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