08 Pulmonary Exam

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Percussion

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• similar to tap on empty barrel, mostly air, hollow

• dull: full of liquid

Auscultation

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• e.g. decreased breath sound in RUL = pathologic in RUL

• adventitious: extra or not native

Rales

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• usually on inspiratory to pop open wet alveoli

• pulmonary edema: gravity pulls water to bottom

• fibrosis: sticky fibrous tissues

Wheezes

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• usually expiratory when pushing air through narrow bronchi

• very rare: obstruction to airflow (see localized wheeze in 1 lobe, think tumor)

Rhonchi

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• sounds like water flowing

Bronchial

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Stridor

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• 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

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• usually shouldn't hear sound through chest.

Fremitus

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• thickened lung tissue, increased fremitus (pneumonia, thickened inflammed tissue)

• decreased: block transmission of vibration

Nail Clubbing

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