Medical Archive

Introduction

History

Dyspnea and cough

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• Maximal inspiratory mouth pressure
  • ??? mouthpiece? ?? RV ?? FRC??? ??? ???? ??? ? ? ???? ?????? ???? ??
  • ??/???? ??? ????? ??
• Transdiaphragmatic pressure ??
• EEG

Additional symptoms

Additional history

Physical examination

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• Vocal fremitus (tactile fremitus)
  • ????? ??? ???, ??? ??
  • Consolidation? ??, pleural effusion, pneumothorax, atelectasis? ??.
• Egophony
  • ?Resonance of voice sounds heard, often caused by lung consolidation and fibrosis.
  • Sounds like the letter “A” when the patient says the letter “E”
• Whispered pectoriloquy
  • ?Loudness of whispering
  • Usually spoken sounds of a whispered volume by the patient would not be heard by the clinician auscultating a lung field with a stethoscope.
  • If consolidated, these whispered spoken sounds by the patient (such as saying ‘ninety-nine’) will be clearly heard through the stethoscope. 

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• Dull or flat
  • Consolidation
  • Atelectasis
    • With patent airway: bronchial breath sound + bronchophony/whispered pectoriloquy, egophony
    • With blocked airway: decreased breath sounds and voice transmission.
  • Pleural effusion
• Resonant
  • Normal
• Hyperresonance
  • Pneumothorax

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• 

• 

Ant: 1st, 2nd interspace
Post : between scapulae

??? ??: ?? ??, ???, ??? (?? ??) ?
??? ??: Consolidation, ???

Bronchial sound at the periphery: alveolar consolidation

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Crackle: ??? – severe HF, COPD / ??? – ??, ILD Wheezing : ???. ??? ??? ??
Rhonchi : ??? ? ???? ??. ???? ? ??
Stridor : ?? ?. ????? ??

Pleural rub

Diagnostic evaluation

Pulmonary function test

Chest imaging

Further studies

Hypoxemia

• (A-a)DO2? ?? ?????? ???? ???? ????.
• Mismatch
  • Airway~Blood? ??? ?? ??? perfusion? ???? ????? ? O2?? ??
  • COPD, asthma, pneumonia, ILD
• Shunt
  • Airway~Blood? ?? ??? ?? O2?? ?? ??.
  • ?? Atelectasis, Pulmonary edema, ?? ??? ? ????!

Alveolar-arterial (A-a) oxygen gradient

Estimated by (2.5 + [0.21*age]) or (age/4 + 4)
Elevation occurs in processes that cause impaired gas exchange.
Normal in alveolar hypoventilation

PAO2 = 150 – 1.25*PaCO2