Respiratory Physical Examination Semiology

Comprehensive vocabulary flashcards covering the four stages of clinical respiratory examination—inspection, palpation, percussion, and auscultation—along with relevant semiological syndromes, pathophysiological signs, and clinical findings from Pr. Abdelkrim Bahlaoui's lecture.

Four Successive Steps of the Physical Examination

The systematic clinical examination of the respiratory system performed symmetrically and comparatively, consisting of: inspection, palpation, percussion, and auscultation.

Qualities of a Good Clinician

A clinician who listens attentively to the patient, observes meticulously, examines correctly, formulates diagnostic hypotheses, orders appropriate paraclinical investigations, and ultimately advises, treats, and monitors the patient.

Thoracic Inspection

The first step of the respiratory physical exam, conducted under optimal conditions to evaluate the patient's general appearance, thoracic morphology (symmetry, deformities), vertebral statics, respiratory rate and pattern, and cutaneous signs.

Upper Costal Breathing Pattern

The typical physiological respiratory movement pattern observed predominantly in women, characterized by upper thoracic motion.

Abdominal Breathing Pattern

The normal physiological respiratory movement pattern observed predominantly in men, characterized primarily by diaphragmatic and abdominal displacement.

Intercostal Indrawing (Tirage intercostal)

An inspiratory retraction of the intercostal spaces reflecting the active recruitment of accessory intercostal muscles and the generation of significant negative intrathoracic pressures.

Hoover's Sign (Signe de Hoover)

A paradoxical inspiratory reduction of the transverse diameter of the lower ribcage (walls move inward rather than outward). It is not a sign of severity, but an indicator of thoracic hyperinflation and diaphragmatic flattening (horizontalization).

Paradoxical Abdominal Respiration

Inward movement of the abdominal wall during inspiration instead of normal outward expansion; a major sign of severity strongly evocative of severe diaphragmatic dysfunction.

Active Abdominal Expiration

Active contraction of the abdominal wall musculature during the expiratory phase, constituting a sign of severity commonly seen in patients with Chronic Obstructive Pulmonary Disease (COPD/BPCO).

Alternating Respiration (Respiration alternante)

An acute respiratory pattern characterized by the alternating occurrence of normal breaths and abnormal breaths lacking abdominal expansion or displaying paradoxical abdominal movement; considered a sign of severity.

Flail Chest (Volet costal)

Paradoxical motion of an unstable section of the thoracic wall during respiration, characteristic of severe trauma involving multiple adjacent ribs with double fracture lines on each affected rib.

Claude Bernard-Horner Syndrome

A clinical triad consisting of ptosis, miosis, and enophthalmos, resulting from compression or injury of the cervical sympathetic nerve chain.

Digital Clubbing (Hippocratisme digital)

Bulbous enlargement of the distal phalanges with loss of the normal nail bed angle, seen in chronic broncho-pulmonary conditions, bronchogenic carcinoma, cyanotic congenital heart diseases, and colopathies.

Paraneoplastic Syndrome

A group of clinical, biological, or radiological manifestations accompanying a carcinoma that fluctuate in parallel with tumor activity, disappearing upon surgical resection and recurring with relapse.

Pierre Marie Hypertrophic Pulmonary Osteoarthropathy (OAHP)

A paraneoplastic condition defined clinically by marked digital clubbing, extremity hypertrophy, extremity vasomotor disturbances, and arthralgias, and radiologically by encasing periostosis of long bones.

Encasing Periostosis (Périostose engainante des os longs)

The hallmark radiological sign of Pierre Marie hypertrophic osteoarthropathy, characterized by symmetrical subperiosteal new bone formation encasing the shafts of long tubular bones.

Vocal Vibrations (Vibrations vocales - VV)

Low-frequency thoracic vibrations produced by the larynx during vocalization (instructing the patient to repeat '$33$' in French or '$44$' in Arabic) that are transmitted to the chest wall and assessed by palmar palpation.

Increased Vocal Vibrations

Palpatory finding indicating condensed, consolidated, and airless pulmonary parenchyma with patent supplying bronchi, characteristic of condensation syndrome (pneumonia, ventilation disturbances).

