lungs3

how many places do you check for tactile fremitus anterior, posterior?

4 both sides anterior 4 both sides posterior

how many places do you ausculate on posterior chest?

5 (both sides)

if the e sound is very nasal/changes to an "a", blank is present

egophony is present (a transmitted voice sound)

in tracheal sounds, inspiration and expiration are almost blank

equal

soft, high pitched crackle -650 Hz/5-10 miliseconds

fine crackles

the intensity and pitch of bronchovesicular sounds are blank

intermediate

crackles in the dependent (lowest) portions of the lungs may be heard after prolonged?

recumbency

if bronchovesicular or bronchial sounds are head in areas outside of normal, suspect?

replacement of air filled lungs by fluid or tissue consolidation

where can you hear bronchovesicular sounds? (3)

1st interspace 2nd interspace between scapula (posterior)

one special technique is the 6 minute blank test which can used to assess COPD, can predict clinical outcomes

6 minute walk test (need 100 foot hallways)

if patients 60 or older have a forced expiratory time of 9 seconds or more are 4x more likely to have?

COPD

3 tests for transmitted voice sounds

Egophony ("ee" sound) Bronchophony ("ninety-nine") whispered pectoriloquy {whispered "ninety-nine")

fine, late, inspiratory crackles that persist from breath to breath suggest?

abnormal lung tissue

in severe asthma, wheezes and breath sounds may be absent due to blank. Is this serious?

absent due to low respiratory airflow, the "silent chest" this is a medical emergency

what are adventitious sounds?

added (abnormal) sounds not part of normal breathing

crackles (aka rales) wheezing rhonci are types of blank sounds

adventitious (added) abnormal breath sounds

the intensity of breath sounds indicates?

air flow rate (decreased sound indicates decreased flow like in COPD, or when transmission of vibrations is compromised)

how many places do you auscultate on anterior chest? lateral?

anterior - 3 (on both sides of sternum) lateral - 2

in some normal people, crackles may be heard in the blank lung bases after maximum expiration

anterior lung bases

blank is the most important examination technique for assessing air flow through the tracheobronchial tree

auscultation

a silent gap between inspiration and expiration suggests blank breath sounds

bronchial breath sounds

loud, harsh, higher pitched normal breath sound with a short silence between inspiration/expiration. Expiration lasts longer than inspiration

bronchial sound, a normal breath sound

which sound has longer expiration than inspiration?

bronchial sounds (loud intensity/high pitch)

if you can hear "ninety-nine" clearly, the paitent has a transmitted voice sound called?

bronchophony (loud voice sound)

what type of sounds is inspiration and expiration almost equal?

bronchovesicular

a normal breath sound that is equal in length in inspiration and expiration, at times separated by a silent interval/gap.

bronchovesicular, a normal breath sound

what do you check if there is abnormal sounds during auscultation?

check for transmitted voice sounds

loud, lower pitched crackle -350 Hz/15-30 miliseconds

coarse crackles

discontinuous adventitious sound that is intermittent, nonmusical, and brief

crackles (rales)

these sounds arise from abnormalities of the lung parenchyma (functional tissue) and can be caused by pneumonia, interstitial lung disease, pulmonary fibrosis or abnormalities of the airways

crackles/rales

what part of your stethoscope is used to listen to breath sounds?

diaphragm (best for high pitched sounds), used directly on skin

when the patient whispers "ninety-nine" the voice should be blank and blank, if at all

faint and indistinct, if it can be heard clearly, the patient has whispered pectoriloquy

special test to assess expiratory phase of breathing, patient takes a deep breath and then breathes out as completely and quickly as possible

forced expiratory time

placing one hand on the sternum and the other on the thoracic spine and then squeezing is a special test for?

fractured rib - if this test is positive the localized pain will increase (distant from the areas your hands are squeezing on)

if crackles, wheezing, or rhonchi clear after coughing/postion change, this suggests?

inspissated secretions (thickened secretions due to dehydration) associated with bronchitis/atelectasis (collapse of lung)

when percussing the anterior chest, check for blank dullness and blank tympany, which may be displaced by hyperinflated lung due to COPD

liver dullness stomach tympany

during egophony, the patient says "ee" and you will hear?

long E sound (bleating)

breath sounds are usually louder in the lower blank lung fields

louder in the lower posterior lung fields

where do you look for retraction during the posterior exam? (1)

lower intercostal muscles during inspiration

where do you look for retraction during the anterior exam? (2)

lower intercostal muscles during inspiration supraclavicular region

before auscultation, ask patient to cough to clear?

mild atelectasis (deflated air sacs) or airway mucus (these can produce unimportant extra sounds)

the patient should be instructed to breath through their?

mouth (larger airway, can move more air, obstructed nasal passages can affect sound)

during bronchophony, the paitent says "ninety-nine". The sounds should be blank?

muffled and indistinct

in cold/tense patients, you may hear?

muscle contraction sounds, muffled/low pitched rumbling/roaring

where can you hear vesicular sounds?

over most of the lungs

where can you hear bronchial sounds?

over the manubrium (larger proximal airways)

stridor/laryngeal sounds are loudest over the blank, while wheezes/rhonchi are faint or absent in this area

over the neck

coarse, grating sounds heard primarily during expiration

pleural rubs

pleural rubs may be heard in? (3)

pleurisy pneumonia pulmonary embolism

localized bronchophony and egophony are seen in lobar consolidation caused by blank

pneumonia

the crackles of heart failure are best heard in the posterior blank lung fields

posterior inferior lung fields

patients with COPD tend to prefer to sit blankly, with lips pursed during exhalation and arms supported by knees/table

prefer to sit leaning forward

clothes, gowns, and hair can cause crackling sounds. How do you manage the chest hair?

press harder

patient is supine for anterior chest examination. How can you make a patient with difficulty breathing more comfortable for this?

raising the head of the bed

relatively low pitched (150-200 Hz) with snoring quality last over 80 miliseconds

rhonchi

a low pitched wheeze that is unrelated to airway secretions

rhonchi (some suggest not using this term)

stridor is a blank sound

tracheal sound

loud, harsh sounds heard over the trachea

tracheal sound, a normal breath sound

if you hear abnormally located bronchovesicular/bronchial breath sounds, assess blank

transmitted voice sounds (may signal pneumonia or pleural effusion, which block airways with inflammation or secretions)

fever cough bronchial breath sounds egophony blanks the likelihood of pnuemonia

triples

inspiratory sound lasts longer than expiration in blank sounds (type of normal sound)

vesicular (fade out after 1/3 of expiration)

4 normal breath sounds?

vesicular (soft/low pitch) Bronchovesicular (equal length I/E, may be gap) Bronchial (loud/harsh/high pitch/gap/long E) Tracheal (loud/harsh/over the trachea)

a soft/low pitched normal breath sound that is heard throughout inspiration, continue without pause through expiration and then fade away 1/3 of the way through expiration

vesicular breath sound (normal/soft/low pitch)

high pitched (over/= 400Hz) with hissing or shrill quality last over 80 miliseconds

wheezes

these sounds arise from narrowed airways due to asthma, COPD, or bronchitis

wheezes

continous abnormal breath sounds that are sinusoidal (fluctuate in a repetitive pattern), musical, and prolonged

wheezes/rhonchi

can chest expansion/lung excursion be done anteriorly?

yes

is tactile fremitus assessed anteriorly?

yes