Using one or two fingers, tap directly on the body part. Skip to content What is tactile vocal Fremitus? What increases fremitus? How do you do Egophony? What is a positive Bronchophony? What does dullness percussion mean? What does Rhonchi sound like? What is important to do when examining for tactile fremitus? When examining for tactile fremitus, it is important is: C. Palpate the chest symmetrically. What are 3 types of normal breath sounds? Why do we palpate the chest?
What is Egophony and Bronchophony? What causes whispered Pectoriloquy? What is the normal vocal resonance? Rhonchal fremitus , also known as bronchial fremitus, is a palpable vibration produced during breathing caused by partial airway obstruction.
The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. See rhonchus rhonchi for the auditory analog of this sign. Vocal Fremitus , also called pectoral fremitus, or tactile vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat the phrase 'boy oh boy' or any other diphthong such as 'toy boat' and 'blue balloons' while the examiner attempts to detect vibrations on the chest wall.
The phrase 'ninety-nine' is also commonly used. The German language equivalent neun und neunzig , is a diphthong, and is appropriate. Vocal fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial bifurcation.
Vocal fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax collapsed lung. The reason for increased fremitus in a consolidated lung is the fact that the sound waves travel quicker through liquid the consolidation than air.
Conversely, the reason for decreased fremitus in a pleural effusion or any pathology separating the pleura , is that this increased space between the pleura acts as a barrier to the sound waves. It has recently been suggested that the artifacts caused by eliciting vocal fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors Sohn and Baudendistel, Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs.
Template:WikiDoc Sources. Symptoms and signs : circulatory R00—R03 , Template:Navbox subgroup. Symptoms and signs : respiratory system R04—R07 , Epistaxis Hemoptysis. Chest pain Precordial catch syndrome.
The liver span The liver span is performed by percussion of the right hemothorax together with palpation of the right upper abdominal quadrant and is used to estimate liver size at the bedside. Kernig's sign and Brudzinski's sign for meningitis Kernig's sign and Brudzinski's sign are popular among medical students in physical exam evaluation of patients with fever and headache, a common reason for hospital admission worldwide, especially when meningitis is in the differential diagnosis.
Homans sign for deep venous thrombosis Homans sign for deep venous thrombosis DVT also seems well-known among medical students who tend to mention it during presentation of cases of pulmonary embolism or DVT. Conclusions In the age of evidence-based medicine, teachers of physical examination skills in medical schools and postgraduate training programs should incorporate more of what we now know about the validity and usefulness of the various physical examination maneuvers in reaching a diagnosis.
Conflict of Interest The author declares that there are no conflicts of interest. References Elhassan M. Can physical examination skills survive the era of modern diagnostic tests? Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med. Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study.
Indian J Gastroenterol. The clinical estimation of liver size: a comparison of techniques and an analysis of the source of error. Br Med J. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study. Feeling the vibrations generated from the spoken voice is termed tactile fremitus. Tactile fremitus: Is evaluated by having the patient say "ninety-nine" or "one-two-three", and feeling the transmitted vibrations with the hands.
Is more prominent in the interscapular regions, less prominent at the lung bases. Provides information about the density of underlying lung tissue and chest cavity. Is decreased or absent in conditions that impede transmission of sound such as an obstructed bronchus, COPD, pleural fluid, or a very thick chest wall.
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