When cexamining ca cpatient cfor cthe capical cimpulse c(PMI), cwhich cof cthe cfollowing
cis cLEAST cimportant cto cassess?
A. Location
B. Amplitude
C. Rhythm
D. Diameter c- cAnswer- cC. cRhythm
Assess clocation, camplitude, cduration, cand cdiameter
5 cA's cof ctobacco ccessation c- cAnswer-
What cis ctactile cfremitus? c- cAnswer- cpalpable cvibrations ctransmitted cthrough cthe
cbronchopulmonary ctree cto cthe cchest cwall cas cthe cpatient cis cspeaking c"99"
NORMAL= cbuzzing con chands cwhen cpatient csay c"99"
SOLIDS cCONDUCT cSOUND/VIBRATIONS cBETTER cTHAN cAIR
Conditions cwhere ctactile cfremitus cis cabsent cor cdecreased c- cAnswer- cFremitus cis
cdecreased cor cabsent cwhen cthe ctransmission cof cvibrations cis cimpeded.
Feeling clittle cor cno cbuzzing cat call ccompared cto csimilar clung careas; cLARGE
cPOCKETS cOF cAIR cIN cTHE cLUNGS
thick cchest cwall
cobstructed cbronchus
cCOPD
pleural
ceffusion
cfibrosis
cpneumo c(Air)
infiltrating ctumor
cfibrosis
cemphysema
cconsolidation
cAsthma
Causes cof casymmetrical cfremitus c- cAnswer- cDecreased cfremitus
cUnilateral cpleural ceffusion
Pneumo
cneoplasm
Increased cfremitus
cUnilateral cpneumonia
Causes cof cincreased cfremitus c- cAnswer- cfeeling cof ca cstrong cvibration ccompared
cto csimilar clung careas
Consolidation cof clung ctissue
cpneumonia
,atelectasis
cbronchitis
Apical cImpulse c(PMI) c- cAnswer- cPoint cof cMaximal cImpulse c(Apex cof cthe cheart):
cbetween c4th cto c5th cintercostal cspace, cmidclavicular
Apex cbeat cis cpalpable cin conly c25-40% cof chealthy cadults cin csupine cposition cand
c50% cin cleft clateral cdecubitus cposition—>especially cthose cwho care cthin
Some chide cbehind crib ccage, cdespite cpositioning
diaphragmatic cexcursion c- cAnswer- c*assesses cdegree cand csymmetry cof
cdiaphragm cmovement; cpercuss cfrom careas cof cresonance cto cdullness
* not cpercussing cthe cdiaphragm citself cyou care cidentifying cthe cresonant clung
ctissue cand cthe cduller cstructures cbelow.
* you ccan cinfer cthe cprobable clocation cof cthe cdiaphragm cfrom cthe clevel cof cdullness
during cdiaphragmatic cexcursion can c"absent cdecent" cmeans cwhat? c- cAnswer-
cAn cabnormally chigh clevel csuggests ca cpleural ceffusion cor can celevated
chemidiaphragm cfrom catelectasis cor cphrenic cnerve cparalysis
fine ccrackles/rales c- cAnswer- coccurrence- con cend cinspiration; cdont cclear cwith
ccough.
