Ab Thorax Week 5

What is the arm position for diaphragmatic excursion?

Crossed in front

What are the breathing instructions for diaphragmatic excursion?

Inhale and hold, mark the diaphragm, exhale and hold and mark the diaphragm

How far apart should the two marks be on one side of the diaphragm?

3-6 cm

T or F: The marks on the two sides of the diaphragm should normally be the same level

False (the right sided marks are normally higher, but space between the marks on one side should equal the other)

What are can early inspiratory crackles indicate?

Chronic bronchitis

Asthma

Emphysema

What can late inspiratory crackles indicate?

interstitial fibrosis

asbestosis

pneumonia

pulmonary congestion (heart failure)

What is the term for a high pitched, hissing sound in the airways?

Wheezes

What is the AKA of wheezes?

Sibilant musical rales

What is the term for a snoring type of sound in the airways?

Rhonchi

What is the AKA of Rhonchi?

Sonorous musical rales

What do global wheezes indicate?

Asthma

What does a local wheeze indicate?

Bronchogenic carcinoma

Foreign object

What does a rhonchi sound indicate?

Fluid in the larger airways

On what part of the breath are wheezes more pronounced?

Exhale (due to constriction of the airway)

What is the term for a high-pitched sound sound which is more pronounced on the inhale?

Stridor

What does a stridor indicate?

Partial obstruction of the trachea or larynx

What is the term for a creaking, grating sound caused by an inflamed pleura?

Pleural friction rub

What is the normal finding of voice sounds?

muffled and indistinct

What is the term for increased sound when the patient speaks the word "99"?

Bronchophony

What is the term for increased sound when the patient whispers the word "99"?

Whipsered pectoiloquy

What do bronchophony and whispered pectoriloquy suggest?

Consolidation

What type of voice sounds are more sensitive to consolidation?

Whispered pectoriloquy

What tactile fremitus finding would correlate with whispered pectoriloquy?

Increased

What is egophony used to determine?

Height (meniscus) of a pleural effusion

What should the patient say when auscultating egophony?

"E"

What does the "E" sound like at the meniscus of pleural effusion?

"A"

What will the "E" sound like below the level of the meniscus?

Muffled or absent

What breath sounds occur over an area of lobar pneumonia?

Bronchovesicular/bronchial

What type of lesion will cause the trachea to deviate towards it (ipsilateral)?

Atelectasis with bronchial plug

What type of lesions will cause the trachea to deviate away from it (contralateral)?

Large pneumothorax

Tumor

Large pleural effusion

What type of breathing occurs with metabolic acidosis?

Kussmaul breathing

What is the term for alternating hyperpnea and apnea near the end of life?

Cheyenne-stokes breathing

What is the term for erratic breathing due to damage of the medulla?

Ataxic/Biot's breathing

What is the term prolonged exhale caused by asthma, COPD, or bronchitis?

Obstructive breathing

What is the term for subconscious occasional sighing?

Sighing respiration

What can sighing respiration indicate?

Hyperventilation syndrome

What can hyperventilation syndrome cause?

Dizziness and dyspnea

What is the normal maximum respiration rate in infants?

44 breath/min

What can cause cheyne-stokes breathing?

Heart failure

uremia

drugs

brain damage

What can cause a gurgling rale?

Air passing through pulmonary secretions in the trachea

Who would gurgling rale be found in?

Moribund / very ill patients

What is the AKA of gurgling rale?

Death rattle

What can cause the pleura to be inflamed?

Pulmonary infarction

inflammation

How can you decrease the sound of chest hair against the stethoscope?

press the stethoscope harder

How can you increase the sound of friction rubs?

press the stethoscope harder

What is the term for a splashing sound heard upon shaking a patient with both air and fluid in the pleural cavity?

Succussion splash

What is the term for a popping sound due to the presence of air under the skin when the pockets are moved back and forth?

Subcutaneous emphysema

What is the term for a grating sound produced when the two ends of a fractured rib are rubbed together?

Bone crepitus