auscultation

Question 1

what is auscultation?

Answer 1

-listening to and interpreting the sounds produced within the thorax
-divided into breath sounds (BS) and added sounds (AS)

Question 2

What are the steps of doing auscultation with a stethoscope?

Answer 2

-use the diaphragm of the stethoscope
-ear pierces should point forwards
-chest should be exposed, dont listen through fabric
-ask pt to breathe in and out through mouth
-always compare left w/ right

Question 3

what are the different areas of auscultation in the front and the back of the lungs?

Answer 3

Question 4

what do normal or vesicular breath sounds sound like?

Answer 4

-faint, muffled and low pitched
-note inspiration is longer than expiration
-heard at the bases of the lungs

Question 5

what are examples of abnormal breath sounds?

Answer 5

-bronchial
-decreased
-absent
-adventitious/added

Question 6

what is the inspiratory time: expiratory time ratio for breath sounds?

Answer 6

3:1

Question 7

where are bronchial breath sounds heard?

Answer 7

heard normally over the trachea / large airway
-abnormal if heard in the peripheral airways

Question 8

describe bronchial breath sounds

Answer 8

• expiration is as loud as inspiration
  -sounds like Darth Vader breathing
  -loud and harsh sounding heard equally on inspiration and expiration

Question 9

where is it normal vs abnormal to hear bronchial breath sounds ?

Answer 9

-normal -over trachea / large airway
-abnormal - in peripheral airways

Question 10

how are breath sounds created?

Answer 10

by flow related turbulence

Question 11

what can reduced flow cause to BS?

Answer 11

less sound

Question 12

what are the causes of decreased or absent breath sounds?

Answer 12

-bi basal post-op atelectasis or lobar atelectasis
-poor inspiratory effort due to pain or fatigue
-emphysema
-asthma
-pneumothorax
-obesity
pleural effusion

Question 13

what are adventitious / added breath sounds?

Answer 13

-extra noises that shouldn’t be there

Question 14

list examples of added breath sounds

Answer 14

-crackles (creps)
-rhonchi (gurgling / bubbling sounds heard during breathing)
-wheezes (whoosh eeeee)
-stridor (inspiratory wheeze due to large airway narrowing)
-pleural rub

Question 15

describe crackles (added sound)

Answer 15

-popping sound (like fireworks)
-created when air is forced through airways that have been narrowed by inflammation, secretions or oedema
-mainly heard on inspiration
-can be early or late
-velcro sound

Question 16

how would you distinguish between early and late crackles?

Answer 16

-ask pt to cough if crackles heard at the mouth
-early inspiratory crackles indicate diffuse airflow limitation eg COPD
-coarse early inspiratory crackles occur when bronchioles open due to secretions eg bronchiectasis
-late inspiratory crackles involve alveoli eg bronchiectasis or IPF

Question 17

describe wheezes

Answer 17

-a whistling sound produced by airflow vibrating a narrowed or compressed airway
-can be high or low pitch
-mainly heard during expiration
-low pitched - known as rhonchi

Question 18

what’s the difference between a monophonic vs polyphonic wheeze?

Answer 18

-monophonic- large airway obstruction - single sound
-polyphonic wheeze - small airway obstruction, multiple sounds

Question 19

what can cause wheezes?

Answer 19

-bronchospasm
-mucosal oedema
-sputum
-foreign body / tumour
-pulmonary oedema

Question 20

what is stridor and what does it indicate?

Answer 20

-a loud inspiratory wheeze heard at the mouth
-indicates significant upper airway obstruction (larynx, trachea, main bronchi)

Question 21

when is stridor heard?

Answer 21

inspiration - if severe airway obstruction it is heard on both inspiration and expiration

Question 22

what are the possible causes of stridor?

Answer 22

-foreign body
-obstruction
-large airway tumour

Question 23

why is stridor common in paediatrics?

Answer 23

as they have small narrow airways - can get blocked easier

Question 24

what is pleural rub?

Answer 24

-creaking or rubbing sound eg creaking door
-inspiratory and expiratory sound
-reoccurs at same time in each resp cycle

Question 25

what is pleural rub caused by?

Answer 25

-caused by inflammation eg lobar pneumonia

Question 26

what area will an increased liver size have an effect on?

Answer 26

the right lower lobe breath sounds

Question 27

what effect will an increase in stomach size have on the BS?

Answer 27

decrease in left lower lobe breath sounds

Question 28

do you listen posteriorly or anteriorly to assess LL?

Answer 28

posteriorly

Question 29

what is the ideal position of a patient to auscultate them?

Answer 29

-forward lean sitting

Question 30

which area of the lung are fine crackles heard well?

Answer 30

-the base of the lung

Question 31

course crackles are louder and longer in duration in comparison to fine crackles … true or false

Answer 31

true

Question 32

how can you test vocal resonance ?

Answer 32

-place stethoscope on the chest wall as the patient whispers 99 or 1,2,3 over and over
-whispered speech cannot usually be heard over normal healthy lung

Question 33

what are some things you need to document about auscultating?

Answer 33

-air entry AE - eg good throughout or poor AE right base
-comment on additional sounds eg expiratory crackles right base