Term
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Definition
● Vocal transmission increased in clarity and intensity
● The intensity of bronchophony depends on the size of the consolidated area
● Note that sound volume may depend on the anatomy – apical segments may transmit more clearly, as they are closer to the vocal cords, with a lot of cartilaginous and osseous structures in the vicinity |
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Term
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Definition
● You should not be able to discern whispered words anywhere in the chest.
● Have patient count 1,2,3
When whispering the vocal cords do not oscillate, make sure the patient is truly whispering and remember that whispered pectoriloquy is never a normal finding. |
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Term
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Definition
● Egophony means “goat’s talk.” The origin of the name is self evident if you listen to the audio file! Egophony can be seen as modified bronchophony.
● A in bronchophony, vocal transmission increased in clarity and intensity
● When listening through a stethoscope "E" becomes "A"
● Egophony is never a normal finding and indicates underlying consolidation |
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Term
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Definition
● A high-pitched, hollow sound
● Only heard over the trachea
● Both the inspiration and expiration phases are heard
● Expiration slightly longer and louder
● Pause between inspiration and expiration |
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Term
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Definition
● Tubular and high-pitched, not as loud as the tracheal sounds
● Normal if heard over the upper lobes, close to sternum
● Expiration slightly longer and louder
● Pause between inspiration and expiration, but may be absent in hyperventilation |
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Term
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Definition
● Muffled and low pitched
● Heard over chest wall, with the exception of areas described under bronchial sounds
● Vesicular sounds are normal, unless severely decreased in intensity, or distant in quality as in early pneumonia, atelectasis, and COPD
● Inspiration is low-pitched and audible. The expiration phase is much shorter and barely audible (I:E ratio: 3:1, even 1:0) |
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Term
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Definition
● This is a combination of bronchial and vesicular sounds
● Inspiration has a vesicular quality
● Expiration has a bronchial quality, so the pitch changes from inspiration to expiration
● These sounds are different from vesicular sounds because there is a pause between inspiration and expiration
● This is predominant, normal breath sound in children under 13 |
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Term
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Definition
● Can be due to:
● Hemothorax/ effusion
● Pneumothorax
● Thickened pleura (fibrosis, effusion)
● COPD; decreased air velocity – overinflation
● Mucous plug
● Hypoventilation |
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Term
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Definition
Fine Rales
● Associated with secretions in the terminal areas of the bronchial tree
● Indicates inflammation and congestion of the alveoli
● Individual “popping” sounds may not be well separated
Medium Rales
● Please note that the terms Rales and Crackles are used synonymously
● A sign of more involvement (tenacious mucous)
● Can occur anywhere in the inspiratory phase |
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Term
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Definition
● Rumbling sound, heard continuously both on inspiration and expiration
● Caused by passage of air through narrowing in the tracheobronchial tree
● Narrowing can be caused by disease or secretions – can typically be cleared with a cough |
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Term
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Definition
● Loud musical sound
● Primarily during inspiration
● Can be due to croup, tracheal stenosis, aspiration
● If severe, accompanied by accessory respiratory muscle activity
● May be a sign of a life threatening condition |
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Term
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Definition
● Visceral and parietal pleurae inflamed and roughened
● The inflamed membranes adhere, creating a squeaking, grating, or clicking rub
● The inflammation may cause the patient to stop breathing, at the point where she feels pain (splinting), but once the membranes “break free” the patient is pain-free and can continue inspiration (or expiration)
● Cyclic adherence and release of pleura is diagnostic for friction, it can be heard at the same point during inspiration and expiration
● Most commonly heard at the posterolateral and anterolateral chest walls
● Causes include pneumonia, trauma, infections of pleura, and post-surgical |
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Term
| Does the patient use accessory respiratory muscles? |
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Definition
● Sternocleidomastoids
● Paraspinals
● Shoulder girdle muscles |
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Term
| Signs and Symptoms of Respiratory Distress |
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Definition
● Chest pain and shortness of breath: Pneumonia, pneumothorax, or pulmonary embolism
● Shortness of breath, dyspnea, cyanosis or pursed-lip breathing: asthma attack
● Shortness of breath and hypoxemia: worsening of pneumonia, pulmonary embolism |
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Term
| Obstructive pulmonary disease |
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Definition
Obstructive diseases are the most common of pulmonary diseases
● Obstructive sleep apnea
● Asthma
● Chronic bronchitis
● Emphysema
● Bronchiectasis
● Cystic fibrosis |
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Term
| Restrictive pulmonary disease |
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Definition
● Obesity (the most common limitation to chest expansion)
● Interstitial lung disease (ARDS)
● Ventilatory muscle dysfunction (denervation) cervical cord injury, and diaphragmatic.
