No clavicle barrel chest wide ap diameter midline

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No clavicle Barrel chest – wide AP diameter Midline structures:* Heart – midline if apex beat is in 5 th ICS MCL Trachea 2. Symmetry of lung expansion* *can be a part of inspection or palpation PALPATION Palpate for midline structures Check for lagging – hand along the 10 th ICS Palpate for Tactile fremiti – ulnar surface of the hand most sensitive to vibration PERCUSSION 1. Flat – muscle and bone 2. Dull – liver or any solid organ 3. Tympany – stomach, intestine 4. Resonant – air-filled lungs 5. Hyperresonant – pathologic, pneumothorax AUSCULTATION 1. Tracheal - trachea 2. Bronchial – manubrium sterni 3. Bronchovesicular – 2 nd ICS parasternal - major lobar bronchi 4. Vesicular – rest of lung fields Extrapulmonary Manifestation of Pulmonary Problems 1. Clubbing Severe cardiac or hepatic problem Lung malignancy Lung abscess 2. Ptosis, myosis, anhydrosis – Horner’s syndrome 3. Snoring 4. Obstructive Sleep Apnea – excessive daytime sleepiness No airflow due to obstruction, brain wakes the patient up due to lack of O2 Frequent cause of HPN at a very young age 5. Superior Vena Cava Syndrome – obstruction to the SPV Due to Malignancy, Prominent veins 6. Unilateral swelling – DVT, prone to pulmonary embolism
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Transmission of Sounds Sounds are transmitted through the large airways Sound is the consequence of the velocity of airflow and the turbulence
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