2. PERCUSSION:
•Resonant sound are low pitched hollow sounds heard
over normal lung tissue.
•Liver dullness can be percussed from the Right 5th
intercostal space downwards.
•Cardiac dullness heard adjacent to the sternal margin
beneath the 4th Rib on the left.
6. 5.PERCUSSION TENDERNESS
• Empyema
• Pleuritis
AUSCULTATION:
Vesicular Breath sound :
• These are normally low pitched, Rustling in nature
• Duration of Inspiratory phase longer than Expiratory
phase.
• No pause between the end of inspiration and beginning
of Expiration.
7. DIMINISHED VESICULAR BREATH SOUNDS:
• Bronchial Asthma
• Tumor
• Pleural Effusion
• Pleural Thickening
• Emphysema
BRONCHIAL BREATHING:
• Produced by Trachea, large Bronchi
• Heard over area of diseased, airless or consolidated
lung
• It is loud and High Pitched
• Duration of Inspiratory shortened and Expiratory
prolonged.
• Pause between Expiratory and Inspiratory
8. CONDITION:
• Consolidation
• Bronchopleural Fistula
• Upper lobe- Fibrosis, Collapse
ABSENT OF BREATH SOUNDS:
• Massive Pleural Effusion
• Fibrothorax
• Pneumothorax
ADDED SOUNDS:
1.CRACKLES:( Crepitations, Rales)
• Non musical, interrupted added sounds of short duration
• They are Explosive in Nature
9. TYPES:
FINE: Less loud, short duration and arise from alveoli
COARSE: low pitched, loud and arise from bronchus and
bronchioles.
CONDITION:
• Early Inspiratory: Chronic Bronchitis
• Mid Inspiratory : Bronchiectasis
• Late Inspiratory : Pulmonary Fibrosis
• Expiratory : Pulmonary Oedema
2.WHEEZE:
• Continuous, High pitched , Musical sound usually heard on
Expiration.
10. • Caused by narrowing of airways.
TYPES:
• Monophonic : Obstruction of one airway such as Tumors,
Foreign bodies or fibrosis. Eg: Bronchogenic Carcinoma
• Polyphonic: Generalized Bronchoconstriction Eg:Asthma
3.RHONCHI:
• Musical, Continuous added sound
• SONOROUS: low pitched, arising from large airways
• SIBILANT: High pitched, arising from small airways
4. SQUAWKS:
• Short inspiratory wheezes.
• Causes: Pneumonia ,Interstitial fibrosis.
11. 5.STRIDOR:
• High pitched, caused airflow obstructed in larynx and
trachea
• Eg:Laryngeal Oedema
6.PLEURAL RUB:
• Continuous or Discontinuous
• Friction between two pleural surface produce these
sound.
• Heard during Expiratory and Inspiratory phase.
CONDITION:
• Pleuritis
• Pleural effusion
• Pneumothorax.
12. REPERTORY OF HERING’S GUIDING
SYMPTOMS OF OUR MATERIA
MEDICA BY KNERR.
(BASED ON EXAMINATION OF RS)
13. CHEST-LUNGS-AUSCULTATION SOUNDS: Pg
no:1379
• Amphoric, in tuberculosis :- NAT ARS
• Bronchial, at base (phthisis) :- ARS-IOD
• Bronchial, in catarrhal pneumonia :-HYOS
• Bronchial, after coughing and profuse expectoration (bronchial catarrh) :- HEP.
• Bronchial, indistinct, with numerous rales, partly dry, partly moist, with dull
percussion over lower portion of thorax on right side :-PHOS
• Bronchial, in pleuritis :- CACT
• Bronchial, in pneumonia :- KALI-I.,LYC,PHOS,SANG
• Bronchial, on right side, in phthisis :- IOD
• Bronchial, in right, suprascapular region (phthisis) :- ARS-IOD
• Bronchial, strong in front, right side, above and behind (pneumonia) :- ANT-T
• Bronchial, in tuberculosis :-FERR-I
• Bronchial, upper half (asthma) :-DIG
14. • Creaking leathery noise, over middle and lower 3rd of right (pneumonia) :-
IOD
• Crepitation in bilateral croupous pneumonia :-KALI-IOD.
• Crepitation, coarse, beneath left clavicle (haemorrhagic pthisis) :- ARS-IOD
• Crepitation, coarse, below border of pectoralis major, and around posteriorly
to back of lung (haemorrhagic phthisis) :-ARS-IOD.
• Crepitation, coarse, in phthisis :-ARS-IOD
• Crepitation, coarse, posteriorly about centre (phthisis) :- ARS-IOD
• Crepitation, dry, over both, veiled by co-existing coarse bronchial
rales (measles) :- LACH
• Crepitation, with or without expectoration, and a sensation of heat and
sharp pain during inspiration :- PHOS.
