Control questions

1. What is percussion?

2. What types of percussion do you know; their diagnostic importance?

3. What are purpose and rules of the comparative percussion?

4. What percussion sound may be obtained over health lung, mechanism of its origin?

5. What is dull percussion sound, its origin and diagnostic importance?

6. What is tympanic (resonance) percussion sound, its origin and diagnostic importance?

7. What distinguished lines and points on chest do you know?

8. What is normal position of the right lower border of the lung? How it can change in pathology?

Practical tasks

1. Performing comparative percussion of the chest of the respiratory patient

2. Assess findings of the comparative percussion

3. Determine position of the lower border of the left lung.

4. Determine position of the lower border of the right lung.

5. Determine height of the lung apex, assess obtained findings

6. Determine active excursion of the lower border of the lung, assess findings

Situation tasks

Task 1

29-year-old male patient noted repeated every day attacks of breathlessness during last 7 years. At the visual inspection patient skin is light cyanotic, the ribs are horizontal, the intercostal spaces are narrow, supra- and subclavicular fossae are not seen, the epigastric angle is obtuse. The upper portion of the chest is especially wide.

1. Why is patient skin cyanotic?

2. What types of the chest does patient have?

3. What position in the bed does patient occupy during attack of breathlessness?

Task 2

57-year-old female patient complains of dyspnea, cough and left side chest pain. The symptoms appeared after hard work and overcooling 3 days before. At the visual inspection skin is pale and cyanotic, respiratory rate is 32 and left part of the chest is left behind from right

1. How is increased respiratory rate named? Why does patient have this sign?

2. Why is one half of the chest left behind from other?

3. What position may patient occupy in the bed? Why?

Task 3

24-year-old female was admitted to pulmonology department with severe mixed dyspnea, high fever (39°C), cough with rusty sputum, piercing chest pain. Her mother said the patient was exited and had visual hallucinations. During examination patient is calm, her respiratory rate is 36. Skin is red and hot.

1. What is general condition of the patient? Which department should patient be admitted?

2. What disorder of consciousness does patient have? Why?

3. How should you palpate the patient chest? What signs of the respiratory disease may you reveal?

Task 4

73-year-old male patient notes increasing dyspnea, cough with purulent sputum production during last week after overcooling. Patient condition is moderate severe. He sits fixing the shoulder girdle. His exhalation is longer than inhalation. Skin is cyanotic.

1. What type of the chest shape may be at the patient? Why?

2. What change of his finger can you find? Why?

3. How is vocal fremitus changed at the patient? Why?