Quality- cHigh cpitched cshort ccrackling
Causes- ccollapses cor cfluid-filled calveoli copen
Course ccrackles/rales c- cAnswer- cOccurrence- cEnd cinspiration, cdoesn't cclear cwith
ccough
Quality- cLoud, cmoist, clow-pitched, cbubbling
Causes- cCollapsed cor cfluid-filled calveoli copen
Wheezes c- cAnswer- cOccurrence- cExpiration cand cinspiration cwhen csevere
Quality- cHigh-pitched, ccontinuous
Causes- cblocked cairflow cas cin casthma, cinfection, cforeign cbody cobstruction
Ronchi c- cAnswer- cOccurrence- cExpiration/inspiration; cchange/disappeat cwith ccough
Quality- cLow-pitched, ccontinuous, csnoring, crattling
Cause- cFluid cblocked cairways
Stridor c- cAnswer- cOccurrence- cInspiration
Quality- cloud, chi-pitched ccrowing cheard cwithout cstethoscope
Cause- cobstructed cupper cairway
,pleural cfriction crub c- cAnswer- cOccurrence- cInhalation/expiration
Quality- clow-pitched cgrating, crubbing
Cause- cpleural cinflammation
Percussion ctechnique c- cAnswer-
Normal cpercussion cfindings cin cAdult cby clocation c- cAnswer-
Tracheal cdeviation cwith catelectasis c- cAnswer- cWhen ca cplug cobstructs cbronchial
cair cflow, caffected calveoli ccollapse cand cbecome cairless
*Trachea cmay cshift cto cinvolved cside
Tracheal cdeviation cwith cPleural ceffusion c- cAnswer- cfluid caccumulates cin cthe
cpleural cspace cand cseparates cair-filled clungs cfrom cthe cchest cwall, cblocking cthe
ctransmission cof cbreath csounds
* Trachea cmay cshift ctowards cthe cunaffected cside cin ca clarge ceffusion
Tracheal cdeviation cin ca cpneumothorax c- cAnswer- cAir cleaks cinto cthe cpleural
cspace, cusually cunilaterally, cthe clung crecoils caway cfrom cthe cchest cwall. cPleural
cair cblocks ctransmission cof csound
*Trachea cshifts ctoward cunaffected cside cif ctension cpneumo
Which cconditions clead cto cabsent cbreath csounds? c- cAnswer- c*Fluid cor cexudate
chas caccumulated cin cpleural cspace c(think cemphysema)
*When clungs care chyperinflated
*Breathing cshallow cfrom csplinting cfor cpain
When cpalpating cthe cposterior cchest, cthe cclinician cnotes cincreased ctactile cfremitus
cover cthe cleft
lower clobe. cThis ccan cbe cindicative cof:
A. Pneumonia
B. Emphysema
C. Pneumothorax
D. Asthma c- cAnswer- cAns: cA
Areas cof cincreased cfremitus cshould craise cthe csuspicion cof cconditions cresulting
cin cincreased
solidity cor cconsolidation cin cthe cunderlying clung ctissue, csuch cas cin cpneumonia,
ctumor, cor
pulmonary cfibrosis. cConversely, careas cof cdecreased cfremitus craise cthe csuspicion
cof cabnormal
fluid- cor cair-filled cspaces, csuch cas coccurs cwith cpleural ceffusion, cpneumothorax,
cor cemphysema. cIn cthe cinstance cof can cextensive cbronchial cobstruction, cno
cpalpable cvibration cis
felt cin cthe crelated cfield.
, During cphysical cexamination cof ca cpatient, cyou cnote cresonance con cpercussion cin
cthe cupper
lung cfields. cThis cis cconsistent cwith:
A. Chronic cobstructive cpulmonary cdisease
B. Pneumothorax
C. A cnormal cfinding
D. Pleural ceffusion c- cAnswer- cANS: cC cThe clung cfields cshould cbe cpercussed
cposteriorly, cstarting cfrom cthe csuperior-most careas cand cthen cproceeding
cinferiorly cto cthe clevel cof cthe cdiaphragm. cResonance cis cthe cnormal csound con
cpercussion. cHyperresonance csuggests cair ctrapping, cwhich coccurs cwith cchronic
cobstructive cpulmonary cdisease cor ctension cpneumothorax. cDullness cto
cpercussion cis cdetected cover cthe cactual csite cof cconsolidated clung cor cpleural
cfluid. cDullness cis calso cfound cwith cpneumonia, csevere catelectasis, cor cpleural
ceffusion.
