08 Pulmonary Exam
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
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