• Crepitation, fine, in broncho-pneumonia :-LYC
• Crepitation, with feeble respiration :-KALI-CYN
• Crepitation, in left (pneumonia) :- ANT-TART
15. • Crepitation, before and after menses (phthisis) :- ARS-IOD
• Crepitation, in pneumonia :- ELAPS,LYC,PHOS
• Crepitation, posteriorly, in right lung, from forced inspiration (phthisis) :- ARS-
IOD
• Crepitation in right suprascapular region (phthisis) :-ARS-IOD
• Murmur, in pneumonia :- ANT-T
• Murmur, harsh, in left apex (phthisis) :- ARS-IOD
• Murmur in apices, rattling, weak, worse in right (consumption) :- KALI-BI
• Murmur, weak respiratory, in right side, in nipple line in 5th intercostal
space (bronchial catarrh) :- HEP
• Purring, in bronchial catarrh :- ANT-T
• Rales, subcrepitant, over summit of, right :-ANT-TART
• Rasping, increasing towards evening (croup) :- ALUM-SIL
• Rhonchi, dry (phthisis) :- ARS-IOD
• Snoring, loud, as if through a tube (bilateral croupous pneumonia) :- KALI-IOD
• Vesicular murmur absent in dropsy of chest :- KALI-IOD
16. • Vesicular murmur absent in dropsy of chest :- KALI-IOD
• Vesicular murmur absent in posterior half of left :- LACH
• Vesicular murmur absent in pleuritis, with plastic exudation :-
HEP
• Vesicular murmur absent in pneumonia :- LYC.
• Vesicular murmur dry in upper part (asthma) :- ARG-N
• Vesicular murmur feeble :- DIG
• Vesicular murmur feeble in cardiac dropsy :- DIG
• Vesicular murmur feeble and obscure :- GELS
• Vesicular murmur indistinct in several places (asthma) :- ARG-N
• Vesicular breathing, weak (œdema of lungs) :- ANT-T
17. CHEST – LUNGS-PERCUSSION SOUNDS:(Pgno:1389)
• Dull :- KALI-CY,KALI-I
• Dull, as a board, from apex to axillary border of pectoralis major in front, and
to middle of scapula behind (phthisis) :- ARS-IOD
• Dull, over lower half of right, in asthma :- DIG
• Dull, below left clavicle (catarrh) :- APIS
• Dull, in right side in nipple line in 5th intercostal space after coughing and
profuse expectoration, tympanitic percussion, worse in morning in bronchial
catarrh :- HEP
• Dull, under left clavicle, in bronchial and vesical catarrh :- COP
• Dull, in dropsy of chest :-KALI-IOD
• Dull, in haemoptysis :-ACAL
• Dull in heart disease :-HYDR
• Dull, in upper left (chronic cough) :-LYC
• Dull, in left infraclavicular region, sensitive to touch (phthisis) :- LACH
• Dull, beneath left clavicle ( haemorrhagic phthisis) :- ARS-IOD
• Dull, in catarrhal phthisis :-KALI-MUR
18. • Dull spot beneath left clavicle, in haemorrhagic phthisis :- ARS-IOD
• Dull, below border of pectoralis major, and around pectoralis major, and
around posteriorly to back of lung, in haemorrhagic phthisis :- ARS-IOD
• Dull, in front to 4th right rib, in pleuritis :- CACT
• Dull, in pleuritis, with plastic exudation :- HEP.
• Dull, empty, in front, right side, in pneumonia :- ANT-TART
• Dull, right, in, near armpits, in pneumonia :- ELAPS
• Dull, in pneumonia, 7th to 9th day :- PHOS
• Dull, under right mamma, in pneumonia :- ELAPS
• Dull, in clavicular region, on right down to 3rd, on left to 2nd rib, in
bilateral croupous pneumonia :- KALI-IOD
• Dull, entire posterior or inferior region of right side, in typhoid
pneumonia :- TER
19. • Dull, over apices, in pulmonary disease :- LYC
• Dull over summit of right :- ANT-TART
• Dull, over lower right, with indistinct bronchial respiration and numerous
rales, partly dry, partly moist :- PHOS
• Dull, over right upper anterior and posterior part, in phthisis :- KALI-BI
• Dull, in front and behind upper portion, worse posteriorly beneath
scapula, in phthisis :-ARS-IOD
• Dull, over right base posteriorly, coarse crepitation, in phthisis :- ARS-IOD
• Empty, in upper portion, particularly right side (consumption) :- IOD
• Empty, hollow in right side (pleuro-pneumonia) :- HEP
• Normal resonance on left side, want of (bronchial and vesical catarrh) :-
COP
• Tympanitic, in edema of lungs :- ANT-TART
• Tympanitic, right side up to 3rd rib behind and below (pneumonia) :-ANT-T
• Tympanitic on sides, in tuberculosis :-FERR-I
21. 1.KALI-IODATUM:
INDICATED IN:
• Pulmonary Edema
• Laryngeal Edema
• Pneumonia, when hepatization commences
• Bronchial Asthma
• Pleuritic Effusion
• Hydrothroax
SPECIFIED IN:
• Larynx feels raw.
