Propaedeutics of Internal Diseases · MU Plovdiv

8. Added sounds – crackles /crepitations/ and pleural friction rub

Inside: 3 sections · 2 labelled pictures · 5 tables · 14 flashcards · 3 min

Topic 8 of 100 in the MU Plovdiv syllabus for Propaedeutics of Internal Diseases (Medicine, Year 3). The free AceMed note covers it in 3 sections, about 204 words (3 min of reading), with 14 flashcards.

In this note

  1. Physical methods of examination of a patients with pulmonary disease — percussion, auscultation
  2. A. PERCUSSION
  3. B. AUSCULTATION

A. PERCUSSION

General Guidelines

  • Compare both sides symmetrically (anterior, lateral, posterior).
  • Use middle finger of non-dominant hand as pleximeter.
  • Tap with the tip of dominant middle finger.
  • Percuss only over intercostal spaces, avoiding ribs (bone transmits dull sounds).
  • Stand at the side of the patient—not directly in front or behind.

What to Listen For

Lines of Percussion & Normal Findings

I. Symmetrical Percussion

  • Percuss over posterior chest, slightly lateral to paravertebral line.
  • Percuss both sides at the same intercostal levels.
  • Note for symmetry and listen for resonant notes.

II. Lower Border of the Lungs

(Percuss downward to detect transition from resonant to dull)

III. Respiratory Movement Assessment

  1. Identify lower lung border via percussion (usually 10th ICS).
  2. Mark the dull area.
  3. Ask the patient to breathe in deeply and hold.
  4. Percuss again—if the sound changes from dull to resonant, it confirms diaphragmatic excursion.
  5. Positive sign = movement of lung border due to inspiration.

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