Pumerantz-Physical Exam And Auscultation

Front 1

Describe the different sounds heard in percussion and what they could mean

Back 1

A. resonance-normal lung; could also indicate chronic bronchitis
B. hyperresonance-indicates emphysema or pneumothorax (more air than there should be)
C. tympany-indicates large pneumothorax
D. flatness-indicates large pleural effusion
E. dullness-lobar pneumonia

Front 2

Describe normal breath sounds

Back 2

A. tracheal
B. bronchovesicular-hollow, high-pitched
C. vesicular-less hollow, low-pitched (normally heard over lung parenchyma)
note-normal breath sounds are abnormal when heard where not expected
bronchovesisular sounds over lung parenchyma suggests fluid in the lungs (sound travels faster in fluid than air)

Front 3

Describe adventitious breath sounds

Back 3

A. rales-inspiratory sounds; alveoli are popping open (discontinuous, intermittent, non-musical)
B. wheezes-peak in expiration (continuous, high-pitched, musical, prolonged)
C. rhonchi-indicates fluid in the lungs (continuous, low-pitched, sonorous)
D. pleural rub-scratchy through inspiration, stuttering in exhalation (friction b/t chest wall and lungs); patient has accompanying chest pain
E. inspiratory stridor-tracheal obstruction; air rushes over obstruction in inspiration

Front 4

Describe transmitted voice sounds

Back 4

A. Bronchophony-“99” heard clearer and louder through chest wall (normally muffled or indistinct)
B. Egophony (E-to-A change)
“ee” sounds like “ay” when lung is consolidated (normally a muffled long E)
C. Whispered pectoriloquy
Whispered “99” or “1-2-3” heard clearer and louder through chest wall (normally faint or absent)

Front 5

slight dullness on percussion
bronchovesicular or bronchial breath sounds

Back 5

small consolidation

Front 6

slight dullness on percussion
bronchovesicular or amphoric breath sounds
pectoriloquy
increased voice sounds
rales are present

Back 6

thick-walled cavity

Front 7

increased fremitus
dull or flat on percussion
bronchial breath sounds
increased whisper and voice sounds
rales present

Back 7

massive consolidation

Front 8

tracheal deviation away
absent fremitus
hyperresonant over some areas, flat over others on percussion
absent breath sounds over some areas; loud bronchial breath sounds over others
whisper and voice sounds are either absent or increased (depending on the area of the lung you are listening to)

Back 8

large pleural effusion

Front 9

dull percussion
decreased breath sounds
decreased whisper and voice sounds

Back 9

small pleural effusion

Front 10

decreased fremitus
dull percussion
decreased breath sounds
decreased whisper and voice sounds

Back 10

pleural thickening

Front 11

absent fremitus
dull percussion
decreased or absent breath, whisper, and voice sounds

Back 11

consolidation and bronchial plug

Front 12

tracheal deviation toward
dull percussion
absent fremitus, breath, whisper, and voice sounds

Back 12

atelectasis and bronchial plug

Front 13

decreased fremitus
hyperresonant percussion
quality of sounds are the same, but are decreased

Back 13

pulmonary emphysema

Front 14

absent fremitus
resonant or hyperresonant on percussion (depending on area percussed)
coin sound
decreased or absent breath, whisper, and voice sounds (depending on area auscultated)

Back 14

closed pneumothorax

Front 15

trachea deviated away
absent fremitus
hyperresonant percussion
decreased or absent breath, whisper, and voice sounds
coin sound

Back 15

tension pneumothorax

Front 16

trachea deviated away
hyperresonant or flat percussion (depending on area percussed)
absent breath, whisper, and voice sounds
coin sound, succession splash, shifting dullness

Back 16

hypopneumothorax