Auscultation Flashcards
Position of Lobes ANTERIORLY
Upper lobe - 2-4 ICS
Middle/Lingular - 4-6 ICS
Lower Lobe - 6 ICS LATERALLY ONLY
Position of Lobes POSTERIORLY
Lower Lobe - T2-T10
middle lobe is wedge shaped, not present posteriorly
Normal Breath Sounds:
Bronchial Sounds
Heard over trachea
- loud and high pitched
- heard between inspiration and expiration - PAUSE HEARD
- expiration sound > inspiration sound
Normal Breath Sounds:
Bronchovesicular Sounds
Anterior Chest: 1st and 2nd ICS near sternum
Posterior Chest: Interscap region (mainstem bronchi)
Normal Breath Sounds:
Vesicular Sounds
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
Abnormal Breath Sounds:
Bronchial Breathing
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
Adventitious Breath Sounds:
Wheezes (rhonchi)
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
Adventitious Breath Sounds:
Crackles (rales)
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
Adventitious Breath Sounds:
Pleural Friction Rub
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
Voice Sounds:
Bronchophany
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
Voice Sounds:
Egophany
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
Voice Sounds:
Whispered Pectoriloquy
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
Heart Sounds:
Aortic Area
2nd ICS on the right - close to the sternum
Heart Sounds:
Pulmonic Area
2nd ICS on the left - close to the sternum
S2 heard best here
Heart Sounds:
Erb’s Point
3rd ICS on the left - close to the sternum
S1 and S2 heard equally well here