by Carlo Raj, MD

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    00:00 Wheezing, what about this? This is a expiratory sound. Wheezing is often audible to the patient especially in asthma. Wheezing is to be distinguished, differentiated from stridor. Highlight your head, stridor. Which is an inspiratory sound best heard in the upper airways. Is that clear? So, the wheezing, for example, if it’s asthma, more or less a lower type of generation and the patient would be able to hear it and the stridor would be an inspiratory and to you that should indicate an upper respiratory issue. Stridor deserves immediate medical attention because this is the upper airway and the fact that you might actually have the upper airway that is now become closed.

    00:47 And if that’s the case, what’s one of the first things that you do when a patient comes in with emergency in the ER? ABC – Airway, bronchi or breathing and number 3 would be your circulation.

    01:00 Wheezing pearls, we’ll do the same thing here as well. These are important, look for the description. Symmetric polyphonic. Meaning to say several sounds and a musical wheeze, you’re thinking about asthma. Unilateral wheezing, this is usually formed by the aspiration, you tell me. If say, they have a child that ends up.. Well the age old question, is maybe a peanut or some kind of food particle, maybe even a toy. Well, of the two lungs, which one are you more likely to go into? The right lung because of less of an angle and it will directly deposit, depending as to the position. For example, if it’s sitting up type of position then it will be post your basal segment of the right lower lobe, so on and so forth.

    01:42 Things that you talked about in anatomy. Unilateral wheezing, maybe PE. When you have a PE from a DVT, a pulmonary embolus. Wow, that’s scary. Mean to say that your patient is going to have rapid shallow breathing, hypoxia will still be present and airway tumours or masses, might also present as unilateral.

    02:03 Wheezes heard more without the stethoscope. These are vocal cord type of dysfunctions.

    02:07 So, wheezing, as I said, when it’s asthma that the patient was expressing it. But, here, without the stethoscope and hearing wheezing, you’re thinking more along the upper airway type of dysfunction. Wheezing after eating, once again, aspiration and food allergy. Look for these descriptions, please, in a stem of a question or history of your patient so that you can then move into the right differential of pulmonary disease.

    About the Lecture

    The lecture Wheezing by Carlo Raj, MD is from the course Introduction to Pulmonary Pathology.

    Included Quiz Questions

    1. It is an expiratory sound.
    2. It is an inspiratory sound.
    3. It is an inspiratory and expiratory sound.
    4. It is neither an inspiratory nor an expiratory sound.
    1. Asthma
    2. Airway tumor
    3. Airway mass
    4. Foreign body aspiration
    5. Pulmonary embolus
    1. Wheezing more prominent without the stethoscope
    2. Unilateral wheezing
    3. Symmetric polyphonic wheezing
    4. Wheezing after eating
    5. Bilateral wheezing

    Author of lecture Wheezing

     Carlo Raj, MD

    Carlo Raj, MD

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