On cassessment cof crespiratory cexcursion, cthe cclinician cnotes casymmetric cexpansion
cof cthe
chest. cOne cside cexpands cgreater cthan cthe cother. cThis ccould cbe cdue cto:
A. Pneumothorax
B. Pleural ceffusion
C. Pneumonia
D. Pulmonary cembolism c- cAnswer- cANS: cA cThe crespiratory cexcursion, cor
cexpansion, cis cdetermined cby cplacing chands caround cthe cpatient's cposterior crib
ccage cwith cthe cthumbs capproximately cat cthe clevel cof cthe c10th crib cbetween cthe
cthumbs, cand cthen casking cthe cpatient cto ctake ca cdeep cbreath cand cobserving
cthe cmovement cof cthe chands. cThe cmotion cshould cbe csymmetrical. cLess cthan
canticipated cmovement coccurs cwith cadvanced cchronic cobstructive cpulmonary
cdisease cand cmany crestrictive cprocesses, csuch cas cinterstitial clung cdisease.
cAsymmetry cof cmovement coccurs cwith catelectasis, clobar ccollapse,
cpneumothorax, cand cseveral cother cconditions
During causcultation cof cthe cchest, cyour cexamination creveals ca cloud cgrating
csound cat cthe clower
anterolateral clung cfields, cat cfull cinspiration cand cearly cexpiration. cThis cfinding cis
cconsistent
with:
A. Pneumonia
B. Pleuritis
C. Pneumothorax
D. A cand cB c- cAnswer- cANS: cA&B
An cadventitious csound, ccalled ca cpleural cfriction crub, cis ca ctypically cloud, cgrating
csound cproduced cwhen cthe ctwo cinflamed cand croughened csurfaces cof cthe cvisceral
cand cparietal cpleurae
rub ctogether. cA cfriction crub cis cusually cnoted cin cthe clate cinspiratory cand cearly
cexpiratory cphases, cand cin cthe clower canterolateral clung cfields. cExamples cof
cconditions cthat cresult cin ca
pleural crub cinclude cpneumonia, cpleuritis, cand cmalignancy.
A ccough cis cdescribed cas cchronic cif cit chas cbeen cpresent cfor:
A. 2 cweeks cor cmore
B. 8 cweeks cor cmore
C. 3 cmonths cor cmore
cis cLEAST cimportant cto cassess?
A. Location
B. Amplitude
C. Rhythm
D. Diameter c- cAnswer- cC. cRhythm
Assess clocation, camplitude, cduration, cand cdiameter
5 cA's cof ctobacco ccessation c- cAnswer-
What cis ctactile cfremitus? c- cAnswer- cpalpable cvibrations ctransmitted cthrough cthe
cbronchopulmonary ctree cto cthe cchest cwall cas cthe cpatient cis cspeaking c"99"
NORMAL= cbuzzing con chands cwhen cpatient csay c"99"
SOLIDS cCONDUCT cSOUND/VIBRATIONS cBETTER cTHAN cAIR
Conditions cwhere ctactile cfremitus cis cabsent cor cdecreased c- cAnswer- cFremitus cis
cdecreased cor cabsent cwhen cthe ctransmission cof cvibrations cis cimpeded.
Feeling clittle cor cno cbuzzing cat call ccompared cto csimilar clung careas; cLARGE
cPOCKETS cOF cAIR cIN cTHE cLUNGS
thick cchest cwall
cobstructed cbronchus
cCOPD
pleural
ceffusion
cfibrosis
cpneumo c(Air)
infiltrating ctumor
cfibrosis
cemphysema
cconsolidation
cAsthma
Causes cof casymmetrical cfremitus c- cAnswer- cDecreased cfremitus
cUnilateral cpleural ceffusion
Pneumo
cneoplasm
Increased cfremitus
cUnilateral cpneumonia
Causes cof cincreased cfremitus c- cAnswer- cfeeling cof ca cstrong cvibration ccompared
cto csimilar clung careas
Consolidation cof clung ctissue
cpneumonia
,atelectasis
cbronchitis
Apical cImpulse c(PMI) c- cAnswer- cPoint cof cMaximal cImpulse c(Apex cof cthe cheart):
cbetween c4th cto c5th cintercostal cspace, cmidclavicular
Apex cbeat cis cpalpable cin conly c25-40% cof chealthy cadults cin csupine cposition cand
c50% cin cleft clateral cdecubitus cposition—>especially cthose cwho care cthin
Some chide cbehind crib ccage, cdespite cpositioning
diaphragmatic cexcursion c- cAnswer- c*assesses cdegree cand csymmetry cof
cdiaphragm cmovement; cpercuss cfrom careas cof cresonance cto cdullness
* not cpercussing cthe cdiaphragm citself cyou care cidentifying cthe cresonant clung
ctissue cand cthe cduller cstructures cbelow.