Abolition of Vocal Vibrations

Complete absence of transmitted vocal vibrations on palpation, typically caused by pleural effusion (liquid, gaseous pneumothorax, mixed hydropneumothorax) or complete lung atelectasis.

Decreased Vocal Vibrations

Reduction in tactile vocal resonance caused by poor sound transmission, seen in broncho-emphysema and partial bronchial obstruction.

Subcutaneous Emphysema (Empysème sous-cutané)

The presence of gas or air in the subcutaneous tissue planes of the chest, recognized on palpation by a characteristic fine crackling sensation compared to stepping on fresh snow (crépitations neigeuses).

Mediate Percussion

Percussion technique performed by hyperextending the non-dominant middle finger (pleximeter) firmly against the chest wall and tapping its interphalangeal joint with the tip of the dominant middle finger (plexor).

Normal Pulmonary Percussion Sound

A clear, resonant, and hollow sound normally heard over the aerated lung fields, extending down anteriorly to the $5^{\text{th}}$ intercostal space and posteriorly to the $10^{\text{th}}$ intercostal space.

Thoracic Dullness (Matité)

A dull, flat, non-resonant percussion sound characteristic of fluid accumulation or airless parenchymal consolidation, typical of pleurisy, pachypleuritis, and pulmonary condensation.

Thoracic Tympanism / Hyperresonance

An exaggerated, high-pitched, drum-like resonant sound produced on chest percussion, typically indicative of intrapleural air accumulation in pneumothorax.

Stethoscope

An acoustic medical instrument invented by René Laennec in $1816$ designed for mediate auscultation of internal sounds generated within the thorax.

Laryngotracheal Breath Sound (Souffle laryngo-trachéal / Bruit glottique)

The normal physiological, high-pitched breath sound generated by turbulent airflow passing through the glottic slit, audible during both inspiration and expiration over the neck and central large airways.

Vesicular Murmur (Murmure vésiculaire - MV)

A soft, rustling parenchymal respiratory sound produced by the vibration of air moving between terminal bronchioles and alveoli, heard across both hemithoraces throughout inspiration and the early portion of expiration.

Tubular Breath Sound (Souffle tubaire)

A loud, harsh, predominantly inspiratory blowing sound resembling airflow through a hollow tube, resulting from conduction of central glottic sounds across consolidated, airless lung tissue (e.g., lobar pneumonia, pulmonary infarction).

Pleuritic Blow (Souffle pleurétique)

A soft, distant, inconstant expiratory blowing murmur heard near the upper boundary of a moderate pleural liquid effusion.

Amphoric Breath Sound (Souffle amphorique)

A hollow, high-pitched breath sound with a distinct metallic timbre, likened to blowing over the neck of an empty bottle; heard predominantly during expiration in pneumothorax or large parenchymal cavitations.

Cavernous Breath Sound (Souffle caverneux / cavitaire)

A low-pitched, hollow, predominantly inspiratory blowing murmur of high intensity, characteristic of a large, rigid pulmonary cavity communicating with a bronchus (e.g., tuberculous cavern, lung abscess).

Fine Crackles / Crepitant Rales (Râles crépitants)

Discontinuous, explosive, dry adventitious sounds that burst specifically at the end of inspiration, resembling the sound of rolling a lock of hair between fingers; indicative of intra-alveolar transudate or exudate (e.g., acute pulmonary edema, early pneumonia).

Coarse Crackles / Subcrepitant Rales (Râles sous-crépitants)

Discontinuous, bubbling adventitious sounds heard throughout inspiration and early expiration, generated by air churning through fluid within bronchi and alveolar ducts (e.g., pneumonia, bronchial secretions).

Rhonchi (Râles ronflants / Ronchus)

Continuous, deep, low-pitched adventitious sounds with a snoring acoustic quality, produced by the vibration of thick, tenacious secretions partially obstructing large bronchial trunks.

Sibilant Rales / Wheezes (Râles sibilants)

Continuous, high-pitched musical whistling sounds audible during both respiratory phases but with expiratory predominance, reflecting widespread diffuse narrowing of small airways (e.g., asthma, COPD).

Wheezing

A continuous, strictly localized musical whistling sound caused by unilateral fixed stenosis of a single large bronchus (e.g., tumor, foreign body).