Question

You are called to the ER to  evaluate b Mr. Collins who has a long standing history of COPD. He was brought to the ER by ambulance and is complaining of increasing shortness of breath and productive high laugh with thick, green sputum. During an examination the his chest you notice hyperesonant percussion with decreased fremitus over the lung except the lower right lope that has a dull percussion note and increased fremitus.

What are the reasons for the differences in the findings?

Based on the findings what would you hear on auscultation over RLL.

Answer 1

COPD  Is Chronic Obstructive Pulmonary Disease.

A group of lung diseases that block airflow and make difficult in breathing

signs and symptoms of COPD includes the following

Shotrness of breathing

A chronic cough ,with mucus that may clear, white ,yellow or greenish

frequint respiratory infections

Lack of energy

weight loss in later stages

swelling of ankles , feet or legs.

Fremitus__Is palpation of chest to detect changes in the intensity of vibrations created with spoken words in a constant tone and voice indicating underlying lung pathology.

Example : ask the patient to say 99, blue moon

Increased fremitus indicates compressed or consolidate of lung tissue , as occures in pneumonia.

What are the reasons for the differences in the findings?

A decrease in vocal fremitus suggests air or fluid in the pleural spaces or a disease in lung tissue density, which can be caused by the COPD or asthma.

Hyperresonant sounds heard beacuse lung may hyperinflated with air, it may indicate pneumothorax.

(Pneumothorax is a air leakeage in the space between lungs and chest wall, is also a collapsed lung)

Based on the findings what would you hear on auscultation over RLL.

RLL- is right lower lung

May hear Ronchi, hyperresonant sound may also be heared while auscultating