● Disease entities that can compress or infiltrate the alveoli include pneumonia, interstitial lung disease, lung tumors and diseases of the pleural space |
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Term
| Pulmonary vascular diseases: |
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Definition
● Pulmonary heart disease
● Pulmonary Thrombosis
● Embolism
● Heart failure |
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Term
| Obstructive Pulmonary Disease presents |
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Definition
Inspection
● Mucous membrane (tongue and buccal) cyanosis? Patient must have 4g of desaturated hemoglobin per 100 ml for cyanosis to be visible
● Membrane pallor, indicating significant anemia
● Respiratory rate / manner. Prolonged expiratory phase +chronic cough and pursed lip breathing is evidence of significant obstructive pulmonary disease.
● Can patient speak in fairly long sentences? A clue to the severity of condition
● Does the chest appear to continuously be in the full inspiratory position? Is it barrel shaped?
● Is there clubbing of the terminal phalanges. Could indicate chronic lung, heart, or liver disease. The severity of the clubbing is related to duration and severity of the disease
● Patient’s sitting position. Does she support the torso with extended arms?
● Ochre-brown stains between the index and second finger? Patient must be a heavy smoker
● Opposite movements of the lower chest and abdomen during inspiration? Indicates respiratory muscle fatigue (percuss/ auscultate posterior lower thorax for diaphragmatic movement)
● Palpate for right ventricular heave left of sternum, below the xiphoid process. A heave could indicate right ventricular hypertrophy due to pulmonary hypertension
● Palpate radial artery for pulsus paradoxus
Auscultation is often of limited value in COPD, due to the decreased lung sounds, but note the following:
● If there are adventitious breath sounds, they will be heard during expiration
● A bronchospastic component, expiratory wheezing, can be found not only in asthma, but in other forms of COPD
● Inspiratory wheezing indicates multiple bronchiolar plugs. If heard in an asthmatic patient inspiratory wheezing can signify impending status asthmaticus |
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Term
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Definition
Exercise can induce asthma, due to associated dehydration and adrenaline flow. To avoid this the physical therapist can take the following steps:
● Provide an adequate warm-up
● Recommend two puffs of the inhaler 10 minutes before exercise
● If symptoms develop during exercise, advise the patient to slow down, take two more puffs.
● If the patient is having a difficult day, take the day off
Some clinical signs and symptoms of Asthma include (see p342 in your text for a complete list):
● Wheezing
● Noisy difficult breathing
● Pursed lip breathing
● Unusual pallor or unexplained sweating
● Fatigue unrelated to working or playing |
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Term
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Definition
Obstructive sleep apnea syndrome refers to partial or complete obstruction of the upper airway during sleep. This is a different category of obstructive diseases because:
● It will respond to ventilatory muscle strengthening and weight loss
● It is not a problem of intrathoracic airway obstruction, but rather decreased muscle tone.
● Almost always seen in persons who are morbidly obese - thus overlaps with restrictive pulmonary disease
● Overlaps with central respiratory diseases. There is apparent insensitivity to hypoxemia and/or hypercapnia.
In interesting characteristic can be seen in the image below: respiratory effort; abdominal and chest movement continues, even though no movement of air is taking place. |
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Term
| Obstructive-emphysema/asthma/bronchitis/sleep apnes/ |
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Definition
| difficult inspration/expiration,decreased FEV/FVC. increased residual volume |
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Term
| restrictive- obesity/interstitial lung disease/muscle weakness/ decreased lung volume |
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Definition
| air flow normal all volumes decreaeed |
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Term
| pulm vascular disease- embolism/artery disease/CHF |
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Definition
| normal lung volume/decreased functional aveoli-capillary area for gas exchange |
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Term
| regulation-hypo/hyperventilation |
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Definition
| abnormal rate exchange normal |
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