Auscultation

Question 1

before listening with stethoscope

Answer 1

Listen to what you can hear from the mouth – noisy breathing indicates increased airflow turbulence due to obstructed upper airways
.
Crackles, wheezes or snores may be heard from the bedside
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A monophonic wheeze in the upper airways called stridor is a serious sign denoting laryngeal or tracheal narrowing to a diameter as small as 5mm

Question 2

listening to chest steps

Answer 2

1. Hold the stethoscope with the ear-pieces facing forwards before inserting them into your ears.
2. Ensure that the diaphragm is receiving the sound.
3. Press the diaphragm firmly on the chest to minimize extraneous sounds
4. Listen for a full inspiratory and expiratory phase
5. Listen alternating between left and right sides of the chest, compare your findings for each lobe

Question 3

Auscultation points

Answer 3

10 possible points anteriorly.
12 possible points posteriorly.

Question 4

What are normal breath sounds?

Answer 4

• Normal turbulence of air flowing in and out of the lungs produces ‘breath sounds’.
• Louder on inspiration and faded/minimal on expiration
• Inspiratory sounds heard for longer than expiratory
  What’s considered ‘normal’ depends on where you are listening:
  Over the trachea – bronchial
  Over the lung fields – soft and muffled (described as vesicular), becoming quieter as you move to the base of the lungs.

Question 5

Abnormal breath sounds

Answer 5

Bronchial Breath sounds heard over lung tissue are abnormal – Due to increased density & mainly due to:
* Lobar collapse
* Consolidation
.
Breath sounds may be diminished
* Shallow breathing
* Poor positioning
* Hyperinflation
* Filtered by the pleura or chest wall

Question 6

Wheeze

Answer 6

due to vibration of the wall of narrowed or compressed airways.
- Primarily during expiration
- Expiratory phase can therefore be prolonged

Mono-phonic wheeze
lower pitched one note
Due to compression or obstruction of a large, central airway

Poly-phonic wheeze
higher pitched multiple notes
Due to diffuse small airway obstruction or compression

Question 7

crackles

Answer 7

• Short, non-musical, popping sounds
• Can be described as fine or coarse
• Also need to consider when in the breath cycle they are heard

Question 8

FIne crackles

Answer 8

• Re-opening of airways
• due to atelectasis or secretions
• End inspiratory: opening of smaller airways and suggests fibrosis or pulmonary oedema

Question 9

coarse crackles

Answer 9

• Like pouring milk on rice Krispies
• Suggests obstruction due to sputum in more proximal, larger airways
• Early expiratory: more central airways
• Late expiratory: more peripheral airways

Question 10

Pleural Rub

Answer 10

• Creaking/rubbing sound, described as sounding like boots walking in fresh snow.
• Sounds the same on inspiration and expiration.
• Usually localised.
• As a result of inflamed pleura and decreased production of pleural fluid
• Pleurisy/pleuritis
• Usually as a result of infection
• Often associated with pleuritic chest pain

Question 11

Voice sounds

Answer 11

• Vibrations of the spoken word can be felt by the hands= Tactile vocal fremitus or heard through a stethoscope = vocal resonance
• Reduced voice sounds are heard when there is atelectasis with a blocked airway or a pneumothorax or pleural effusion
• 99

Question 12

inspiration stridor

Answer 12

upper airway obstruction

Question 13

wheeze

Answer 13

Asthma or COPD

Question 14

coarse crackles meaning

Answer 14

Pneumonia and pulmonary odema

Question 15

Fine crackles meaning

Answer 15

pulmonary fibrosis

Question 16

increased vocal resonance

Answer 16

• Consolidation
• Lobar collapse
  Tumor

Question 17

decreased vocal resonance

Answer 17

pleural effusion