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.