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    Thorax and Lung - Lecture

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    Таншолпан Шохбутова
    The document provides guidance on performing a physical examination of the lungs, including inspection, palpation, percussion, and auscultation of the chest. It describes the techniques for each component of the exam and how to assess common lung symptoms like cough, dyspnea, and hemoptysis. The goal is to learn how to distinguish normal from abnormal breath sounds and understand what different physical exam findings may indicate.

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    Thorax and Lung - Lecture

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    Таншолпан Шохбутова
    13 views60 pages
    The document provides guidance on performing a physical examination of the lungs, including inspection, palpation, percussion, and auscultation of the chest. It describes the techniques for each component of the exam and how to assess common lung symptoms like cough, dyspnea, and hemoptysis. The goal is to learn how to distinguish normal from abnormal breath sounds and understand what different physical exam findings may indicate.

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    Thorax and lung - Lecture

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    The document provides guidance on performing a physical examination of the lungs, including inspection, palpation, percussion, and auscultation of the chest. It describes the techniques for each component of the exam and how to assess common lung symptoms like cough, dyspnea, and hemoptysis. The goal is to learn how to distinguish normal from abnormal breath sounds and understand what different physical exam findings may indicate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13 views60 pages

    Thorax and Lung - Lecture

    Uploaded by

    Таншолпан Шохбутова
    The document provides guidance on performing a physical examination of the lungs, including inspection, palpation, percussion, and auscultation of the chest. It describes the techniques for each component of the exam and how to assess common lung symptoms like cough, dyspnea, and hemoptysis. The goal is to learn how to distinguish normal from abnormal breath sounds and understand what different physical exam findings may indicate.

    Copyright:

    © All Rights Reserved
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    of 60

    http://www.easyauscultation.

    com/lung-
    sounds
     Know the key anatomical landmarks of the thorax
    and lungs and use these landmarks to accurately
    describe location of abnormal findings.
     Perform an orderly examination of the
    thorax/lungs.
     Learn how to assess chest expansion.
     Learn how to feel for tactile fremitus.
     Learn the technique of percussion.
     Learn the technique of auscultation.
     Distinguish between the different types of breath
    sounds.
    1)Inspection

    2)Palpation

    3)Percussion

    4)Auscultation
     Chest pain
     Shortness of breath (dyspnea)
     Wheezing
     Cough
     Blood-streaked sputum (hemoptysis)
     Lung tissue has no pain fibers.
     Pain in conditions such as pneumonia or
    pulmonary infarction usually arises from
    inflammation of the adjacent parietal pleura.
     Muscle strain from prolonged recurrent
    coughing may also be responsible.
     The pericardium also has few pain fibers.
    The pain of pericarditis stems from
    inflammation of the adjacent parietal pleura.
     Chest pain is commonly also associated with
    anxiety, but the mechanism remains obscure.
     Your initial questions should be as open-
    ended as possible.
     “Do you have any discomfort or unpleasant
    feelings in your chest?”
     Ask the patient to point to location of the
    pain in the chest.
     Watch for any gestures as the patient
    describes the pain.
     A clenched fist over
    the sternum
    suggests angina
    pectoris
     a finger pointing to a
    tender area on the
    chest wall suggests
    musculoskeletal pain
     a hand moving from
    neck to epigastrium
    suggests heartburn
     to appreciate the level of distress
     use of accessory muscles
     respiratory position
     chest structure
     respiratory pattern
     clues outside of the chest
     Assess the patient’s color for cyanosis.
     Listen to the patient’s breathing.
     Is there audible wheezing?
     Inspect the neck.
     During inspiration, is there contraction of the
    accessory muscles, namely the sternomastoid
    and scalene muscles, or supraclavicular
    retraction?
     Is the trachea midline?
     Observe the shape of the chest
     Dyspnea - shortness of breath, is a painless
    but uncomfortable awareness of breathing
    that is inappropriate to the level of exertion.
     Thoroughly assess this prominent symptom
    of cardiac and pulmonary disease.
     “Have you had any difficulty
    breathing?”
     Cough is a reflex response to stimuli that
    irritate receptors in the larynx, trachea, or
    large bronchi
     These stimuli include mucus, pus, and blood,
    as well as external agents such as dust,
    foreign bodies, or even extremely hot or cold
    air.
     Cough can be a symptom of left-sided heart
    failure.
     Mucoid sputum is translucent, white, or gray;
     Purulent sputum is yellowish or greenish.
     Foul-smelling sputum in anaerobic lung
    abscess;
     Tenacious sputum in cystic fibrosis
     Hemoptysis is the coughing up of blood from
    the lungs;
     it may vary from blood-streaked phlegm to
    frank blood.
     For patients reporting hemoptysis, assess the
    volume of blood produced as well as the
    other sputum attributes;
     ask about the related setting and activity and
    any associated symptoms.
    Barrel Chest
     pectus excavatum,  pectus carinatum,
    which the sternum is anterior protrusion
    depressed relative to of the sternum
    the ribs
    Pectus Carinatum (Pigeon)
    Pectus Excavatum (Funnel)
     Tenderness
     Asymmetry
     Diaphragmatic excursion
     Crepitus
     Tactile fremitus
     Thumbs at about the level of
    the 10th ribs

