Ab Thorax Week 4

What do you initially palpate the thorax for?

masses and tenderness

How should the patient hold their arms when palpating between the scapulae?

crossed in front

How many areas are palpated on the posterior thorax?

4 areas bilaterally; 8 areas total

How many areas are palpated on the anterior thorax?

3 areas bilaterally; 6 areas total

What are you palpating for in different areas of the thorax?

tactile fremitus

What should the examiner instruct the patient to say while you palpate for tactile fremitus?

say "99" in a low, slow, deep voice

What part of the hand do you use to palpate tactile fremitus?

ball or ulnar edge

Increased vibration of tactile fremitus indicates _________, such as in __________.

increased density of lung tissue; pneumonia

Decreased vibration of tactile fremitus indicates ________, such as in _______.

decreased density of lung tissue; emphysema

What can cause decreased transmission of air to the chest wall?

pneumothorax or pleural effusion

Increased vibrations would have more _____ in the lung tissue, whereas decreased vibrations would have more ______ in the lung tissue.

solid; air

What is the patient's arm position when testing respiratory expansion?

down at their sides

What vertebral level is respiratory expansion performed at?

T10

How is the respiratory expansion performed?

1. grasp around the patient's ribcage

2. leave loose skin between thumbs

3. instruct the patient to inhale deeply and observe

What are you observing when performing the respiratory expansion?

distance between the thumbs

How many times should the patient breath when testing for respiratory expansion?

3x

What are the causes of unilateral decreased expansion of the ribs?

lung problem; diaphragm problem; pleural effusion/pneumothorax; lobar pneumonia

What are the causes of bilateral decreased expansion of the ribs?

emphysema; ankylosing spondylitis

How many areas do you percuss on the posterior thorax?

7 areas bilaterally; 14 areas total

What is the patient arm position during posterior thorax percussion?

crossed in front

How many areas are percussed on the anterior thorax?

6 areas bilaterally; 12 areas total

What is the patient arm position for anterior thorax percussion?

down by sides

What is the direction of percussion of the thorax?

ladder pattern; right-left then left-right

What body part would normally have a flat sound?

thigh

What does a flat sound on the lung indicate?

massive pleural effusion; pneumonectomy; atelectasis

What organ normally sounds dull?

liver

What does a dull sound on the lung indicate?

tumors; pulmonary edema; enlarged organs

What normally sounds resonant?

the lungs

What pathology of the lung can a resonant sound accompany?

chronic bronchitis

What normally sounds hyperresonant?

nothing

What does a hyper-resonant sound on the lung indicate?

emphysema; small pneumothorax; acute asthmatic attack

What normally sounds tympany?

Abdomen or gastric air bubble

What does tympany over the lung suggest?

large pneumothorax

In general, ________ percussion tone is normal in the lungs. Less air would have ________ or ________ percussion tone. More air would have _________ or ________ percussion tone.

resonant; dull or flat; hyperresonant or tympany

What condition would cause hyperresonance in the top of the lung and dull sound in the lower lung?

hemopneumothorax

What is the only posterior thorax examination where the patient has their arms by their sides?

respiratory expansion

How many points are ausculated for posterior lung sounds?

7 areas bilaterally; 14 total

How many points are auscultated for anterior lung sounds?

6 areas bilaterally; 12 total

T/F: Auscultation of the thorax uses the same amount of points as percussion of the thorax.

T

What is the term for an abnormal breath sound?

adventitious sound

If abnormalities are heard, while auscultating the thorax, you should listen to the patient's ______ or ________ voice.

spoken or whispered

What part of the stethoscope is used to auscultate the lung sounds?

diaphragm

What are the breathing instructions for lung auscultation?

breath slowly, deeply, and quietly through open mouth

What are the four primary breath sounds?

vesicular; bronchovesicular; bronchial; tracheal

T/F: The patient should take one breath every time the doctor moves to the next auscultation point

F - breathe normally

What is the dominant normal breath sound?

vesicular

What are the two abnormal breath sounds?

bronchovesicular and bronchial

What are the characteristics for vesicular breath sounds?

Inhale:Exhale Ratio:

Intensity of expiratory:

Pitch of expiratory:

Location heard:

3:1; soft; low; majority of lung field

What demographics are diminished vesicular breath sounds found in?

elderly; thick-walled people; emphysema

What demographics are harsh vesicular breath sounds found in?

children; thin-walled individuals; after exercise

What are the characteristics for bronchovesicular breath sounds?

Inhale:Exhale Ratio:

Intensity of expiratory:

Pitch of expiratory:

Location heard:

1:1; intermediate; intermediate; between scapula and first 2 interspaces

What are the characteristics for bronchial breath sounds?

Inhale:Exhale Ratio:

Intensity of expiratory:

Pitch of expiratory:

Location heard:

2:3; loud; high; manubrium

What is the highest pitched breath sound?

tracheal

What are the characteristics for tracheal breath sounds?

Inhale:Exhale Ratio:

Intensity of expiratory:

Pitch of expiratory:

Location heard:

1:1; harsh; high; trachea over neck

What conditions can cause a lack of ventilating lung tissue?

complete airway obstruction; pneumonectomy; paralyzed diaphragm; atelectasis with bronchial plug

What pleural processes can prevent breath sound from reaching the stethoscope?

pleural effusion and pneumothorax

Cogwheel breath sounds are similar to vesicular except the inspiratory phase is interrupted by _________ and may indicate ________.

short pauses; fibrosis

Bronchovesicular breath sounds may be produced by what four abnormalities?

partial atelectasis; early pneumonia; small tumor; pulmonary edema

The process by which alveoli fill with fluid and cells, is called what?

consolidation

What are some pathologies that can cause bronchial breath sounds?

atelectasis; lung tumors; pneumonia; pulmonary infarction

Metamorphosing breath sounds are sounds that change during inspiration. What is this pathway of change?

faint vesicular to bronchial

What are the most common added or adventitious lung sounds?

crackles (rales); wheezes; rhonchi

How would you define crackles or rales?

discontinuous, intermittent, nonmusical and brief

In patient with fine crackle sounds; if there is a problem with the lungs, the patient would present with ______ or _____ . In a patient with coarse crackles; if there is a problem with the airway, the patient would present with ______ or _______.

fibrosis or pneumonia; bronchitis or bronchiectasis

Early inspiratory crackles present with severe airway obstruction. Some examples include ________, ________, and ________.

chronic bronchitis, asthma, and emphysema

Late inspiratory crackles are characteristics of restrictive pulmonary disease. These often presents in patients with ______, _______, _______, and _______.

interstitial fibrosis, asbestosis, pneumonia, and pulmonary congestion

Wheezes are high-pitched, musical sounds with a hissing or shrill quality. They suggest narrowed airways in patients with ______, ______, and ________.

asthma, bronchitis, and emphysema

A persistent, localized wheeze suggests a partial obstruction of bronchus by a _____ or _______.

tumor or foreign object

If the wheezing sound is entirely or predominantly inspiratory, it is called?

stridor

A stridor is an urgent sign that suggests a partial blockage of what two organs?

trachea or larynx

Rhonchi are prolonged, low-pitched, musical sounds with a snoring quality. They suggests what?

secretions in large airways

A creaking, grating sound caused by inflamed, roughened pleural surfaces is called a...

pleural friction rub