* you ccan cinfer cthe cprobable clocation cof cthe cdiaphragm cfrom cthe clevel cof cdullness
during cdiaphragmatic cexcursion can c"absent cdecent" cmeans cwhat? c- cAnswer-
cAn cabnormally chigh clevel csuggests ca cpleural ceffusion cor can celevated
chemidiaphragm cfrom catelectasis cor cphrenic cnerve cparalysis
fine ccrackles/rales c- cAnswer- coccurrence- con cend cinspiration; cdont cclear cwith
ccough.
Quality- cHigh cpitched cshort ccrackling
Causes- ccollapses cor cfluid-filled calveoli copen
Course ccrackles/rales c- cAnswer- cOccurrence- cEnd cinspiration, cdoesn't cclear cwith
ccough
Quality- cLoud, cmoist, clow-pitched, cbubbling
Causes- cCollapsed cor cfluid-filled calveoli copen
Wheezes c- cAnswer- cOccurrence- cExpiration cand cinspiration cwhen csevere
Quality- cHigh-pitched, ccontinuous
Causes- cblocked cairflow cas cin casthma, cinfection, cforeign cbody cobstruction
Ronchi c- cAnswer- cOccurrence- cExpiration/inspiration; cchange/disappeat cwith ccough
Quality- cLow-pitched, ccontinuous, csnoring, crattling
Cause- cFluid cblocked cairways
Stridor c- cAnswer- cOccurrence- cInspiration
Quality- cloud, chi-pitched ccrowing cheard cwithout cstethoscope
Cause- cobstructed cupper cairway
,pleural cfriction crub c- cAnswer- cOccurrence- cInhalation/expiration
Quality- clow-pitched cgrating, crubbing
Cause- cpleural cinflammation
Percussion ctechnique c- cAnswer-
Normal cpercussion cfindings cin cAdult cby clocation c- cAnswer-
Tracheal cdeviation cwith catelectasis c- cAnswer- cWhen ca cplug cobstructs cbronchial
cair cflow, caffected calveoli ccollapse cand cbecome cairless
*Trachea cmay cshift cto cinvolved cside
Tracheal cdeviation cwith cPleural ceffusion c- cAnswer- cfluid caccumulates cin cthe
cpleural cspace cand cseparates cair-filled clungs cfrom cthe cchest cwall, cblocking cthe
ctransmission cof cbreath csounds
* Trachea cmay cshift ctowards cthe cunaffected cside cin ca clarge ceffusion
Tracheal cdeviation cin ca cpneumothorax c- cAnswer- cAir cleaks cinto cthe cpleural
cspace, cusually cunilaterally, cthe clung crecoils caway cfrom cthe cchest cwall. cPleural
cair cblocks ctransmission cof csound
*Trachea cshifts ctoward cunaffected cside cif ctension cpneumo
Which cconditions clead cto cabsent cbreath csounds? c- cAnswer- c*Fluid cor cexudate
chas caccumulated cin cpleural cspace c(think cemphysema)
*When clungs care chyperinflated
*Breathing cshallow cfrom csplinting cfor cpain
When cpalpating cthe cposterior cchest, cthe cclinician cnotes cincreased ctactile cfremitus
cover cthe cleft
lower clobe. cThis ccan cbe cindicative cof:
A. Pneumonia
B. Emphysema
C. Pneumothorax
D. Asthma c- cAnswer- cAns: cA
Areas cof cincreased cfremitus cshould craise cthe csuspicion cof cconditions cresulting
cin cincreased
solidity cor cconsolidation cin cthe cunderlying clung ctissue, csuch cas cin cpneumonia,
ctumor, cor
pulmonary cfibrosis. cConversely, careas cof cdecreased cfremitus craise cthe csuspicion
cof cabnormal
fluid- cor cair-filled cspaces, csuch cas coccurs cwith cpleural ceffusion, cpneumothorax,
cor cemphysema. cIn cthe cinstance cof can cextensive cbronchial cobstruction, cno
cpalpable cvibration cis
felt cin cthe crelated cfield.
