Auscultation

Question 1

What is auscultation

Answer 1

The process of listening to and interpreting the sounds produced within the thorax, listen to mouth before auscultation and ask them to cough in order to prevent masking other sounds during auscultation

Question 2

What are you listening for in auscultation

Answer 2

Breath sounds

Added sounds

Question 3

What are breath sounds

Answer 3

A more accurate term for air entry as sometimes air may be entering lungs but transmission is blocked

Question 4

What can breath sounds be

Answer 4

Normal, increased, decreased

Question 5

How are breath sounds generated

Answer 5

Turbulent air in airways, only in small proportion of airways, transmitted through lungs to chest wall, air is a poor conductor

Question 6

What are increased breath sounds

Answer 6

More coarse compared to normal, inspiration and expiration are equal pitch, definite pause in between, sometimes described as darth Vader breathing, occurs when lung tissue more dense pneumonia, COPD, emphysema and heart failure

Question 7

What are decreased breath sounds

Answer 7

It’s normal to have a reduced level of breath sound the further away form the trachea you auscultate, decreased breath sounds a much quieter breath sound caused by the pathology of underlying lung causing a disproportionate reduction in normal breath sound caused by decreased ventilation e.g consolidation or collapse, obesity or pleural effusion

Question 8

What are added sounds

Answer 8

Added sounds are superimposed on the breath sounds, can be obvious and mask breath sound, in order for them to be added sounds they. Just be respiratory in origin, added sounds can occur in any or both parts of the respiratory cycle

Question 9

What are the 3 types of added songs ds

Answer 9

Crackles, wheezes, pleural rub

Question 10

What are crackles

Answer 10

The primary source of crackling is due to the explosive equalisation of gas between 2 components of the lung when a closed section of airway separating them suddenly opens or could be due to secretions in airways being audible as air passes through them , mostly indicate sputum

Question 11

What are the two types of crackles

Answer 11

Coarse and fine

Question 12

What is wheeze

Answer 12

Whistling sound caused by air passing through narrowed airway

Question 13

What are the two types of wheeze

Answer 13

Monophonic generated by one airway,

Question 14

How is monophonic wheeze generated

Answer 14

By one airway, single note, same position in respiratory cycle

Question 15

How’s polyphonic wheeze generated

Answer 15

By several airways giving diff notes, pitch varies depending on the amount of narrowing, greater narrowing= higher pitch, can occur on inspiration, expiration or both

Question 16

What’s the auscultation technique

Answer 16

Should be conducted In a system comparing one side to the other, whilst visualising underlying lung structures, important to have good surface anatomy knowledge to ensure correct placement

Question 17

How should the stethoscope be placed in auscultation

Answer 17

Shouldn’t be placed over clothing, cleaned between each patient use, patients should be asked to sit upright where they can breathe through mouth

Question 18

What’s pleural rub

Answer 18

Squeaking and grating sounds of pleural linings rubbing together can be described as treading on fresh snow, they occur where pleural layers are inflamed and have lost lubrication

Question 19

What’s the auscultation technique

Answer 19

Place ear pieces forward, ask permission to expose cheats area, position patient to access both anterior and posterior aspects of chest, may need to lean them forward to listen posteriorly

Question 20

Auscultation technique continued

Answer 20

Place in a methodical order comparing lobes on one side to the same lobe on other lung, no middle lobe in left lung, corresponding area compared to that of right middle lobe, upoer lobe accessed anteriorly, middle lobes accessed anteriorly or laterally, lower lobes accessed posteriorly

Question 21

Crackles and the respiratory cycle

Answer 21

Early inspiratory crackles- proximal airways
Late inspiratory crackles- peripheral airways
Early expiratory crackles- prox airways
Late expiratory crackles- peripheral airways

Question 22

Things that can interfere with assessment

Answer 22

Movement of stethoscope on skin, oral cavity sounds, clothing, talking, hairy skin, shivering, external sounds