Auscultation

Question 1

Position of Lobes ANTERIORLY

Answer 1

Upper lobe - 2-4 ICS
Middle/Lingular - 4-6 ICS
Lower Lobe - 6 ICS LATERALLY ONLY

Question 2

Position of Lobes POSTERIORLY

Answer 2

Lower Lobe - T2-T10

middle lobe is wedge shaped, not present posteriorly

Question 3

Normal Breath Sounds:

Bronchial Sounds

Answer 3

Heard over trachea

• loud and high pitched
• heard between inspiration and expiration - PAUSE HEARD
• expiration sound > inspiration sound

Question 4

Normal Breath Sounds:

Bronchovesicular Sounds

Answer 4

Anterior Chest: 1st and 2nd ICS near sternum

Posterior Chest: Interscap region (mainstem bronchi)

Question 5

Normal Breath Sounds:

Vesicular Sounds

Answer 5

Heard all over areas of the chest distal to the central airways

• soft, breezy quality
• heard inspiration and expiration - NO PAUSE
• inspiration sound > expiration sound

Question 6

Abnormal Breath Sounds:

Bronchial Breathing

Answer 6

absent or diminished:

• obesity, pleural effusion, pneumothorax, COPD
• due to a loss of ventilatory power
• reduced intensity of sound

bronchial heard away from trachea

• lung consolidation, congestion, atelectasis, fibrosis
• increased during expiration - harsh blowing

Question 7

Adventitious Breath Sounds:

Wheezes (rhonchi)

Answer 7

heard in asthma, bronchitis (COPD)

• continuous, musical quality, polyphonic
• heard over CONSTRICTED lungs and airways
• mostly heard on exhalation
  - if heard on inhalation - v severe

if heard in one airway only (monophonic) it is an EMERGENCY - there is a blockage

Question 8

Adventitious Breath Sounds:

Crackles (rales)

Answer 8

heard in COPD (bronchitis, emphysema, asthma), interstitial lung dz, pulm edema, pulm effusion

• discontinuous, intermittent bubbling/crackling
• hear air bubbling through secretions, small airways as they snap open
• heard during inspiration

Question 9

Adventitious Breath Sounds:

Pleural Friction Rub

Answer 9

heard when there is pleural inflammation

• low pitch, non musical, “cracking leather”
• heard over the lateral lung fields during insp and exp
  - does not move - sound will be heard in the same place bc things are stuck

Question 10

Voice Sounds:

Bronchophany

Answer 10

instruct pt to say “99”

• normal - inaudible
• positive - 99 heard loud and clear
• positive when there is tissue consolidation - sound travels better through denser tissue
  - pulm edema, tumor, pneumonia

Question 11

Voice Sounds:

Egophany

Answer 11

instruct pt to say “ee”

• normal - muffled
• positive - hear “ay” loud and clear
• positive when there is tissue consolidation - sound travels better through denser tissue
  - pleural effusion

Question 12

Voice Sounds:

Whispered Pectoriloquy

Answer 12

instruct pt to whisper “99”

• normal - inaudible
• positive - hear 99 loud and clear
• positive when there is tissue consolidation - sound travels better through denser tissue
  - pulm edema, tumor

Question 13

Heart Sounds:

Aortic Area

Answer 13

2nd ICS on the right - close to the sternum

Question 14

Heart Sounds:

Pulmonic Area

Answer 14

2nd ICS on the left - close to the sternum

S2 heard best here

Question 15

Heart Sounds:

Erb’s Point

Answer 15

3rd ICS on the left - close to the sternum

S1 and S2 heard equally well here

Question 16

Heart Sounds:

Tricuspid Valve

Answer 16

4-5th ICS to the left - close to the sternum

Question 17

Heart Sounds:

Mitral Valve - PMI

Answer 17

5th ICS to the left - MCL

S1 heard best here
S3 and S4 heard here in LLDP
left S/L with 1/4 turn downwards use bell of steth