• Violent Cough. Expectoration like Soap suds,greenish
• Dyspnea on ascending, with pain in the heart.
• Cold travels downwards to the chest.
22. RUBRICS:
AUSCULTATION:
• Bronchial, in pneumonia :- KALI-I
• Crepitation in bilateral croupous pneumonia :-KALI-IOD
• Vesicular murmur absent in dropsy of chest :- KALI-IOD
PERCUSSION:
• Dull, in dropsy of chest :-KALI-IOD
• Dull, in clavicular region, on right down to 3rd, on left to 2nd rib,
in bilateral croupous pneumonia :- KALI-IOD
23. 2.ARSENICUM IODATUM:
INDICATED IN:
• Pleuritis Exudativa
• Chronic Bronchitis
• Pulmonary tuberculosis
• Pneumonia
SPECIFIED IN:
• In early stage of TB, it is effective. Associated with Profound
prostation, Rapid irritable pulse, recurring fever, sweat, emaciation
and tendency to diarrhea
• Chronic Pneumonia with Lung Abscess
• Pneumonia that fails to clear-up
• Broncho-pneumonia after Influenza
• Slight Hacking cough with dry and stopped up nostrils
• Aphonia.
24. RUBRICS
AUSCULTATION:
• Bronchial, at base (phthisis) :- ARS-IOD
• Bronchial, in right, suprascapular region (phthisis) :- ARS-IOD
• Crepitation, coarse, beneath left clavicle (haemorrhagic pthisis) :- ARS-
IOD
• Crepitation, coarse, below border of pectoralis major, and around
posteriorly to back of lung (haemorrhagic phthisis) :-ARS-IOD.
• Crepitation, coarse, in phthisis :-ARS-IOD
• Crepitation, coarse, posteriorly about centre (phthisis) :- ARS-IOD
• Crepitation, posteriorly, in right lung, from forced
inspiration (phthisis) :- ARS-IOD
• Crepitation in right suprascapular region (phthisis) :-ARS-IOD
• Murmur, harsh, in left apex (phthisis) :- ARS-IOD
• Rhonchi, dry (phthisis) :- ARS-IOD
25. PERCUSSION:
• Dull, as a board, from apex to axillary border of pectoralis major in
front, and to middle of scapula behind (phthisis) :- ARS-IOD
• Dull, beneath left clavicle ( haemorrhagic phthisis) :- ARS-IOD
• Dull spot beneath left clavicle, in haemorrhagic phthisis :- ARS-IOD
• Dull, below border of pectoralis major, and around pectoralis
major, and around posteriorly to back of lung, in haemorrhagic
phthisis :- ARS-IOD
• Dull, in front and behind upper portion, worse posteriorly
beneath scapula, in phthisis :-ARS-IOD
• Dull, over right base posteriorly, coarse crepitation, in phthisis :-
ARS-IOD
26. 3.PHOSPHORUS:
INDICATED IN
• Clergyman’s Sore throat & Laryngitis & Bronchitis
• Pneumonia with oppression < lying on left side
• Tuberculosis in tall, rapidly growing young people
SPECIFIED IN:
• Cannot talk, larynx – painful, dry, raw, rough, sore
• Tightness across chest. Great weight on chest
• Hard, dry, tight, racking cough
• Nervous cough < Strong odors, Entrance of Stranger
• Cough < going from warm to cold air, lying left side
• Do not give it too low or too frequent it may hasten destructive
degeneration of Tubercular masses.
27. AUSCULTATION:
• Bronchial, indistinct, with numerous rales, partly dry, partly
moist, with dull percussion over lower portion of thorax on right
side :-PHOS
• Bronchial, in pneumonia -PHOS
• Crepitation, with or without expectoration, and a sensation of
heat and sharp pain during inspiration :- PHOS.
