Lecture 52 - Approach to Pts with Pulmonary Disease

Question 1

Physical Exam Findings: Asthma/COPD

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 1

• Inspection –Pursed Lip breathing, barrel chest
• Palpation - Decreased fremitus
• Percussion - Hyper resonance
• Auscultation – wheezing or rhonchi bilaterally

Question 2

Physical Exam Findings: Pneumothorax

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 2

• Inspection - ipsilateral hyperinflation
• Palpation - ipsilateral decreased movement and decreased fremitus; contralateral tracheal deviation, subcutaneous crepitus
• Percussion – Hyperresonance on ipsilateral
• Auscultation – Decreased BS over ipsilateral hemithorax

Question 3

Physical Exam Findings: Pleural Effusion

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 3

• Inspection –
• Palpation – ipsilateral decreased movement; ipsilateral decreased or absent fremitus, contralateral tracheal shift
• Percussion – dull or FLAT on ipsilateral
• Auscultation – decreased BS over ipsilateral side; occasional pleural rub

Question 4

Physical Exam Findings: Lung consolidation

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 4

• Inspection — N/A
• Palpation – Increased fremitus over areas of consolidation
• Percussion — DULL over consolidated areas
• Auscultation – Bronchial Breath sounds, egophony and whispered pectoriloquy over consolidated areas

Question 5

Physical Exam Findings: Bronchial Obstruction (with atelectasis)

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 5

• Inspection
• Palpation – decreased ipsilateral movement; ipsilateral tracheal shift; ipsilateral decreased fremitus
• Percussion - DULL
• Auscultation – decreased BS over ipsilateral

Question 6

Physical Exam Findings: Fibrosis

• Inspection
• Palpation
• Percussion
• Auscultation

Answer 6

• Inspection – Clubbing
• Palpation
• Percussion
• Auscultation – Crackles, usually bilaterally