     Ask the patient to inhale


    deeply

     Watch the distance between


    your thumbs as they move
    apart during inspiration

     Feel for the range and


    symmetry of the rib cage as
    it expands and contracts
    Symmetric
    Expansion
     Chronic fibrotic disease of the underlying
    lung or pleura,
     Pleural effusion,
     Lobar pneumonia,
     Pleural pain with associated splinting
     Unilateral bronchial obstruction.
     Pneumothorax – shifts to unaffected side
     Pleural Effusion – shifts to unaffected side
     Fibrosis or Atelectasis – shifts towards
    affected side
     Pulmonary consolidation – no shift
     Asymmetric decreased
    fremitus occurs in unilateral
    pleural effusion,
    pneumothorax, neoplasm
    due to decreased
    transmission of low
    frequency sounds;
     asymmetric increased
    fremitus occurs in unilateral
    pneumonia from increased
    transmission through
    consolidated tissue
     Helps to identify if underlying tissues are air-
    filled, fluid-filled, or solid
    ◦ Hyperextend middle finger of either hand and press
    against chest wall
    ◦ Strike with flexed middle finger of opposite hand
     Always percuss symmetrically on chest wall
     Dullness replaces resonance when fluid or
    solid tissue replaces air containing lung
    ◦ Pleural Effusions
    ◦ Hemothorax
    ◦ Tumor
     Unilateral Hyperresonance
    ◦ Pneumothorax
     Generalized Hyperresonance
    ◦ COPD
     12 anterior locations
     14 posterior locations
     Auscultate symmetrically
     Should listen to at least 6 locations
    anteriorly and posteriorly
     Normal  Adventitious
    ◦ Tracheal ◦ Crackles (Rales)
    ◦ Bronchial ◦ Wheeze
    ◦ Bronchovesicular ◦ Rhonchi
    ◦ Vesicular ◦ Stridor
     Abnormal ◦ Pleural Rub
    ◦ Absent/Decreased
    ◦ Bronchial
     Bronchovesicular
    ◦ Intermediate intensity, intermediate pitch
    ◦ Inspiratory = Expiratory sound duration
    ◦ Heard best 1st and 2nd ICS anteriorly, and between
    scapula posteriorly
    ◦ If heard in any other location suggestive of
    consolidation
     Vesicular
    ◦ Soft, low pitched sound
    ◦ Inspiratory > Expiratory sounds
    ◦ Major normal BS, heard over most of lungs
     Crackles (Rales)
    ◦ Discontinuous, intermittent, nonmusical, brief
    sounds
    ◦ Heard more commonly with inspiration
    ◦ Classified as fine or coarse
    ◦ Normal at anterior lung bases
     Maximal expiration
     Prolonged recumbency
    ◦ Crackles caused by air moving through secretions
    and collapsed alveoli
    ◦ Associated conditions
     pulmonary edema, early CHF, PNA
     Wheeze
    ◦ Continuous, high pitched, musical sound, longer
    than crackles
    ◦ Hissing quality, heard > with expiration, however,
    can be heard on inspiration
    ◦ Produced when air flows through narrowed airways
    ◦ Associated conditions
     asthma, COPD
     Rhonchi
    ◦ Similar to wheezes
    ◦ Low pitched, snoring quality, continuous, musical
    sounds
    ◦ Implies obstruction of larger airways by secretions
    ◦ Associated condition
     acute bronchitis
     Stridor
    ◦ Inspiratory musical wheeze
    ◦ Loudest over trachea
    ◦ Suggests obstructed trachea or larynx
    ◦ Medical emergency requiring immediate attention
    ◦ Associated condition
     inhaled foreign body
     Pleural Rub
    ◦ Discontinuous or continuous brushing sounds
    ◦ Heard during both inspiratory and expiratory
    phases
    ◦ Occurs when pleural surfaces are inflamed and rub
    against each other
    ◦ Associated conditions
     pleural effusion, PTX
     Asthma
     COPD
     Pleural Effusion
     Pneumothorax
     ARDS
     Atelectasis
    Sequence
    for percussion
    & auscultation
     Vesicular Breath  Bronchial (Tracheal)
    Sounds
     Soft and low pitched  Loud and high
     Fine rustling/swishing pitched
    sound.  Tubular quality
     Heard on inspiration  Expiration>Inspirati
    continuosly without
    pause until expiration. on
     Heard over all post.  Heard only
    Lung fields and anteriorly over
    anterior periph. Fields.
     Inspiration> Expiration trachea & larynx
     Expiration loud
     BRONCOPHONY: “99”
     NL. Muffled sound
     Abnormal: hear, clear loud “99” (consolidation)
    ◦ WHISPERED PECTORILOQUAY
     Whisper “99”
     Normal-Don’t hear or very faint
     Abnormal hear “99”
     EGOPHONY Say “E”
     Normal- hear “E”, Abnormal-hear “A”

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