呼吸試験 II: 打診と聴診
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Q1: What are the normal breath sounds heard during respiratory auscultation?
Normal breathing produces two distinct breath sounds: bronchial sound, which is tubular and hollow, heard over large airways in the anterior chest; and vesicular sound, which is soft, low-pitched, and rustling, heard over most lung tissue. Both sounds should be symmetrical when comparing side-to-side during auscultation and working mechanism of a stethoscope assessment.
Q2: How do you perform percussion on the respiratory system?
Ask the patient to sit upright or lean forward. Place your non-dominant hand's middle finger firmly over the mid-back, then tap it twice with your dominant hand's middle finger. Repeat at four to five levels posteriorly, then anteriorly, comparing side-to-side. Ensure the middle finger rests in intercostal spaces, not on ribs, to accurately assess percussion sounds.
Q3: What do abnormal percussion sounds indicate about lung pathology?
Dullness during percussion suggests solid tissue or fluid accumulation, such as pleural effusion. Hyper-resonance indicates hollow spaces or air trapping, suggesting pneumothorax. Normal air-filled lungs produce resonant, low-pitched, hollow sounds. Tympanic notes resemble drum sounds and occur over hollow spaces like Traube's space.
Q4: What abnormal breath sounds indicate airway obstruction or fluid?
Crackles, also called rales, indicate fluid in small airways. Wheezes or rhonchi suggest airway constriction or swelling causing partial obstruction. Stridor indicates upper airway obstruction. Pleural rubs occur when inflamed pleural surfaces slide against each other during respiration. These abnormal sounds help identify specific pulmonary conditions during clinical percussion examination.
Q5: How do you assess for lung consolidation during auscultation?
Three tests identify consolidation: bronchophony—ask the patient to say "99" and listen for increased sound transmission; egophony—ask for "E" and listen for it changing to "A" through the stethoscope; and whispering pectoriloquy—ask the patient to whisper "99" and listen for clearer sound transmission. Perform these tests posteriorly at multiple locations covering the entire lung area.
Q6: What is the anatomical relationship between lung lobes and the chest wall?
The right lung has three lobes—superior, middle, and inferior—separated by horizontal and oblique fissures. The left lung has two lobes—superior and inferior—separated by an oblique fissure. Each lobe projects beneath the chest wall and corresponds to specific percussion and auscultation zones. Understanding this anatomy helps clinicians locate pathology during respiratory exam inspection and palpation.
Q7: What pulmonary conditions can be diagnosed through percussion and auscultation?
Percussion and auscultation can identify chronic obstructive pulmonary disease, asthma, pneumonia, and pneumothorax. Abnormal sounds and percussion notes provide almost immediate diagnostic clues. With practice, clinicians develop the ability to recognize characteristic sound patterns associated with specific lung pathologies, enabling spot diagnosis at the bedside.