Lung Examination: Abnormal

Сентябрь 11, 2022

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Lung Examination: Abnormal

Содержание

5. Illustrative Pathological problems Consolidation Atelectasis Pleural effusion Pneumothorax Mass Diffuse lung disease
12. Steps General Examination Mediastinal position Chest expansion Lung resonance Breath sounds Adventitious sounds Voice transmission
13. General Examination Respiratory rate Pattern of breathing Cyanosis Clubbing Weight Cough Hospital setting Effort of ventilation
14. Respiratory Rate Bradypnea: rate less than 8 per minute Tachypnea: rate greater than 25 per minute
15. Pattern of Breathing Kussmals Sleep apnea Cheyne strokes Pursed lip breathing Orthopnoea: Short of breath in
16. Sleep apnea syndrome
17. Central Cyanosis Results from pulmonary dysfunction, the mucous membrane of conjunctiva and tongue are bluish. If
18. Central Cyanosis
19. Corpulmonale
20. Clubbing
21. Clubbing In clubbing, there is widening of the AP and lateral diameter of terminal portion of
22. Significance: Clubbing Observed In: Intrathoracic malignancy: Primary or secondary (lung, pleural, mediastinal) Suppurative lung disease: (lung
23. Gibbus
24. Weight Emaciation cachectic Malignancy Tuberculosis
25. 320 lbs
26. Weight Obese: Sleep apnea syndrome
27. 3 Layered sputum
28. Cough Productive Dry Whooping Bovine
29. 2 liters of O2
30. Hospital Setting Isolation room Oxygen set up
31. Effort of Ventilation Person appears uncomfortable. Breathing seems voluntary. Accessory muscles are in use, expiratory muscles
32. Resting Size and Shape of Thorax Barrel chest Kyphosis Scoliosis Pectus excavatum Gibbus
33. Barrel Chest AP Diameter = Transverse Diameter
34. Tracheal Position: Mediastinum Any deviation of the mediastinum is abnormal Lateral shift: The mediastinum can be
35. Tracheal shift to right
36. Chest Expansion Asymmetrical chest expansion is abnormal The abnormal side expands less and lags behind the
37. Percussion: Decreased or Increased Resonance is Abnormal Dullness Decreased resonance is noted with pleural effusion and
38. Breath Sounds: Diminished or Absent Intensity of breath sounds, in general, is a good index of
39. Bronchial Bronchial breathing anywhere other than over the trachea, right clavicle or right inter-scapular space is
40. Bronchial breathing
41. Rhonchi Rhonchi are long continuous adventitious sounds, generated by obstruction to airways. When detected, note whether
42. Rhonchi Asthmatic Continuous
43. Rhonchi Localized rhonchi suggests obstruction of any etiology e.g., tumor, foreign body or mucous. Mucous secretions
44. Pleural Rub Normal parietal and visceral pleura glide smoothly during respiration. If the pleura is roughened
45. Pleural rub Scratching, Grating Related to respiration
46. Stridor Loud audible inspiratory rhonchi is called a stridor. Inspiratory rhonchi in general, implies large airway
47. Stridor Asthma
48. Crackles Interrupted adventitious sounds are called crackles. Make a notation about timing, intensity, effect with respiration,
49. Crackles When the crackles are heard at the end of inspiration and the beginning of expiration
50. Voice Transmission (tactile fremitus, vocal resonance) Asymmetrical voice transmission points to disease on one side. Increased:
51. Voice Transmission (tactile fremitus, vocal resonance) Decreased: A quantitative decrease in voice transmission could be due
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Illustrative Pathological problems
Consolidation
Atelectasis
Pleural effusion
Pneumothorax
Mass
Diffuse lung disease

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Steps
General Examination
Mediastinal position
Chest expansion
Lung resonance
Breath sounds
Adventitious sounds
Voice transmission

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General Examination
Respiratory rate
Pattern of breathing
Cyanosis
Clubbing
Weight
Cough
Hospital setting
Effort of ventilation
Shape of thorax

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Respiratory Rate
Bradypnea: rate less than 8 per minute
Tachypnea: rate greater

than 25 per minute

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Pattern of Breathing
Kussmals
Sleep apnea
Cheyne strokes
Pursed lip breathing
Orthopnoea: Short of breath in

supine position, gets some relief by sitting or standing up.

