Round barrel shape kyphosis outward curvature of

Round Barrel shape
- Kyphosis: outward curvature of thoracic spine
- Bony prominence: d/t ↓ subcutaneous fat
- Chest expansion ↓, but still symmetric
- Fatigue during Auscultation (take deep breath in and out)
- SHALLOW BREATHS W/ ↑ R.R.
What is the correct procedure
for auscultating lung sounds?
Is it alright to listen through a
patient’s gown?
PX sitting position, leaning forward slightly
Breath through mouth
Listen to a full respiration cycle (I + E) at each location
Use Diaphragm, holding firmly against skin, leaving a slight circle mark
Listen to 6 locations anteriorly, 8 posteriorly and 2 laterally
How would you describe
bronchial breath sounds?
Where would you normally hear
these sounds?

What is the significance of
hearing louder sounds where
softer sounds are expected?
What causes wheezes?
bronchial sounds?
bronchophony?

Describe egophany,
bronchophany,
whispered pectoriloquy
EGOPHONY:
Normal: “eeeee”
Abnormal: weak and long “aaaa” sound
d/t Consolidation/Compression
BRONCHOPHONY:
Normal: voice is soft, muffled, indistinct, can’t distinct words exactly
Abnormal: distinct words, sound close to your ear → “99” test
d/t ↑ lung density
WHISPERED PECTORILOQUY:
Normal: faint, muffled, inaudible
Abnormal: whispered voice is transmitted very clearly and distinct → “123” test
d/t Consolidation
IF POSITIVE → THERE IS CONSOLIDATION
● ABNORMAL: With fluid filled or consolidation (DULL PERCUSSION), words
sound very clear and very loud
● NORMAL: becomes softer and less distinct than when heard directly
What is fremitus?
TEXTBOOK PG 436
TACTILE FREMITUS: palpable vibration
- Sounds from Larynx transmitted thru Bronchi and Lungs to chest wall as
vibrations
- Most prominent at the Scapula and around Sternum d/t major bronchi being
closer to chest wall
- ↓ as progress downward on chest wall
- Use palmar base of finger or ulnar edge
- Vibration should be symmetric
- Vocal resonance

- Sound: need air to travel and cause vibration
↓ FREMITUS: obstruction, thichning → BARRIER