Quick Review: Examination of the Respiratory System

by Stephen Holt, MD, MS

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    00:01 So let's review some of the content that we've learned.

    00:04 This is a big table.

    00:05 I'm just going to hone in on a few specific boxes on this table that review some of the important, most salient stuff that we've covered during this lecture.

    00:13 So in the normal lung, all of these findings in green are normal.

    00:17 You'd expect the patient to have some tactile fremitus, we're really talking about excursions in terms of how strongly you find tactile fremitus in certain situations.

    00:26 So let's move on to the next column. Lung consolidation.

    00:29 In this case, you'll have increased tactile fremitus, you'll have bronchophony, egophony.

    00:33 You'll be able to potentially even hear words intelligibly simply by having your stethoscope on the back of the chest.

    00:41 Patients with infusion in contrast, have the opposite findings.

    00:44 There's essentially muffled quiet sounds all over the area where there is a large effusion so your breath sounds are quiet and muffled.

    00:52 You're not going to have any of those other findings that would go along with consolidation.

    00:56 And you may have crackles above the border of where the effusion is because of some compression atelectasis compressing the lung in that area.

    01:07 Patients with COPD, you may look for hyperresonance generally diminished breath sounds throughout possibly with some wheezing that's accompanying it.

    01:16 And there are some extra pulmonary manifestations that we've also discussed as well.

    01:21 And lastly, heart failure.

    01:23 In general, everything appears to be normal oftentimes, with heart failure.

    01:28 It's really looking for those diffuse crackles, particularly starting at the bases and gradually moving up depending upon how much volume overload your patient has.

    01:39 So which of the following would be seen with a pleural effusion? Increased tactile fremitus, bronchial breath sounds egophony, or dullness to percussion? Well, the first of those three letters all represent things you would find with lung consolidation.

    01:59 And they should actually all be decreased or absent in the setting of atrial effusion.

    02:03 It's only dullness to percussion that you would find with both a pleural effusion and with lung consolidation.

    02:12 Which of the following is not associated with a consolidated pneumonia? Whisper pectoriloquy, bronchiolar breath sounds, diminished tactile fremitus, or dullness to percussion.

    02:27 Well, we've just said that you'll expect to see dullness to percussion with both in fusion and consolidation, so it can't help to tease them apart.

    02:34 A consolidated pneumonia should have whispered pectoriloquy and would also have bronchial breath sounds.

    02:39 It's really just the diminished tactile fremitus that would only go along with an effusion but would not be expected to be found with a consolidated pneumonia.

    About the Lecture

    The lecture Quick Review: Examination of the Respiratory System by Stephen Holt, MD, MS is from the course Examination of Cardiovascular and Respiratory System.

    Author of lecture Quick Review: Examination of the Respiratory System

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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