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Sleep apnea syndrome

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Central Cyanosis
Results from pulmonary dysfunction, the mucous membrane of conjunctiva and

tongue are bluish.
If there was chronic hypoxemia and secondary erythrocytosis, you can detect the conjunctival and scleral vessels to be full, tortuous and bluish.

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Central Cyanosis

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Corpulmonale

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Clubbing

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Clubbing
In clubbing, there is widening of the AP and lateral diameter

of terminal portion of fingers and toes giving the appearance of clubbing.
The angle between the nail and skin is greater than 180.
The periungual skin is stretched and shiny.
There is fluctuation of the nail bed.
One can feel the posterior edge of the nail.

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Significance: Clubbing Observed In:
Intrathoracic malignancy: Primary or secondary (lung, pleural, mediastinal)
Suppurative

lung disease: (lung abscess, bronchiectasis, empyema)
Diffuse interstitial fibrosis: Alveolar capillary block syndrome
In association with other systemic disorders

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Gibbus

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Weight
Emaciation cachectic
Malignancy
Tuberculosis

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320 lbs

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Weight
Obese: Sleep apnea syndrome

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3 Layered sputum

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Cough
Productive
Dry
Whooping
Bovine

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2 liters of O2

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Hospital Setting
Isolation room
Oxygen set up

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Effort of Ventilation
Person appears uncomfortable. Breathing seems voluntary.
Accessory muscles are in

use, expiratory muscles are active and expiration is not passive any more.
The degree of negative pleural pressure is high.
The respiratory rate is increased.

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Resting Size and Shape of Thorax
Barrel chest
Kyphosis
Scoliosis
Pectus excavatum
Gibbus

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Barrel Chest
AP Diameter = Transverse Diameter

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Tracheal Position: Mediastinum
Any deviation of the mediastinum is abnormal
Lateral shift: The

mediastinum can be either pulled or pushed away from the lesion
Pull: Loss of lung volume (Atelectasis, fibrosis, agenesis, surgical resection, pleural fibrosis)
Push: Space occupying lesions (pleural effusion, pneumothorax, large mass lesions)
Mediastinal masses and thyroid tumors

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Tracheal shift to right

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Chest Expansion
Asymmetrical chest expansion is abnormal
The abnormal side expands less and

lags behind the normal side
Any form of unilateral lung or pleural disease can cause asymmetry of chest expansion
Global expansion decrease

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Percussion: Decreased or Increased Resonance is Abnormal
Dullness
Decreased resonance is noted with

pleural effusion and all other lung diseases
The dullness is flat and the finger is painful to percussion with pleural effusion
Hyper resonance: Increased resonance can be noted either due to lung distention as seen in asthma, emphysema, bullous disease or due to Pneumothorax
Traube's space

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Breath Sounds: Diminished or Absent
Intensity of breath sounds, in general, is

a good index of ventilation of the underlying lung.
Breath sounds are markedly decreased in emphysema.
Symmetry: If there is asymmetry in intensity, the side where there is decreased intensity is abnormal.
Any form of pleural or pulmonary disease can give rise to decreased intensity.
Harsh or increased: If the intensity increases there is more ventilation and vice versa.

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Bronchial
Bronchial breathing anywhere other than over the trachea, right clavicle or

right inter-scapular space is abnormal.
In consolidation, the bronchial breathing is low pitched and sticky and is termed tubular type of bronchial breathing.
In cavitary disease, it is high pitched and hollow and is called cavernous breathing. You can simulate this sound by blowing over an empty coke bottle.

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Bronchial breathing

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Rhonchi
Rhonchi are long continuous adventitious sounds, generated by obstruction to airways.
When

detected, note whether it is generalized or localized, during inspiration or expiration, and the pitch.
Diffused rhonchi would suggest a disease with generalized airway obstruction like asthma or COPD.

