Auscultation

Question 1

What are the instructions to your patient when performing auscultation?

Answer 1

“Can you please breathe in and out through your mouth, take slightly deeper breaths than normal, let me know if you start to feel dizzy or short of breath so you can have a rest”

Question 2

What should we be cautious of with auscultation?

Answer 2

• Hyperventilation

- Worsening of dyspnoea

Question 3

What will you listen for on auscultation?

Answer 3

Breath sounds:
• Normal
• Reduced/ Absent
• Bronchial

Added sounds:
• Crackles
• Wheeze
• Pleural rub

Question 4

What mechanism leads to reduced or absent breath sounds?

Answer 4

Reduced sound generation
or
Reduced sound transmission

Question 5

What are some causes of reduced sound/flow generation?

Answer 5

Hypoventilation (pain, weakness)
Airway obstruction
Severe asthma

Question 6

What are some causes of reduced sound transmission?

Answer 6

Parenchymal destruction or hyperinflation (emphysema)
Pleural effusion
Pneumothorax
Obesity

Question 7

What is bronchial breathing?

Answer 7

When tracheal or bronchial sounds are abnormally heard in the lung periphery.

Question 8

What does bronchial breathing indicate?

Answer 8

Indicates open airway surrounded by consolidated lung tissue.
-*Consolidation (usually associated with pneumonia)

Question 9

What may course crackles mean?

Answer 9

Sputum

Question 10

What may fine crackles be?

Answer 10

• Atelectasis
• Pulmonary Oedema
• Pulmonary Fibrosis

Question 11

Atelectasis

• Common patient groups:
• Common presentation:
• Physio appropriate?

Answer 11

Most common patient groups: poor inspiratory volume (e.g. pain inhibited and positional) post-operative cardiac, thoracic and upper abdominal surgery Common presentation: bilateral, localised to lung bases, but may be unilateral, mid-late inspiration, “dry”
Amenable to physiotherapy: YES through techniques to increase lung volumes (+/- sputum clearance)

Question 12

Fibrosis

• Common patient groups:
• Common presentation:
• Physio appropriate?

Answer 12

Most common patient groups: interstitial lung diseases (e.g. pulmonary fibrosis, sarcoidosis, asbestosis)
Common presentation: bilateral, widespread, does not change with positioning, could be ‘coarse’ crackles also
Amenable to physiotherapy: NO (does not change with deep breath/cough)