, During cphysical cexamination cof ca cpatient, cyou cnote cresonance con cpercussion cin
cthe cupper
lung cfields. cThis cis cconsistent cwith:
A. Chronic cobstructive cpulmonary cdisease
B. Pneumothorax
C. A cnormal cfinding
D. Pleural ceffusion c- cAnswer- cANS: cC cThe clung cfields cshould cbe cpercussed
cposteriorly, cstarting cfrom cthe csuperior-most careas cand cthen cproceeding
cinferiorly cto cthe clevel cof cthe cdiaphragm. cResonance cis cthe cnormal csound con
cpercussion. cHyperresonance csuggests cair ctrapping, cwhich coccurs cwith cchronic
cobstructive cpulmonary cdisease cor ctension cpneumothorax. cDullness cto
cpercussion cis cdetected cover cthe cactual csite cof cconsolidated clung cor cpleural
cfluid. cDullness cis calso cfound cwith cpneumonia, csevere catelectasis, cor cpleural
ceffusion.
On cassessment cof crespiratory cexcursion, cthe cclinician cnotes casymmetric cexpansion
cof cthe
chest. cOne cside cexpands cgreater cthan cthe cother. cThis ccould cbe cdue cto:
A. Pneumothorax
B. Pleural ceffusion
C. Pneumonia
D. Pulmonary cembolism c- cAnswer- cANS: cA cThe crespiratory cexcursion, cor
cexpansion, cis cdetermined cby cplacing chands caround cthe cpatient's cposterior crib
ccage cwith cthe cthumbs capproximately cat cthe clevel cof cthe c10th crib cbetween cthe
cthumbs, cand cthen casking cthe cpatient cto ctake ca cdeep cbreath cand cobserving
cthe cmovement cof cthe chands. cThe cmotion cshould cbe csymmetrical. cLess cthan
canticipated cmovement coccurs cwith cadvanced cchronic cobstructive cpulmonary
cdisease cand cmany crestrictive cprocesses, csuch cas cinterstitial clung cdisease.
cAsymmetry cof cmovement coccurs cwith catelectasis, clobar ccollapse,
cpneumothorax, cand cseveral cother cconditions
During causcultation cof cthe cchest, cyour cexamination creveals ca cloud cgrating
csound cat cthe clower
anterolateral clung cfields, cat cfull cinspiration cand cearly cexpiration. cThis cfinding cis
cconsistent
with:
A. Pneumonia
B. Pleuritis
C. Pneumothorax
D. A cand cB c- cAnswer- cANS: cA&B
An cadventitious csound, ccalled ca cpleural cfriction crub, cis ca ctypically cloud, cgrating
csound cproduced cwhen cthe ctwo cinflamed cand croughened csurfaces cof cthe cvisceral
cand cparietal cpleurae
rub ctogether. cA cfriction crub cis cusually cnoted cin cthe clate cinspiratory cand cearly
cexpiratory cphases, cand cin cthe clower canterolateral clung cfields. cExamples cof
cconditions cthat cresult cin ca
pleural crub cinclude cpneumonia, cpleuritis, cand cmalignancy.
A ccough cis cdescribed cas cchronic cif cit chas cbeen cpresent cfor:
A. 2 cweeks cor cmore
B. 8 cweeks cor cmore
C. 3 cmonths cor cmore
