Auscultation Flashcards
What are the anatomical landmarks for auscultation?
Anterior
Oblique fissure starts at the 4th chondrocostal junction
Upper lobe above 4th chondrocostal junction
Middle lobe (R Lung) is between the 4th and 6th chondrocostal junction and finishes mid axillary line
Posterior Oblique fissure starts at T3 Upper lobe above T3 Lower lobe bellow T3 Distal border of lung is T10
Where are the sites for auscultation?
Anterior and posterior upper lobe R + L
Middle lobe mid axillary line for R and middle zone for L
Posterior lower lobe all the way down to T10 R + L
What are the advantages and disadvantages of using a stethoscope for auscultation?
Advantages
Cheap
Lightweight
Portable
Disadvantages
Subjective - depends on skill and ‘ear’ of clinician
Low frequency sounds below human hearing range
What area of the lungs are breath sounds harsher?
Upper lobes
What are normal breaths sounds described as?
Vesicular
How are vasicular breath sounds produced?
Turbulence in the airways
What are crackles during auscultations?
Opening of previously closed bronchioles
When are crackles mostly heard?
During inspiration
What are early inspiratory crackles and late inspiratory crackles associated with?
Early inspiratory crackles - airflow limitation
Late inspiratory crackles - pulmonary oedema, fibrosis of the lung and bronchiectasis
How can you differentiate between crackles and wheezing?
Wheezing is a continuous sound
Crackles are interrupted sounds
What are the 2 types of crackles and what do they mean?
Fine crackles - fibrotic lung disease
Coarse crackles - heard more in obstructive disease
When do you usually hear wheezing and why do they occur?
Expiration
Result from vibrations in collapsed airways - resistance as a result of flow limiting mechanisms
What is monophonic and polyphonic?
Monophonic - Single large airway obstruction
Polyphonic - Narrowing of many smaller airways
What are the typical lung sound on auscultation for asthma?
Decreased breath sounds due to diminished airflow
Expiratory wheeze = bronchospasm
Prolonged expiration phase
Crackles = if sputum present
What are the typical lung sound on auscultation for COPD?
Inspiratory and expiratory wheeze = bronchospasm
Prolonged expiration forced expiration - to try and prevent airway walls collapsing during expiration
Coarse crackles - Airway closure due to mucus
Paradoxical quiet breathing sounds
What are the typical lung sound on auscultation for bronchiectasis?
Abnormal dilation of the bronchi after obstruction and infection
Inspiratory and expiratory crackles = pus in lungs
What are the typical lung sound on auscultation for pulmonary oedema?
Inspiratory and expiratory crackles in bases = fluid accumulation in base of lungs
Wheeze heard sometimes = obstruction of airways with fluid
What are the typical lung sound on auscultation for interstitial lung disease?
End-inspiratory crackles heard in half of cases = Thickening of airways causes obstruction
What are the typical lung sound on auscultation for cystic fibrosis?
Inspiratory and expiratory wheeze = obstruction due to hypertrophy and increased amount of mucous-secreting glands
Some fine crackles = secretions
When auscultating how do you find the middle lobe from posterior of the patient?
Find T5, follow line horizontally to the mid axillary line
This is where the middle lobe starts
What are the anatomical landmarks for the lower border of the lung on a normal breath?
T10 posteriorly
8th rib mid axillary line
6th rib mid clavicular line
S-shaped
What are the anatomical landmarks for the lower border of the lung on a deep breath?
T12 posteriorly
10th rib mid axillary line
8th rib mid clavicular line
S-shaped
What is the anatomical marks of the oblique fisser?
Starts at T3 posteriorly
T5 mid axillary line to meet with horizontal fissure (R lung)
Continues to angle down to meet the lower border of the lung at the 6th rib mid clavicular line
From the anterior view, what are the 2 main lobes you can see?
Upper and middle lobe R
Upper lobe L
Which is longer inspiration of expiration in healthy lungs?
Expiration
1:2 ratio
Where do breath sounds become fainter? And why?
Apex in an upright position as inspiration progresses
Due to differences in regional flow rates
Where are expiratory breath sounds produced more than inspiratory?
Centrally
When do you hear paradoxically quiet breath sounds?
When expiration is restricted e.g. COPD
Due to loss of elastic tension in the lung
Can crackles be cleared by coughing?
No
What is bronchial breathing?
More hollow sounding and higher pitch than vesicular sounds
Believed these are true lung sounds and vesicular sounds are filtered
When would you hear bronchial breathing?
Over consolidation, collapsed lung and areas of fibrosis
What is a pleural rub in auscultation?
Creaking or groaning sound
What does a pleural rub in auscultation indicate and why?
Inflammation or thickening of the pleural surfaces
Pleural surfaces would glide silently over one another in normal lungs
What is a stridor in auscultation and what causes it?
Inspiratory musical type of noise
Rapid airflow due to obstruction in the upper respiratory tract
