Auscultation Flashcards
the 2 types of sounds & sub types
1) Main
- Vesicular
- Tubular (bronchial/tracheal)
- Harsh breathing
- Cogwheel
2) adventitious
- Dry Rales (wheeze)
- Moist rales (Crackles)
- Crepitation
- Pleural friction rub
characteristics of wheezing
heard on constriction or secretions in the airways
- Asthma
- COPD
-heard on expiration
characteristics of crackles/rales/crepitation
caused by secretions in the terminal bronchi or alveoli.
fine/corse/wet/dry
- Crackles can be heard in patients with pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis,pulmonary hypertension(edema)
- heard on terminal inspiration
- if they disappear after a cough or change in body position it means, they are not from the lungs but but the URT
Rhonchi
heard by having secretions in the larger airways
-heard on inspiration & expiration
**Ddx from pleural rub- Rhonchi are louder on the trachea
Pleural friction rub
Caused by inflammation of the pleural space
- fluid in the pleural space is replaced by a sticky substance=> stretching of the substance causes noise
- heard on inspiration & expiration => “crunch of snow”
**Ddx from Rhonchi is that it is louder on the chest walls
characteristics of Vesicular breathing
Soft
inhale:exhale= 3:1
no pauses between inhalation & exhalation
in infants 3-6 months- weak vesicular breathing
from 6months- 7years -strengthened vesicular breathing= puerile respiration
characteristics of tubular breathing
inhale:exhale= 1:1
can binormal or pathologic
tracheal auscultation=normal
bronchial auscultation=pathologic
characteristics of harsh breathing
inhale:exhale= 1:1
rough, coarse, sharp
mechanism- irregular narrowing of the bronchial tubes (inflammatory edema, sticky exudate in the lumen of the bronchi), thereby lengthening the exhalation
types of airway obstruction
1-bilateral a) upper airway obstruction b) lower airway obstruction= bronchial obstruction 2-unilateral a) infiltration of the lung tissue b) atelectasis c) pleural effusion d) pneumothorax
characteristics of stridor
"Noisy breathing" - sound on inhaling, caused by obstructed air in the oropharynx, or trachea Causes of stridor: ●False croup ●retropharyngeal abscess ●Foreign body ●Diphtheria (true croup) ●Epiglottitis ●Congenital anomalies (congenital stridor) anomalies of cartilage epiglottis, laringomalyatsiya, extra folds of mucous membrane ●Anaphylaxis ●Burns in airways
Bronchial obstruction syndrome
Type of breathing: harsh
Adverse respiratory sounds:
dry wheezing, crepitation
Disease entities:
obstructive bronchitis, bronchial asthma, bronchiolitis, foreign body
Syndrome of infiltration of the lung tissue
Type of breathing: bronchial or weakened
Adverse respiratory sounds:
crepitation, localised moist rales
Disease entities:
pneumonia, pulmonary infarction, bleeding in the lung
atelectasis
is defined as the collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung
Type of breathing: weakened
Adverse respiratory sounds:
absent
Acute atelectasis may occur as a post-operative complication or as a result of surfactant deficiency(it prevents the alveoli from collapsing). In premature neonates, this leads to infant respiratory distress syndrome.
Pleural effusion
Type of breathing: absent or weakened over the effusion Adverse respiratory sounds: pleural rub in the resolution
Disease entities:
hydrothorax, hemothorax, pneumothorax, pyothorax
Ventricular septal defect
Auscultation: accent and splitting of II tone
