | | | | | | | | sound | | | | | | | | conduct | | | | | | | | ion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | +---------+---------+---------+---------+---------+---------+---------+ | **Acute | Cough, | Typical | Resonan | Clear | None | Broncho | | Bronchi | sore | ly | t | bilater | | phony: | | tis\ | throat, | normal | (no | ally | | Usually | | **Bronc | fatigue | | consoli | | | normal | | hial | | | dation | | | or sli | | inflamm | | | or | | | ghtly m | | ation, | | | effusio | | | uffled | | but | | | n) | | | (words | | alveoli | | | | | | somewha | | and | | | | | | t indis | | pleura | | | | | | tinct) | | not | | | | | | ------- | | signifi | | | | | | ------- | | cantly | | | | | | ------- | | involve | | | | | | ------- | | d | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (you | | | | | | | | hear " | | | | | | | | eee" as | | | | | | | | "eee") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t/norma | | | | | | | | l (no d | | | | | | | | istinct | | | | | | | | whispe | | | | | | | | r ampli | | | | | | | | ficatio | | | | | | | | n) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Bronc | | | | | | | | hial in | | | | | | | | flammat | | | | | | | | ion wit | | | | | | | | hout al | | | | | | | | veolar | | | | | | | | consoli | | | | | | | | dation) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | +---------+---------+---------+---------+---------+---------+---------+ | **Chron | Cough | Typical | Resonan | Normal | Crackle | | | ic | with | ly | t | vesicul | s | | | Bronchi | thick | normal | (no | ar, | over | | | tis\ | sputum, | | consoli | prolong | deflate | | | **Bronc | cyanosi | | dation | ed | d | | | hial | s, | | or | expirat | areas, | | | inflamm | fatigue | | effusio | ion | wheezes | | | ation, | | | n) | | | | | but | | | | | | | | alveoli | | | | | | | | and | | | | | | | | pleura | | | | | | | | not | | | | | | | | signifi | | | | | | | | cantly | | | | | | | | involve | | | | | | | | d | | | | | | | +---------+---------+---------+---------+---------+---------+---------+ | **Emphy | Barrel | ↓ (less | Hyperre | Diminis | Wheezin | Broncho | | sema\ | chest, | dense | sonant | hed | g | phony: | | **Overd | SOB, | lung | (excess | breath | may | Muffled | | istenti | tripod | transmi | trapped | sounds | occur | (words | | on/ | positio | ts | air) | (poor | (narrow | not cl | | destruc | n | vibrati | | airflow | ed | early h | | tion | | ons | | through | airways | eard) | | of | | poorly) | | damaged | ) | ------- | | alveoli | | | | alveoli | | ------- | | → | | | | ) | | ------- | | hyperin | | | | | | ------- | | flated | | | | | | ------- | | lung | | | | | | ------- | | with | | | | | | ----- | | less | | | | | | | | tissue | | | | | | Egophon | | density | | | | | | y: Abse | | | | | | | | nt (you | | | | | | | | hear " | | | | | | | | eee" as | | | | | | | | "eee") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pered w | | | | | | | | ords no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Hyper | | | | | | | | inflate | | | | | | | | d lungs | | | | | | | | reduce | | | | | | | | sound | | | | | | | | conduct | | | | | | | | ion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | +---------+---------+---------+---------+---------+---------+---------+ | **Pulmo | Anxiety | Usually | Typical | Tachyca | Crackle | Broncho | | nary | , | normal. | ly | rdia, | s, | phony: | | Embolis | dyspnea | \ | normal | accentu | wheezes | Usually | | m\ | , | Diaphor | (no | ated | | normal | | **Clot | cyanosi | esis, | fluid | S2 | | (muffl | | obstruc | s | hypoten | or | | | ed as p | | ts | | sion | consoli | | | er norm | | pulmona | | | dation) | | | al lung | | ry | | | | | | s) | | artery | | | | | | ------- | | branch; | | | | | | ------- | | alveoli | | | | | | ------- | | often | | | | | | ------- | | spared | | | | | | ------- | | initial | | | | | | ------- | | ly | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt ("ee | | | | | | | | e" does | | | | | | | | not be | | | | | | | | come "a | | | | | | | | aa") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Norm | | | | | | | | al/fain | | | | | | | | t (no d | | | | | | | | istinct | | | | | | | | whispe | | | | | | | | rs) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | --- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Prima | | | | | | | | rily va | | | | | | | | scular | | | | | | | | problem | | | | | | | | ; no al | | | | | | | | veolar | | | | | | | | consoli | | | | | | | | dation | | | | | | | | or effu | | | | | | | | sion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | +---------+---------+---------+---------+---------+---------+---------+ | **Lung | Weight | Variabl | Dull | May | --- | Broncho | | Cancer\ | loss, | e---may | over | have | | phony: | | **Tumor | hoarsen | decreas | tumors | decreas | | Variabl | | mass | ess, | e | | ed | | e (can | | +/- | hemopty | if | | sounds, | | be clea | | post‐ob | sis | obstruc | | or | | r if po | | structi | | ting, | | bronchi | | st-obst | | ve | | or | | al | | ructive | | pneumon | | increas | | breathi | | pneumo | | ia/atel | | e | | ng | | nia/con | | ectasis | | if | | if | | solidat | | | | there's | | post‐ob | | ion, or | | | | consoli | | structi | | muffle | | | | dation | | ve | | d if at | | | | behind | | pneumon | | electas | | | | the | | ia | | is) | | | | block | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | --- | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Poss | | | | | | | | ible (i | | | | | | | | f there | | | | | | | | is loc | | | | | | | | alized | | | | | | | | consoli | | | | | | | | dation) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Also | | | | | | | | variab | | | | | | | | le (dis | | | | | | | | tinct w | | | | | | | | ith con | | | | | | | | solidat | | | | | | | | ion, fa | | | | | | | | int wit | | | | | | | | h colla | | | | | | | | pse) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ---- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Depen | | | | | | | | ds on w | | | | | | | | hether | | | | | | | | tumor c | | | | | | | | auses o | | | | | | | | bstruct | | | | | | | | ion/col | | | | | | | | lapse o | | | | | | | | r infil | | | | | | | | tration | | | | | | | | /consol | | | | | | | | idation | | | | | | | | ) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | +---------+---------+---------+---------+---------+---------+---------+ | **Pneum | Anxiety | Decreas | Dull | May be | Crackle | Broncho | | ocystis | , | ed | over | relativ | s | phony: | | jirovec | SOB, | chest | infiltr | ely | (may be | Often n | | i | dry | expansi | ates, | normal | absent) | ormal o | | Pneumon | cough | on | but | initial | | r sligh | | ia\ | | | usually | ly | | tly dec | | **Diffu | | | resonan | or have | | reased | | se, | | | t | diffuse | | (words | | often | | | | fine | | not sha | | interst | | | | crackle | | rply am | | itial/a | | | | s | | plified | | lveolar | | | | | | ) | | infecti | | | | | | ------- | | on | | | | | | ------- | | in | | | | | | ------- | | immunoc | | | | | | ------- | | ompromi | | | | | | ------- | | sed | | | | | | ------- | | patient | | | | | | ------- | | s | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Rare | | | | | | | | ly pres | | | | | | | | ent (us | | | | | | | | ually " | | | | | | | | eee" re | | | | | | | | mains " | | | | | | | | eee") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pers no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Diffu | | | | | | | | se, int | | | | | | | | erstiti | | | | | | | | al infe | | | | | | | | ction r | | | | | | | | ather t | | | | | | | | han den | | | | | | | | se loba | | | | | | | | r conso | | | | | | | | lidatio | | | | | | | | n) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | +---------+---------+---------+---------+---------+---------+---------+ | **Tuber | Cough, | ↑ over | Dull | Normal | Crackle | Broncho | | culosis | night | areas | over | or | s | phony: | | \ | sweats, | of | consoli | decreas | over | Variabl | | **Granu | weight | consoli | dation, | ed | upper | e (may | | lomatou | loss | dation | possibl | vesicul | lobes | be norm | | s | | or ↓ | y | ar | | al unle | | infecti | | over | hyperre | sounds | | ss ther | | on | | cavitat | sonant | | | e is si | | → can | | ion | over | | | gnifica | | cause | | | cavitie | | | nt cons | | consoli | | | s | | | olidati | | dation, | | | | | | on or c | | cavitat | | | | | | avity) | | ion | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Poss | | | | | | | | ible (m | | | | | | | | ay have | | | | | | | | "eee" | | | | | | | | → "aaa" | | | | | | | | if loc | | | | | | | | alized | | | | | | | | consoli | | | | | | | | dation) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Dist | | | | | | | | inct if | | | | | | | | consol | | | | | | | | idated, | | | | | | | | faint | | | | | | | | if cavi | | | | | | | | tation | | | | | | | | dominat | | | | | | | | es | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | -- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Patch | | | | | | | | y/cavit | | | | | | | | ary les | | | | | | | | ions pr | | | | | | | | oduce v | | | | | | | | ariable | | | | | | | | conduc | | | | | | | | tion ch | | | | | | | | anges) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | +---------+---------+---------+---------+---------+---------+---------+ | **Acute | Restles | Can be | Dull if | Diffuse | Fine to | Broncho | | Respira | s, | ↑ if | alveola | crackle | coarse | phony: | | tory | rapid | consoli | r | s | crackle | Often d | | Distres | breathi | dation | fluid | (fluid | s | ecrease | | s | ng, | is | accumul | in | through | d (word | | Syndrom | frothy | extensi | ation | alveoli | out | s not c | | e | sputum, | ve | is | ), | | learly | | (ARDS)\ | hypoten | | substan | often | | heard) | | **Wides | sion, | | tial | severe | | ------- | | pread | tachyca | | | | | ------- | | alveola | rdia | | | | | ------- | | r | | | | | | ------- | | injury | | | | | | ------- | | → | | | | | | ------- | | noncard | | | | | | ------- | | iogenic | | | | | | ------ | | pulmona | | | | | | | | ry | | | | | | Egophon | | edema, | | | | | | y: Abse | | "stiff" | | | | | | nt (you | | lungs | | | | | | hear " | | | | | | | | eee" as | | | | | | | | "eee") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pered w | | | | | | | | ords no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Diffu | | | | | | | | se alve | | | | | | | | olar da | | | | | | | | mage/co | | | | | | | | llapse | | | | | | | | impairs | | | | | | | | sound | | | | | | | | transmi | | | | | | | | ssion) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------ | +---------+---------+---------+---------+---------+---------+---------+ | **COVID | Fever, | Often | Dull | Diminis | Crackle | Broncho | | -19 | cough, | normal | over | hed | s, | phony: | | Viral | dyspnea | or | infiltr | breath | rhonchi | Often n | | Pneumon | , | slightl | ates | sounds | (in | ormal o | | ia\ | fatigue | y | | | severe | r sligh | | **Prima | | ↓ | | | cases) | tly dec | | rily | | | | | | reased | | interst | | | | | | (words | | itial | | | | | | remain | | and | | | | | | fairly | | alveola | | | | | | muffled | | r | | | | | | ) | | inflamm | | | | | | ------- | | ation | | | | | | ------- | | typical | | | | | | ------- | | of | | | | | | ------- | | viral | | | | | | ------- | | pneumon | | | | | | ------- | | ias | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | - | | | | | | | | | | | | | | | | Egophon | | | | | | | | y: Abse | | | | | | | | nt (no | | | | | | | | "eee" → | | | | | | | | "aaa") | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | | | | | | | | | Whisper | | | | | | | | ed Pect | | | | | | | | oriloqu | | | | | | | | y: Fain | | | | | | | | t (whis | | | | | | | | pers no | | | | | | | | t disti | | | | | | | | nctly h | | | | | | | | eard) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ----- | | | | | | | | | | | | | | | | Reason: | | | | | | | | (Diffu | | | | | | | | se/inte | | | | | | | | rstitia | | | | | | | | l chang | | | | | | | | es rath | | | | | | | | er than | | | | | | | | dense, | | | | | | | | lobar | | | | | | | | consoli | | | | | | | | dation) | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | | | | | | | | ------- | +---------+---------+---------+---------+---------+---------+---------+ **FOCUSED CONDITIONS** +-----------+-----------+-----------+-----------+-----------+-----------+ | **Conditi | **Palpati | **Percuss | **Auscult | **Adventi | [**Voice | | on** | on | ion** | ation** | tious | Sounds | | | of | | | Sounds** | Findings* | | | Vibration | | | | *](https: | | | Tactile | | | | //chatgpt | | | Fremitus* | | | |.com/c/67 | | | * | | | | a6d9e3-4f | | | | | | | 6c-8001-9 | | | | | | | 9b6-054f6 | | | | | | | a4f1da9) | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Consoli | ↑ (solid | Dull | Crackles | Bronchoph | | | dation | lung | (denser | (fluid in | ony: Clea | | | (e.g., | transmits | tissue) | alveoli | r (words | | | Pneumonia | vibration | | opening) | become di | | | )** | s) | | | stinctly | | | | | | | heard) | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ------ | | | | | | | | | | | | | | Egophony: | | | | | | | Present | | | | | | | (you hear | | | | | | | "aaa" in | | | | | | | stead of | | | | | | | "eee") | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ------ | | | | | | | | | | | | | | Whispered | | | | | | | Pectoril | | | | | | | oquy: Dis | | | | | | | tinct (wh | | | | | | | ispered w | | | | | | | ords are | | | | | | | clearly h | | | | | | | eard) | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ----- | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Pleural | ↓ (fluid | Dull | Diminishe | Possible | Bronchoph | | Effusion* | in | (fluid is | d | pleural | ony: Muff | | * | pleural | dense) | breath | rub if | led (word | | | space | | sounds | inflamed; | s not dis | | | dampens | | (lung is | often | tinctly h | | | vibration | | \"pushed | none | eard) | | | ) | | away\") | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ----- | | | | | | | | | | | | | | Egophony: | | | | | | | Absent o | | | | | | | r slightl | | | | | | | y increas | | | | | | | ed near f | | | | | | | luid leve | | | | | | | l (usuall | | | | | | | y no clea | | | | | | | r "eee" → | | | | | | | "aaa") | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ------- | | | | | | | | | | | | | | Whispered | | | | | | | Pectoril | | | | | | | oquy: Fai | | | | | | | nt (whisp | | | | | | | ers not d | | | | | | | istinctly | | | | | | | heard) | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | --------- | | | | | | | ------- | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Pneumot | ↓ (air in | Hyperreso | Absent or | Bronchoph | | | horax** | pleural | nant | markedly | ony: Muff | | | | space | (excess | decreased | led or ab | | | | blocks | air) | breath | sent (wor | | | | transmiss | | sounds | ds not tr | | | | ion) | | (collapse | ansmitted