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Rhonchi
Asthmatic
Continuous

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Rhonchi
Localized rhonchi suggests obstruction of any etiology e.g., tumor, foreign body

or mucous.
Mucous secretions will disappear with coughing, so would the rhonchus.
Expiratory rhonchi implies obstruction to intrathoracic airways.
Asthmatics can also have inspiratory rhonchi while it is uncommon in COPD.

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Pleural Rub
Normal parietal and visceral pleura glide smoothly during respiration.
If the

pleura is roughened due to any reason, a scratching, grating sound, related to respiration is heard.
You can hear the sound by compressing harder with the stethoscope and making the patient take deep breaths.
It is localized and can be palpable.

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Pleural rub
Scratching, Grating
Related to respiration

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Stridor
Loud audible inspiratory rhonchi is called a stridor.
Inspiratory rhonchi in general,

implies large airway obstruction.

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Stridor
Asthma

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Crackles
Interrupted adventitious sounds are called crackles.
Make a notation about timing, intensity,

effect with respiration, position, coughing and character.
Timing and Intensity Crackles heard only at the end of inspiration are called fine crackles.
When the surfactant is depleted, the alveoli collapse. Air enters the alveoli at the end of inspiration.
This sound is generated as the alveoli pop open from it's collapsed state.

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Crackles
When the crackles are heard at the end of inspiration and

the beginning of expiration the fluid or secretions are probably in respiratory bronchioles: medium crackles.
If the crackles are heard throughout it implies the secretions are in bronchi: coarse crackles.

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Voice Transmission (tactile fremitus, vocal resonance)
Asymmetrical voice transmission points to disease

on one side.
Increased:
Any situation where bronchial breathing is heard the sounds become loud, sharp and distinct: Bronchophony.
In extreme situations, the whispered words come clearly and distinctly: Whispering pectoriloquy.

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Voice Transmission (tactile fremitus, vocal resonance)
Decreased: A quantitative decrease in voice

transmission could be due to any other form of lung or pleural disease.
Qualitative alteration:
A qualitative alteration of voice transmission is noted over consolidation and along the upper margin of pleural effusion: Egophony
The sound is like a nasal twang or goat bleating.

Lung Examination: Abnormal

Содержание

Illustrative Pathological problemsConsolidationAtelectasisPleural effusionPneumothoraxMassDiffuse lung disease

StepsGeneral ExaminationMediastinal positionChest expansionLung resonanceBreath soundsAdventitious soundsVoice transmission

General ExaminationRespiratory ratePattern of breathingCyanosisClubbingWeightCoughHospital settingEffort of ventilationShape of thorax

Respiratory RateBradypnea: rate less than 8 per minute Tachypnea: rate greater

Pattern of BreathingKussmalsSleep apneaCheyne strokesPursed lip breathingOrthopnoea: Short of breath in

Sleep apnea syndrome

Central CyanosisResults from pulmonary dysfunction, the mucous membrane of conjunctiva and

Central Cyanosis

Corpulmonale

Clubbing

ClubbingIn clubbing, there is widening of the AP and lateral diameter

Significance: Clubbing Observed In:Intrathoracic malignancy: Primary or secondary (lung, pleural, mediastinal)Suppurative

Gibbus

WeightEmaciation cachecticMalignancyTuberculosis

320 lbs

WeightObese: Sleep apnea syndrome

3 Layered sputum

CoughProductiveDryWhoopingBovine

2 liters of O2

Hospital SettingIsolation roomOxygen set up

Effort of VentilationPerson appears uncomfortable. Breathing seems voluntary.Accessory muscles are in

Resting Size and Shape of ThoraxBarrel chestKyphosisScoliosisPectus excavatumGibbus

Barrel ChestAP Diameter = Transverse Diameter

Tracheal Position: MediastinumAny deviation of the mediastinum is abnormalLateral shift: The

Tracheal shift to right

Chest ExpansionAsymmetrical chest expansion is abnormalThe abnormal side expands less and

Percussion: Decreased or Increased Resonance is AbnormalDullnessDecreased resonance is noted with

Breath Sounds: Diminished or AbsentIntensity of breath sounds, in general, is

BronchialBronchial breathing anywhere other than over the trachea, right clavicle or