• Crepitation, in pneumonia :- PHOS
PERCUSSION
• Dull, in pneumonia, 7th to 9th day :- PHOS
• Dull, over lower right, with indistinct bronchial respiration and
numerous rales, partly dry, partly moist :- PHOS
28. 4. ELAPS CORALLINUS:
INDICATED IN:
• TB in apex of the Right lung ,Pneumonia
SPECIFIED IN:
• Haemorrhage from lungs: Black like ink and watery
• Stopping Causes Fainting
• Cough with terrible pain through lungs
• Stitches in the apex of Right lung ( phthisis)
• Coldness in the chest after drinking
• <Lying on Right Side
AUSCULTATION:
• Crepitation, in pneumonia :- ELAPS
PERCUSSION:
• Dull, right, in, near armpits, in pneumonia :- ELAPS
• Dull, under right mamma, in pneumonia :- ELAPS
29. 5.ACALYPA INDICA:
INDICATED IN:
• Incipient phthisis with hard, racking cough, bloody expectoration
SPECIFIED IN:
• Cough dry, hard followed by hemoptysis
• Constant and severe pain in chest
• Blood bright red and profuse in morning
• Dark and clotted in the afternoon
PERCUSSION:
• Dull, in haemoptysis :-ACAL
30. 6.HYDRASTIS CANADENSIS:
INDICATED IN:
• Follicular Pharyngitis
• Bronchitis in old exhausted person
• Asthma
SPECIFIED IN:
• Thick, yellow, tenacious expectoration
• Frequent fainting spells with cold sweat all over
• Pain from chest to left shoulder
• < lying left side.
PERCUSSION:
• Dull in heart disease :-HYDR
31. 7.HEPAR SULPHURIS CALCAREUS:
INDICATED IN
• Pneumonia
• Asthma
• Bronchitis – Cough < Dry cold wind
SPECIFIED IN :
• Cough – Croupy, chocking, strangling < Dry cold wind, uncovered
body.
• Asthma: Breathing Anxious, wheezing, rattling; short, deep breathing,
threatens suffocation
• >Must bend head back and sit up
AUSCULTATION:
• Bronchial, after coughing and profuse expectoration (bronchial
catarrh) :- HEP.
• Murmur, weak respiratory, in right side, in nipple line in 5th
intercostal space (bronchial catarrh) :- HEP
32. PERCUSSION
• Empty, hollow in right side (pleuro-pneumonia) :- HEP
• Dull, in pleuritis, with plastic exudation :- HEP.
8.FERRUM IODATUM:
INDICATED IN:
• TB of lungs
• Bronchorrea
SPECIFIED IN :
• Corya discharge of mucus from nose, trachea, larynx
• Chest feel oppressed
• Hemoptysis
AUSCULTATION:
• Bronchial, in tuberculosis :-FERR-I
PERCUSSION:
• Tympanitic on sides, in tuberculosis :-FERR-I
33. 9. ANTIMONIUM TARTARICUM:
INDICATED IN:
• Asthma & Bronchitis
• Emphysema in the aged
• Icterus with Pneumonia especially of Right lung
• Edema and impending Paralysis of lungs
• Asphyxia Neonatorum
SPECIFIED IN:
• Cough with large accumulation of mucus in bronchi but nothing
comes up
• Asphyxia with Drowsiness and Coma
• Velvety feeling in the chest
• Dyspnea relieved by Eructation
• Cough and dyspnea > lying on Right side
34. AUSCULTATION:
• Bronchial, strong in front, right side, above and
behind (pneumonia) :- ANT-T
• Crepitation, in left (pneumonia) :- ANT-TART
• Murmur, in pneumonia :- ANT-T
• Purring, in bronchial catarrh :- ANT-T
• Rales, subcrepitant, over summit of, right :-ANT-TART
• Vesicular breathing, weak (œdema of lungs) :- ANT-T
PERCUSSION:
• Dull, empty, in front, right side, in pneumonia :- ANT-TART
• Dull over summit of right :- ANT-TART
• Tympanitic, in edema of lungs :- ANT-TART
35. 10.LACHESIS MUTUS:
INDICATED IN :
• Edema of lungs
• Laryngismus
• Asthma
SPECIFIED IN :
• Sense of suffocation and strangulation on lying down and
everything around throat
• Spasm of glottis feel as if something ran down from neck to larynx
• Cough Dry, suffocative fits, tickling
• Breathing almost stop on falling asleep
• Sensation of a plug which moves up and down with short cough.
36. AUSCULTATION:
• Crepitation, dry, over both, veiled by co-existing coarse bronchial
rales (measles) :- LACH
• Vesicular murmur absent in posterior half of left :- LACH
PERCUSSION:
• Dull, in left infraclavicular region, sensitive to touch (phthisis) :-
LACH
