Ausculatation

Question 1

Bowel Auscultation

Why do it and how to do it?

Answer 1

Why? To assess bowel motility and to determine causes of abdominal complaints
or Searching for renal stenosis

How?
– supine position
– place the stethoscope on the abdomen

Question 2

Normal bowel sounds?

Answer 2

Normal sounds = clicks and gurgles 5-30/min

Question 3

Abnormal sounds? Give examples of why you would have increased intensity, decreased intensity

Answer 3

Increased intensity and frequency: diarrhea or intestinal obstruction=obstructive ileus

Decreased intensity and frequency, or no sounds at all: paralytic ileus,
peritonitis

Splash in ileus (lot of air and liquid)

Question 4

What are Bruits?

Answer 4

Bruit- french for noise
aka vascular murmur.
It is the abnormal sound generated by turbulent flow of blood in an artery due to a partial obstruction; or a localized high rate of blood flow through an unobstructed artery.

Question 5

Why do we hear Bruits over the abdomen?

Answer 5

Normally there shouldn’t be any
Reason- Renal artery stenosis
Where? upper quadrants of epigastrium & costovertebral angles
Sounds like vascular murmurs

Question 6

Position for lung auscultation

Answer 6

Arms crossed in front of the chest
Ask the patient not to speak and to breathe deeply through the mouth
•Compare two sides at the identical locations
•At least one full breath at each location

Use Diaphragm of the stethoscope

Question 7

What are normal breath sounds?

Answer 7

Tracheal or bronchial breath sounds
Vesicular breath sounds

Question 8

Tracheal/ Bronchial breath sounds

Answer 8

The turbulent airflow in central airways
Loud, high pitched sound (like over trachea, scapula)

Normally not heard
as not transmitted in air filled lung

Can be heard: pneumonia, large pleural effusions
when lung tissue loses air

Question 9

Vesicular airsounds

Answer 9

Distal to trachea & proximal to alveoli
Normally over the lung
Soft & low pitched

Question 10

Severe asthma bronchiale (how does it affect the sounds heard)

Answer 10

Decreased sounds

Question 11

Emphysema (effect of sound)

Answer 11

Decreased sounds

Question 12

PTX (effect of sounds)

Answer 12

Absent or decreased sounds

Question 13

Bronchial sounds heard with what 2 conditions?

Answer 13

Pneumonia

effusion

Question 14

6 Conditions causing crackles

Answer 14

• pneumonia
• ARDS
• bronchiectasis
• early CHF
• interstitial lung disease
• pulmonary edema

Question 15

What type of sound is a wheeze?

Answer 15

A continuous, high pitched, hissing sound

Question 16

When do we normally hear wheezing/ wheezes?

Answer 16

heard normally on expiration but also sometimes on inspiration

Question 17

What produces the wheezing sounds?

Answer 17

Produced when air flows through airways narrowed by secretions, foreign bodies, or obstructive lesions.

Question 18

What are crackles and when do we hear them?

Answer 18

Discontinuous, non musical brief sounds

More commonly heard on inspiration

Question 19

Describe two types of crackles?

Answer 19

Fine: High pitched, soft and v brief

Coarse: low pitched, louder, less brief

Question 20

What is the mechanical basis behind the two types of crackles?

Answer 20

The collapse of small airways during expiration (fine crackles)
or
air bubbles through secretions or incompletely closed airways during expiration (coarse crackles)

Question 21

What conditions cause wheezes?

Answer 21

• asthma bronchiale
• CHF
• chronic bronchitis
• COPD
• pulmonary edema

Question 22

What is stridor? Where and when do we hear it?

Answer 22

inspiratory musical wheeze heard loudest over the trachea during inspiration

Question 23

What does stridor suggest?

Answer 23

stridor suggests an obstructed trachea or larynx
• constitutes a medical emergency that requires immediate attention
• foreign body

Question 24

What is pleural rub?

Answer 24

creaking or brushing sounds produced when the pleural surfaces are inflamed and rub against each other

may be discontinuous or continuous sounds

usually localised at a particular place on the chest wall

Question 25

What phases of resp cycle would we expect to hear plural rub?

Answer 25

heard during both the inspiratory and expiratory phases

Question 26

Conditions causing pleural rub

Answer 26

• Pleuritis
• Pneumonia with pleuritis
• Postthoracothomy syndrome